Postburn Contractures Research Articles

Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome

IntroductionWhile there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla. MethodsA retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint. ResultsAll patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively. ConclusionThe square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

Medial Sural Artery Islanded Pedicled Perforator Flap for Resurfacing Areas in the Popliteal Fossa Following Postburn Contracture Release Using Normal versus Scar Tissue

Abstract Background The medial sural artery perforator (MSAP) flap is reliable in resurfacing defects of the popliteal fossa. There is possibility of resurfacing the popliteal fossa defects after postburn contracture release with scarred MSAP flaps with good overall long-term outcomes. Materials and Methods A study was conducted from June 2017 to July 2023 to evaluate the functional and surgical scar aesthetic outcome in patients with soft-tissue defects in the popliteal fossa after postburn contracture release that were reconstructed using scarred and unscarred MSAP flap with 10 patients in each group. Results The clinical outcome was assessed in terms of the perioperative and late postoperative complications, range of motion of the knee joint along with surgical scar outcome using the Patient and Observer Scar Assessment Scale (POSAS). The functional results in the scar tissue flap group were comparable with those in the normal tissue flap group, but the aesthetic outcome of surgical scar was found to be better in the normal tissue flap group. Conclusion The MSAP flap provides ideal tissue for soft-tissue reconstruction with minimal donor site morbidity for popliteal fossa defects after postburn contracture release in both the scarred and unscarred flap groups.

Axilla Reconstruction Post Burn Contracture: Thoracodorsal Artery Flap Versus Local Flap and Skin Grafts

Background: Burns are a prevalent worldwide morbidity that frequently results in contractures that impede function and appearance, especially in the axilla, which has a major impact on upper limb mobility. Aim: To compare the functional results of local flaps with skin transplants versus Thoracodorsal artery flaps for axilla repair following burn contracture. Methods: A prospective comparative study was conducted. In the Department of Plastic and Reconstructive Surgery, thirty patients were split into two groups for a prospective comparative study. Group B underwent local flaps utilizing skin grafts, whereas Group A underwent thoracodorsal artery flaps. An analysis was conducted on pre- and post-operative shoulder joint abduction, complications, and demographic factors. Result: The two groups' post-operative shoulder abduction did not significantly differ, according to the results; however, younger patients and those with concomitant conditions including diabetes and hypertension were more likely to benefit from thoracodorsal artery flaps because of increased vascularization. The study discovered that middle-aged individuals typically had local flaps, but younger patients frequently had thoracodorsal artery flaps. Though not statistically significant, the gender distribution revealed a trend with more males obtaining local flaps and more females receiving thoracodorsal artery flaps. Thoracic dorsal artery flaps were substantially more common in patients with diabetes and hypertension. Practical Implication: The higher prevalence of thoracodorsal artery flaps in patients with diabetes and hypertension underscores importance of choosing flaps that provide better vascular support for patients with compromised vascular health. Conclusion: The findings highlight the significance of considering patient-specific criteria when choosing a flap, as thoracodorsal artery flaps provide better vascular support and are advantageous for patients with compromised vascular health. These results emphasize the need for customized surgical planning to improve results in post-burn contracture axilla repair. To enhance patient care and further improve surgical protocols, future research should concentrate on long-term results.

Soft-tissue origin joint contractures treated with the Ilizarov fixation method

Introduction Soft-tissue origin joint contractures are a common orthopedic problem. It could be due to various etiologies. Treatment options are available from conservative to surgical methods. These joint contractures slowly become irreversible causing impairment in activities of daily routine. The Ilizarov method is a well established and time-tested method used for management of bone pathologies, but its use in the management of soft-tissue origin contractures is also possible. It has an established role in neoosteogenesis and histogenesis. Fixator assisted soft-tissue stretching done at sustained slow pace leads to histoneogenesis that avoids stretching of neurovascular structures and reduces the possibility of recurrence.Aims To determine usefulness of the Ilizarov method in management of joint contractures of soft tissue origin; to meet functional requirements of patients; to study complications of Ilizarov method in management joint contractures due to soft tissue origin.Material and methods A total of 6 cases of soft-tissue origin joint contractures due to tuberculosis, post‑traumatic stiffness, post-burn contracture, deformity due to a snake bite in the age group from 3 to 55 years were treated with gradual distraction of joint with the Ilizarov method from January 22 to October 23. Two cases were of triple knee deformity, two were post-traumatic elbow stiffness, one was post-burn great toe contracture and one was post snake bite valgus foot contracture. All cases were operated with transarticular Ilizarov frame application and gradual distraction of joints and soft tissue with the help of hinge- and rod distractor assembly done. All cases completed follow up of 1 year. Aggressive physiotherapy was given postoperatively.Results All cases obtained a reasonable functional outcome, with no recurrence of deformity. All patients walk independently.Conclusion The Ilizarov method can be used for treating joint contractures due to traumatic and non‑traumatic pathologies.

Evaluation of Functional Outcomes After Reconstruction of Post-burn Contracture of the Hand in the Pediatric Age Group: A Prospective Study.

Background Injuries on the hand due to burns affect the quality and functions of activities of daily living (ADL). Severe burns cause lasting complications and deformities, such as contracture of the hand, which require multiple staged surgeries and rehabilitation for extended periods to regain function. This is of major significance to children, as they are in the growing and developmental age group, which should be considered while planning a reconstructive procedure. Psychological counselling is equally important for these patients to accept the residual deformity and cosmesis of the hand following surgery. Methods A prospective interventional study was conducted on 40 patients to assess the functional outcomes of various reconstructive procedures for post-burn contracture of the hand and to find out which is the better surgical intervention for restoring the hand functions needed for ADL. Functional outcomes were analyzed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months. Results In the group of children operated on with flap procedures, the maximum number of patients had average functional outcomes. Functional outcomes were assessed using the Modified JHFT, in which fine motor, weighted, and non-weighted hand function activities were assessed and analyzed. However, in the group of children operated on by the Z-plasty procedure and skin graft procedure, the maximum number of patients had poor functional outcomes. Conclusion The management of burn injuries on the hand and subsequent contractures is often challenging, especially in pediatric patients. Timely intervention, patient education, and surgical skills with an appropriate choice of reconstructive procedures play a vital role in achieving good postoperative results. This study showed that hands reconstructed using flap procedures had good functional outcomes compared to graft and Z-plasty procedures.

A Surgical Experience of Oral Squamous Cell Carcinoma Co-Existing with Post Burn Contractures of Neck.

A female patient in her early 60s was diagnosed with squamous cell carcinoma of right buccal mucosa. Interestingly, the patient also presented with post-burn contractures of face, neck and chest which posed significant anaesthetic and surgical challenges, thus making this case report unique. Through this case report, we highlight the reflections in management of such a case.

Skin Grafting in Post burn contractures of Groin and perineum in patients

Background: Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Material and Methods: This is prospective and descriptive study conducted in the Department of Plastic Surgery at Tertiary Care Teaching Hospital over a period of 1 Year. First dressing was seen on third or fourth postoperative day and percentage of graft take/loss was noted. Complications, if any, were recorded. Indwelling urinary catheter drainage was instituted for 3 to 4 days postoperatively. Once the graft stabilized, patients were discharged and advised to wear compression garments. Results: In our study, 77.1% of the patients, post burn contractures of the groin and perineum were because of Open chulla. Other less common causes were hot water (14.3%) and flame burn (8.6%). Majority of the patients were brought with complaints of difficulty in squatting (80.0%) followed by limitation of movements of hip joints (71.4%) and (44.3%) impairment of walking. In our series of 70 patients two types of operative procedures were performed: (1) release of contracture with split thickness skin grafting; (2) release of contracture and closure by multiple Zplasties. Moreover, 30 (42.9%) patients having bilateral groin contractures underwent release of contracture with split thickness skin grafting. 29 (41.4%) patients underwent release of unilateral groin contracture with split thickness skin grafting and 4 (5.7%) patients underwent release of unilateral groin contracture and closure by multiple Zplasties.Conclusion: To conclude, recuperation from perineal burns, both in acute period and chronic phase in case contracture occurs, is a difficult challenge physically and mentally. The agony that a burn patientendures during treatment is evident even to an onlooker.

Improving cosmetic and functional outcome in case of post burn contracture of hand and fingers by using de-epithelized plantar skin graft

Background: Burn scar contractures in the fingers and hand often lead to debilitating functional and cosmetic issues. Various surgical approaches exist, but achieving optimal outcomes remains a challenge. While grafting glabrous split-thickness skin from the foot's plantar aspect is a well-established method, it remains underutilized, with conventional grafts leading to complications, especially in darker-skinned individuals. Method: This study involved 35 patients with McCauley grade II and III hand burn contractures, spanning various age groups and genders. Surgical procedures encompassed scar removal, contracture release, and plantar skin graft application. Post-operatively, patients received dressing, splinting, and physiotherapy. Donor site healing was evaluated at the 3-week mark. Results: Remarkably, all patients exhibited successful donor site healing within 3 weeks. The surgical technique effectively addressed contractures, enhancing range of motion and function. Post-operative care, featuring physiotherapy, coconut oil massages, and pressure garment use for at least 6 months, significantly contributed to post-burn hand and finger contracture management. Conclusions: De-epithelized plantar skin grafts offer a promising avenue for enhancing both aesthetics and function in individuals with post-burn hand and finger contractures. This technique minimizes complications common with traditional grafts while promoting successful donor site healing and improved range of motion. The study underscores the significance of using like-for-like reconstruction to achieve the best possible results in managing post-burn contractures.

Distraction assisted management of post burn contracture of hand

Burns are one of the injuries that causes significant morbidity and reduced quality of life.Despite making up only 3% of the body's surface area, hands are involved in more than 80% of serious burs. Scarring, joint contractures and stiffness are devastating in the upper extremity due to its dependence. In this article, we have used Distraction assisted management is one of the methods for the management of finger webspace contracture release. In this case, we will be using a JESS distractor in the management of web space contracture in the upper extremity.

PATTERNS AND OUTCOMES OF PEDIATRIC BURN INJURIES IN A TERTIARY HOSPITAL’s BURN UNIT

IntroductionBurn is skin and tissue damage caused by various agents such as fire, scalds, electricity, chemicals, or radiation injuries. Globally, burn injuries pose a substantial public health challenge, with a high risk of mortality and morbidity, accounting for over 310,000 annual deaths. Nearly 75 % of burns in young children result from scald burns and infants have the highest mortality rates. Factors such as large surface area of burn, inhalational injury, poverty, and the presence of sepsis contribute significantly to mortality and morbidity in burns. ObjectiveTo assess the pattern of presentation of pediatric burn injuries and their management outcomes. MethodsA hospital-based retrospective cross-sectional study was conducted. Data were extracted from patient charts, cleaned, coded, checked for completeness, and entered into SPSS version 25 for analysis. Descriptive statistics and logistic regression were used for data analysis, and graphical presentations were utilized to present the result findings. ResultsAmong the 218 paediatric burn patients admitted to the Addis Ababa Burn, Emergency and Trauma Hospital’s burn unit, 71.1 % had sustained scald burns due to hot water splashes, while 20.2 % of the patients were admitted due to flame burns. Superficial partial thickness burns occurred in 53.6 % of the patients, with the upper extremity and trunk being the most commonly affected sites. Approximately 38.2 % of the patients developed acute complications, with sepsis of the wound focus being the most common. Chronic complications occurred in 30.7 % of patients, primarily in the form of post-burn contractures. A mortality rate of 3.2 % was observed during the admission period with 2.3 % of deaths occurring in children under 5 years and those with major burns. Conclusion & RecommendationThe primary causes of burns in the pediatric age group are predominantly preventable scalds. Children, especially when unsupervised at home, particularly in kitchens, demand meticulous attention and care to mitigate the risk of burn injuries.

A clinical study on different surgical options for management of post-burn axillary contractures

Background: Post-burn contracture is a common sequele occurring after burn. Upper limb contracture like axilla is also occurring more commonly because it is most mobile part of body and likely to involve in burn. Post-burn contracture of axilla leads to functional deficit as it limits the movement of upper extremity mainly abduction and extension. Patients with axillary contracture are unable to utilize his upper limb because he is unable to take the hand at required site. Aims and Objectives: The objective of this study was to study various operative strategies for patients presenting with post-burn axillary contracture. Materials and Methods: Twenty patients presenting with post-burn axillary contractures were taken in our study. Results: In our study of 20 patients of post-burn axillary contracture, five patients had Grade I (25%), Grade II 05 (25%), Grade III 01 (5%), and Grade IV 09 (45%) contractures. Regarding surgical procedure, Z-plasty was done in 8 patients (40%), release with skin grafting 10 patients (50%), and local flap done in 2 patients (10%). In our study, the mean degree of range of motion achieved after release of axillary contracture was 120°. In our study, 2 patients (10%) developed re-contracture, 1 patient (5%) had a graft failure while 85% of the patients had no complications. Conclusion: In the present study of 20 cases of management of post-burn axillary contracture, it is reasonable to conclude that the prevention of contracture is of utmost importance. The choice of surgical procedure for reconstruction of post-burn axillary contractures can be made according to the pattern of scar contracture and the state of the surrounding skin. The choice of a flap should have priority over the skin graft due to the superior functional and esthetic results of flaps. The results were satisfactory in our study in most cases with regard to quality of life, coverage, and range of motion.

The Square-Plus Flap: A Modification to Release Long Postburn Scar Contractures.

The square flap method has been successful in releasing contracture bands at various body regions. However, the original square flap method alone may not be efficient in releasing long contracture bands. We, therefore, proposed an extended design to the traditional design, which is called the "square-plus flap." A 4-year-old girl presented with a postburn web-like contracture band over the right axilla. We marked a square flap technique at the center of the contracture band and then two additional Z-plasties were placed on both edges of the flap. After the release and securing of the square flap, the adjacent distal Z-plasty was then transposed and sutured in their new locations. We do not need to incise the proximal Z-plasty as we could achieve complete relaxation of the contracture band. This novel modification can be added to the plastic surgeon's armamentarium for releasing long postburn contracture bands involving distinct body regions.

Risk factors for burn contractures in a lower income country: Four illustrative cases.

Burns are most prevalent in low- and middle-income countries but the risk factors for burn contractures in these settings are poorly understood. There is some evidence from low- and middle-income country studies to suggest that non-medical factors such as socio-economic and health system issues may be as, or possibly more, important than biomedical factors in the development of post-burn contractures. Four cases are presented to illustrate the impact of non-biomedical factors on contracture outcomes in a low-income setting. The cases were drawn from participants in a cross-sectional study which examined risk factors for contracture in Bangladesh. The two cases had similar burns but different standards of care for socio-economic reasons, leading to very different contracture outcomes The two cases both had access to specialist care but had very different contracture outcomes for non-medical reasons. The risk factors and contracture outcomes in each case are documented and compared. The impact of non-biomedical factors in contracture development after burns in low- and middle-income countries is highlighted and discussed. Burns are common in low- and middle-income countries (LMICs) but the risk factors for burn contractures in these settings are poorly understood. Burn contractures are formed when scarring from a burn injury is near or over a joint and results in limited movement. There is some evidence from LMIC studies which suggests that non-medical factors such as socio-economic (e.g., household income, level of education) and health system issues (e.g., whether specialist burn care could be accessed) may be as, or possibly more, important than non-medical factors (such as the type and depth of burn and the treatments received) in the development of contractures following burn injuries.Four cases are presented to illustrate the impact of non-biomedical factors on contracture outcomes in a low-income setting. The cases were drawn from participants in a larger study which examined risk factors for contracture in Bangladesh. Two cases had similar burns but different standards of care and different outcomes. Two cases had similar access to specialist care but very different outcomes for non-medical reasons. The risk factors present and contractures outcomes in each case are documented and compared.The importance of non-biomedical factors in contracture development after burns in LMICs is highlighted and discussed.

Managing difficult airway in a post burn neck contracture: A case report

Post burns neck contracture is always considered a difficult airway and requires meticulous planning for proper management. Awake fiberoptic intubation (AFOI) have been gold standard for managing difficult airways [1]. Here we will discuss a case of difficult airway due to post burn contractures at the neck posted for debridement and Split Skin Grafting (SSG) for Marjolin’s ulcer at the nape of the neck. Internal changes in the airway due post inhalational injury fibrosis proved the major cause of difficulty and following traditional clinical teachings helped in successful management of airway.

Acquired Hallux Varus Deformity Correction: Pivotless Distraction Technique.

Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.

Awake tracheal intubation in a patient with a post-burn contracture performed via direct laryngoscopy in a resource-limited setting.

Awake tracheal intubation in a patient with a post-burn contracture performed via direct laryngoscopy in a resource-limited setting.

Closed Incision Negative Pressure Wound Therapy Assisted Full Thickness Graft Aite Wound Dressing to Prevent Surgical Site Infection

Closed incision Negative Pressure Wound Therapy (CiNPWT) which is a topical application of negative pressure over the wound plays a key role in healing and prevention of surgical site infections. We have used full thickness graft following post burn contracture release. We then applied negative pressure wound therapy over to this flap to assess its efficacy and safety in aiding healing.

ROLE OF SQUARE FLAP IN POST BURN AXILLARY CONTRACTURES

Background: Post-burn contractures are a commonly encountered problem and many techniques have been described in their treatment. Zplasties are the commonest local ap procedure done for linear bands with adjacent healthy tissue. Our aim was to assess the use of square ap technique in axillary contractures. Ten patients with type I and II axillary c Methods: ontractures underwent release by the square ap technique. All cases were followed up for at least one year and analysed for range of motion and aesthetic outcome. All cases achieved full range of Results: movement postoperatively with no recurrence during follow up period and a good cosmetic outcome. Square ap was shown to be a Conclusion: reliable technique for mild to moderate axillary contractures of the anterior or posterior axillary folds even when there is signicant adjacent scarring of chest wall or back of types I and II.

Z-plasty in post-burn contracture of hand among pediatric patients.

Objective: To find out the frequency of hand burn and the effectiveness of Z-plasty in post-burn hand contractures. Study Design: Descriptive Cross-sectional study. Setting: Department of Pediatric Surgery, Khawaja Muhammad Safdar Medical College, Sialkot. Period: January to December 2021. Material & Methods: A preformed proforma was used, consisting of 4 parts, the first part including demographic data like age and gender, second part consist of patient’s history, consisting of presenting complaint, its duration, past history of any medical or surgical illness or comorbidity. Third part consisted of physical clinical examination of the hand (fingers and palm) while fourth part was for post-operative complications of reconstructive procedure, Z-plasty. The data was analyzed by using Statistical Package for Social Sciences (SPSS) version-20. Results: The most commonly affected age group was less than 6 years of majority of them, 53.3%, were male. The most common cause was thermal burns as compared to electrical burns. Among 91.1% of the participants, the right hand was affected more. Majority of the cases (48.9%) reported single finger burn, followed by multiple fingers (31.1%) and very few (20%) were having palm burns. Segregating the single figure, results showed that little finger was affected in 20% of cases No post-operative complications, like skin necrosis, wound dehiscence, hematoma or infection, were noted. Conclusion: It can be concluded that post-burn hand contractures and hand deformity was common among children. Z-plasty with/without skin grafting is an ideal surgical management to subside the contracture of hand.

Skin graft as a modality reconstruction of post-burn contractures during pandemic area: case series

Background: The Covid-19 pandemic causes the postponement of elective surgery. At the same time, patients with post-burn contractures require immediate operation due to impaired function that can lead to depression and disruption of daily life. Operations on contracture patients during a pandemic must be carried out using the principles of accuracy, speed, and safety. The skin graft is one of the most appropriate treatments modalities for releasing contractures. This case study aims to evaluate the skin graft as a modality reconstruction of post-burn contractures during pandemic area. Case Presentation: We present three cases of post-burn contractures who underwent contracture release and skin graft surgery with a hospital stay of 3-5 days. Surgical results showed that graft take reached 90%-100% in all patients, and 100% epithelialization occurred at donor sites between 2-4 weeks postoperatively. There were no post-operative complications. Conclusion: The skin graft is an effective and suitable technique for treating post-burn contractures in the pandemic era.