Success, Failure and Problems in the management of ...

Success, Failure and Problems in the management of Post burn contracture Dr. Fahmina Buriro FCPS Dr. Mazhar Nizam FRCS Department of Burns and Plastic Surgery Patel Hospital Karachi Pakistan

Post burn contractures  Most frustrating sequelae of burn

injury  First documented in Ebers’ Papyrus

in 1500 BC, describing the use of copper splints.  Incidence ranges from 28 to 48%  Hands most commonly involved

 2 burns unit  Total beds 70 beds  Catchment population

approximately 50 million

 Most burns not treated in a

burns unit

 Late presentation and high

incidence of contracture

 As burn mortality is decreasing,

attention is shifting to issues of morbidity and function and preventing and treating contractures.

 In children Contracture prevention

and treatment is very difficult  Require more procedures during

growth spurts

 Defining Success  Defining Failure  Defining Problems

Material and Methods  Release of contracture performed in 65 patients with post

burn contracture from January 2011 to September 2014  Setting: Patel Hospital Karachi

Age Distribution  6 months to 53 years  Mean age 15 years

Age Groups

F (%)

12 Years

30(46.2%)

Burn Types

Primary Treatment of Burn FTSG

1(1.5%)

Non Operative

23(35.4%)

Not Documented

8(12.3%)

STSG

31(47.7%)

Time since burn (from 1 month to 29yeras) Time Since Burn

Percentage

Less than 3 months

13.8%

3 months to 1 year

27.6%

More than one year

50.7%

Not documented

6%

Regional Distribution of PBCs Region

Frequency

Percent

Hand & Wrist

23

30.2

Canthus/EYELID Elbow PERIORAL/FACE/NL NECK Knee Axilla Foot & Ankle Breast Perinium Trunk Ear Total

9 8 8 6 6 5 5 2 2 1 1 76

11.5 10.5 10.5 7.8 7.8 6.5 6.5 2.6 2.6 1.3 1.3 100.0

Presentation

8

Primary contractures

57

Recurrent contracyures

Treatment  Release of contracture  Coverage  Splintage  Physical therapy  Scar therapy  Counseling to improve compliance

 MOTIVATION

Surgical Procedures Surgery

Frequency

Percentages

STSG

30 26

39.4% 34.2%

16

21%

4

5.2%

FTSG Z /VY/ COMMISSUROPLASTIES LOCOREGIONAL FLAPS KWIRES

16

Initial Results  Initial result good: 95.4%  Complications:

4.6%

 2 Partial graft loss and

 1 complete graft loss

 Desired release achieved

 Grafts taken well  Flaps fine

Late Results  Documentation

No follow-up record

25%

failure  Lost follow up a)

b) c) d)

Non compliance Language barrier Live in remote area Lack of resources/ finances

Late Results  Grafts soft /supple

Satisfactory result:

57.6%

 Flaps fine

 ROM good  Pt. back to work  Pt. or family satisfied  Result good

 Recurrence: 11.8

%

 Mostly in hands and neck mostly in STSG group  Stiff hands: 6.5%

No follow up after graft check

ROC FTSG Z Plasties

3 months After surgery

Success and failures  Skin grafts are good and reliable options and provide good

results if post operative therapy is followed properly.  Flaps are very few but success rate is high and should be done

whenever possible.  Failures are more in late outcome due to lost follow up, non

compliance to physical therapy and use of splints specialty in children, lack of resources

Problems  Post burn contractures are difficult to treat specially in children  There are many problems associated with their treatment  Donor site limitations  Involvement of patients and family in treatment  Compliance specially in larger burns  Follow up and follow up record

Conclusion  More resources are needed including  Funding  Specialized training for doctors and all support staff  Availability of advance treatment options  Web based discussion with other burn units national and

international

Defeated are those who never fail...

Thank you…