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ORIGINAL ARTICLE
P J M H S VOL. 7 NO.2 APR – JUN 2013 575
Post Burn Contracture Treatment Options and Prevention
RAFI IQBAL FARKHAD, SUMAIRA ASHRAF, JAVERIA NOREEN
ABSTRACT
This is a clinical prospective study with preoperative and post operative evaluation of treatment options
for post burn complications and prevention. In this clinical research 46 patients were opted even more
than 200 cases had being treated. This study was over 2 years period and we kept only those patients
who came for follow up for 6 months to 2 years. Most of the patients were between age 4 years and 46
years, only one was 70 years and 3 patients were less than 3 years old.32 patients were female and
14 were male. Most the patients were flame burn only 2 were acid victim females with neck
contracture. Contracture involves neck, axilla, elbow, hip joint, knee joint. Treatment options were Skin
graft, Z-Plasty and local flaps. Patients who were going through treatment of burn and with risk of post
burn contracture were splinted to prevent this complication.
Keywords: Contracture, reconstructive surgery, skin graft, Z-Platy local flap
INTRODUCTION
The rehabilitation of patients who have suffered
burns in the large joints, in particular the shoulder,
remains a difficult problem in reconstructive surgery.
Spontaneous epithelialization of burn wounds and
late skin grafting result in various kinds of scar
deformations and contractures. This significantly
restricts physical and social rehabilitation after burns.
Skin scar contractures related to destruction of skin,
subdermal fat, and fascia are very frequent.
Secondary contractures involve muscles and tendons
(shortening, serous induration, and scarring of
tissues around a joint), after which joint contractures
develop. Primary arthro-osseous contractures result
from direct deep burns in a joint, leading to severe
and irreversible processes1.
PATIENTS AND METHODS
Treatment options we had Skin graft, Z-Plasty in
leaner contracture and local flaps. Most of the cases
were treated with Split skin grafts and Z-Plasty and
splints were used in all cases that were treated with
skin grafts. Record was collected on Performa
including age sex cause of burn with percentage and
site of body affected. In follow up post operative
results with Patients and in case of children Parents
satisfaction rate is documented.
RESULTS
In our study most of the cases were treated with skin
grafts, Z-plasty and only 2 cases with local flaps. In
postoperative and follow up period. Success of
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Department of Plastic & Reconstructive Surgery, Holy
Family Hospital/Rawalpindi Medical College, Rawalpindi
Correspondence to Dr. Rafi Iqbal Farkhad, Assistant
Professor of Plastic Surgery
surgical option, functional aspect and patients
satisfaction were recorded. Patient’s satisfaction was
70 to 100%. Five patients develop complications ,one
patient who had flexion contracture of pipj had tip
necrosis of right little finger,3had patial graft loss and
one who had contracture of axlilla and treated with z-
plasty had patial loss of one of the flap which was
later gafted.
Preoperative PBC Knee
4 weeks post operative PBC Knee
Post Burn Contracture Treatment Options and Prevention
576 P J M H S VOL. 7 NO.2 APR – JUN 2013
Preoperative
Operative
Postop 5 days
PBC local flap
DISCUSSION
The feasibility of a particular procedure depends on a
set of particular local anatomic conditions. Whatever
surgical option we apply restoration of normal
anatomy and prevention of recurrence always be
preferred. Post-bum contractures of the hand require
appropriate surgical treatment whenever
conservative approaches have failed. The purpose of
every surgical operation is to carry out a stable
coverage of the involved area and to avoid
recurrence of contracture or chronic ulcers or
breakdown. Caleffi E., Bocchi A., Toschi S., Ghillani
M. Annals of the MBC - vol. 3 - n' 1 - March 1990.
The mortality and morbidity from burns have
diminished tremendously over the last six to seven
decades. However, these do not truly reflect whether
the victim could go back to society as a useful person
or not and lead a normal life because of the inevitable
post-burn scars, contractures and other deformities
which collectively have aesthetic and functional
considerations. This article gives an overview of the
post-burn scars and scar contractures, especially
their prevention, minimisation and principles of
management2.
Contractures occur when the burn scar matures,
thickens, and tightens, preventing movement. A
contracture is a serious complication of a burn.
wearing a splint: sometimes, after a child has been
burned, he/she will need to wear a splint on the joint
to keep it straight and to help prevent a contracture.
Splints should be worn on top of the pressure
garment. Sometimes, after a child haspracticing
range of motion exercises: range of motion (ROM)
exercises help keep the muscle and joints of the
burned limbs flexible. A physical therapist (PT) will
teach you and your child how to do ROM, so you can
help in the healing process.
Rafi Iqbal Farkhad, Sumaira Ashraf, Javeria Noreen
P J M H S VOL. 7 NO.2 APR – JUN 2013 577
Exercising: Do the special exercises given by your
child's physical therapist with your child faithfully.
Exercises are very important to keep the scar area
stretched and prevent a thick, hard, tight contracture.
and dress. Even if it is a little difficult for your child, let
Exercises must be done even if your child.
Promoting independence: Have your child do daily
activities for himself/ herself, as much as possible.
For example, let your child eat, brush teeth, brush
hair, him/her do these activities and joints of the
burned limbs flexible. A physical therapist (PT) will
teach you and your child how to do ROM, so you can
help in the healing process.
Exercising: Do the special exercises given by your
child's physical therapist with your child faithfully.
Exercises are very important to keep the scar area
stretched and prevent a thick, hard, tight contracture.
Exercises must be done even if your child
Promoting independence: Have your child do daily
activities for himself/ herself, as much as possible.
For example, let your child eat, brush teeth, brush
hair, and dress. Even if it is a little difficult for your
child, let him/her do these activities.
CONCLUSION
Treatment options for PBC are available but it will be
more beneficial and cost effective to prevent these
complications when we are treating these burn
patients before they develop post burn complications.
REFERENCES
1. Annals of Burns and Fire Disasters - vol. XVI - n.
3 - September 2003 Moroz V.Y.,
2. Arun Goel, Prabhat ShrivastavaDepartments of
Burns, Plastic, Maxillofacial & Microvascular
Surgery, Lok Nayak Hospital & Associated
Maulana Azad Medical College, New Delhi - 110
002, India
3. Edlich RF, Nichter LS, Persing JA. Burns of the
head and neck. Otolaryngol Clin North Am
1988;12:361–88.
4. Kobus K, Stepniewsky J. Surgery of post-burn
neck contractures. Eur J Plast Surg
1988;11:126–8.
5. Iwuaqwu FC, Wilson D, Bailie F. The use of skin
grafts in postburn contracture release: a 10-year
review. Plastic Reconstructive Surgery
1999;103:1198–201.
6. Fernandez-Palacios J, Baeta Bayon P, Cubas
Sanchez O. Multilevel release of an extended
postburn contracture. Burns 2002;28:490–3.
7. Yang JY, Tsai FC, Chana JS. Use of free thin
anterolateral thigh flaps combined with
cervicoplasty for reconstruction of postburn
anterior cervical contractures. Plast Reconstr
Surg 2002;110:39–46.
8. Kobus K, Stepniewsky J. Free flaps versus
conventional surgery. Ann Plast Surg
1985;15:14–34.
