Burn scar contractures: A debilitating but reversible condition!

Despite various measures internationally and locally to prevent burn injuries and their complications, burns are still a global public health problem, accounting for an estimated 265 000 deaths annually (WHO).
A patient with a burn scar contracture before surgery. Courtesy.
A patient with a burn scar contracture before surgery. Courtesy.

Despite various measures internationally and locally to prevent burn injuries and their complications, burns are still a global public health problem, accounting for an estimated 265 000 deaths annually (WHO).

According to WHO statistics, burn death rates have been decreasing in many high-income countries, and the rate of child deaths from burns is currently over 7 times higher in low- and middle-income countries than in high-income countries. Burns are among the leading causes of disability-adjusted life-years lost in low- and middle-income countries.

Burns are the fourth most common type of trauma worldwide, following traffic accidents, falls, and interpersonal violence. Approximately 90 percent of burns occur in low- to middle-income countries, regions that generally lack the necessary infrastructure to reduce the incidence and severity of burns.

Along with adult women, children are particularly vulnerable to burns. Burns are the 11th leading cause of death of children aged 1–9 years and are also the fifth most common cause of non-fatal childhood injuries, such as bad scars and contractures, among others. While a major risk is improper adult supervision, children unfriendly environments like outdoor cooking, many hot fluid containers within reach of children, lighting with candles, etc. all increase risks of children sustaining burn injuries. A good number of burn injuries in children result from child maltreatment.

A burn scar contracture is tightening of the scar during and after healing of a deep burn wound that crosses joints. If no proper medical attention to this healing process of a burn wound, the burn scar matures, thickens, and tightens and this will restrict joint movements over the scarred region.

A contracture is a serious complication that one ought to put in consideration while nursing a burn wound. If one develops or your child gets a contracture, he or she will not be able to move the scarred area normally. For example, one may have trouble doing normal things like dressing, walking, eating, or playing—depending on where the scar contracture is located.

Most deep burn wounds do cause some degree of scarring, but there are several things that one can do to minimize scarring and reduce developing contractures, although these need to be done after proper medical evaluation and continuous close follow up.

Wearing a splint might help one from developing a contracture. Sometimes, after one has been burned, he or she will need to wear a splint on the joint to keep it in a stretched position and to help prevent a contracture, and these splints need to be worn on top of the pressure garment.

Learn how to practice some form of special exercises called range of motion exercises to prevent contracture formation. Range of motion exercises help keep the muscles and joints of the burned limbs flexible. A physical therapist will teach you (or your child) how to do these ranges of movements, so you can help in the healing process. The types of exercises and how often to do them depend on a number of factors, and need to be done after proper guidance by physiotherapist and/ or occupation therapists.

In addition to the range of motion exercises, the physiotherapist might recommend other special exercises for you or your child. If it is the child burned, help them to do these exercises religiously. Exercises are very important to keep the scar area stretched and prevent a thick, hard, tight contracture. Exercises should be done even if your child does not like them. You may achieve better cooperation from the child by rewarding them at the completion of each stage of exercises.

Do or have your child (if they are the ones burned) do daily activities on their own 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 or her do these activities and resist the temptation to help. The movement that occurs during daily activities will help keep the scar area stretched. Your child should do daily range of motion exercises as directed by the physiotherapist or your child’s doctor.

It is important to know that special attention needs to be taken by parents with these children who have sustained burn wounds, since children will rarely have the courage and resilience to do these contracture preventive measures on their own due to the pain and discomfort associated with them, and hence prone to developing these contractures!

Once these burn scar contractures have been formed, they do not go away on their own although they may improve with persistent and proper physiotherapy or splinting. If these contractures are persistent despite adequate physiotherapy, the person will need surgery to release these contractures and restore normal functioning of the affected area.

Rwanda Military Hospital runsa plastic Surgery outpatient clinic every Thursday of the week where patients with conditions such as contractures among other plastic surgical conditions, get to meet a plastic surgeon, and are properly evaluated for various treatment options. Surgery to release these contractures and restore normal functioning of the affected limbs and body areas is also carried out at Rwanda Military Hospital.

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Pictures of a patient with a burn scar contracture before and after having contracture release surgery by a plastic surgeon, at Rwanda Military Hospital.
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Rwanda Military hospital also has a fully-fledged physiotherapy unit, which runs every day of the week and where these patients who need physiotherapy follow up services are managed.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.

 

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