Dealing with post burn contractures

Plastic surgeons from Operation Smile with the Rwandan medical team doing free corrective plastic surgeries for patients with conditions such as post burn contractures, among others, at Rwinkwavu Hospital. /Courtesy Photo

A burn is an injury to the skin or other organic tissue primarily caused by heat but can also be due to radiation, radioactivity, electricity, friction or contact with chemicals.

Globally, burns are a serious public health problem. An estimated 180,000 deaths occur each year from fires alone, with more deaths from scalds, electrical burns, and other forms of burns, for which global data are not available.

According to the 2015 Global Health Estimates, 95 per cent of fatal fire-related burns occur in low and middle-income countries. In addition to those who die, millions more are left with lifelong disabilities and disfigurements, often with resulting stigma and rejections.

A burn scar contracture is tightening of the scar during and after healing of a deep burn wound that crosses joints. If there is 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 can be a serious complication that everyone needs to put in consideration while nursing a burn wound. If one develops, or your child gets a contracture, he or she might 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.

Despite some measures to prevent them such as early intervention in burn wounds by covering these wounds with skin (skin grafting) as well as physiotherapy and splinting the areas of the body parts affected by burn wounds involving joints, burn contractures still represent a considerable morbidity. Still, these measures to prevent severe contractures following burn wounds are not widely applied by many health care professionals. Also, due to poor adherence to the physiotherapy and follow up by the affected patients as soon as the initial burn wound heals, leads to a big number of patients who later turn up with severe contractures following burn wounds.

The deeper the burn wound, the higher the chances of healing with a thick scar or contractures. Special attention should be paid to burn wounds which involve the hands, elbows, feet, knees, armpit regions, but generally, burn wounds involving joints of the limbs.

Children, who are at a generally increased risk to getting burns, also need special attention to prevent these contractures from developing. This is because children will not easily comply with the recommendations of the health care provider and need extra input from their parents. Besides, most of these physiotherapies and splinting will be painful and uncomfortable for them.

Wearing a splint might help one from developing a contracture. This splint is worn on the involved joint to keep it in a stretched position and help prevent a contracture forming during the healing process.

Special exercises called range of motion exercises to prevent contracture formation help to prevent contracture formation after burn wounds. Range of motion exercises help keep the muscles and joints of the burned limbs flexible. These exercises are different depending on a number of factors including age and joints affected, hence, need to be done after proper guidance by a physiotherapist and/ or occupation therapist for the best results.

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.

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.

For health centres, early referral of burn injuries to hospitals equipped with facilities and expertise to replace the burn wounds with skin (skin grafting) would reduce the risk of developing these contractures.

Once these burn scar contractures have been formed, they usually do not go away on their own, although 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.

 Dr Ian Shyaka , Resident in Plastic surgery,Rwanda Military Hospital,

iangashugi@gmail.com

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