Post burn digital contracture our way: The pains, The gains

Abstract

Background: Post burn digital contractures account for 30% of new outpatient clinic visits but 25% of elective surgery load in our practice. There is a lot of backlog and pressure to operate particularly in the pediatric age group. We were able to demonstrate in this series that irrespective of the duration, uncomplicated post burn contractures are usually not complicated by ankylosis and a single stage complete release is possible. Aims and Objectives: 1. To determine if multiplicity of joint involvement and duration between burn and corrective surgery affect outcome. 2. To determine the range of complications after post burn digital contracture release. 3. To determine if preoperative plain radiographs are necessary in uncomplicated post burn digital contractures. Materials and Methods: Retrospective analysis of the records of 33 patients. Data collected included socio demographic and disease characteristics, etiology of burns, duration of burns before corrective surgery, complications after corrective surgery. Data was analyzed using SPSS version 16.0. All patients with contractures in other joint other than digits and from other causes other than burns, or burns associated with mechanical trauma were excluded. Results: Mean age 8 yrs, nearly equal sex distribution. Scald 48.5%, flame 21.2%, contact burn 9.1%, others 21.2%. Mean duration between burn and contracture release 40months. Overall, 172 joints were involved in 33 patients, 69.7% had incision ,+ FTSG, 3% had incision+ STSG, 6.1% had Z plasty only and 21.2% had Z plasty + FTSG. In 32 patients (97%) complete intra op contracture release was achieved. Twenty patients (60.6%) healed without complications, recorded complications post op were wound infection (30%), graft shift and digital tip gangrence. Conclusion: Prolonged duration between burn and eventual contracture release does not affect achieving complete contracture release, neither does multiplicity of joint involvement.