This example highlights the case of a 22-year-old woman who suffered severe contractures on both hands after sustaining burn injuries from a gas bottle explosion. The contractures caused extension of the wrist and metacarpophalangeal (MCP) joints, as well as flexion of the proximal interphalangeal (PIP) joints. She underwent a series of surgeries to address the contractures and regain hand function.
The case presented here features a 10 year old girl who was treated at Haydom Lutheran Hospital for a 39% total body surface area (TBSA) full-thickness burn affecting her back, shoulders, and buttocks. Although the patient survived and the wounds healed, she developed contractures in both axillae. This case serves as an example of how contractures with a narrow band, typically forming a fold with good quality skin on at least one side, can be effectively treated using local flaps without the need for skin grafts.
In this case we show the treatment of the remaining contractures of the right axilla and elbow one year post-injury in Haydom Lutheran Hospital, Tanzania. The patient had previously received care here for his acute burns of the shoulder and upper arm.
In the river islands of northern Bangladesh known as the Chars, the majority of households use clay stoves fueled by wood for cooking. In this challenging environment, even a small accident near a burning stove can result in severe burn injuries. The population residing in these areas faces limited access to healthcare, but organizations like Friendship are working diligently to bridge this gap. Friendship operates hospital ships that navigate from island to island, delivering essential medical care to those in need, including reconstructive surgical procedures like burn contracture release.
Contractures in the neck can significantly impact a patient's daily life, often resulting from unintentional burn accidents or intentional "acid attacks" in certain situations. In this case, we will explore the treatment journey following an unintentional burn injury that caused a contracture in the neck.
This example shows the treatment of a post-burn contracture in an approximately 50 year-old man in Bangladesh. He presented to the doctors on one of Friendship’s hospital ships in the northern part of the country, with a contracture of the ankle joint and toes. This example shows the treatment of this contracture with a combination of local flaps and a skin graft: a Z-plasty and a full thickness graft, followed by 6 weeks of immobilization with a plaster of Paris (POP) cast.
This example shows the treatment of a severe contracture of the left knee, after a burn wound caused by an open fire in rural Tanzania. The girl survived the large burn wound, but the acute wound had to heal by itself as she was treated at a hospital where surgical burn care was not available. Her wounds healed slowly, and when she arrived at Haydom Lutheran Hospital six months after the injury occurred, the remaining broad contracture that she had developed was treated with a release, local flaps, and skin grafts.
A 5 year-old girl had sustained an acute burn wound covering 36% TBSA, that was treated at Haydom Lutheran Hospital in Tanzania. She survived and was treated with three sessions of skin grafting. Despite adequate surgical treatment, she developed contractures involving both hips and also affecting the genital area. She came back to the hospital one year later for contracture release.
In this example from Tanzania, we present a young boy with flexion contractures of four fingers on the palmar surface of the hand, to show how to perform a release and coverage with local flaps and FTGs.
Burns on the dorsal side of the hand can lead to contractures, causing the wrist and MCP joints to be fixed in extension. In the experience of the doctors at Haydom Lutheran Hospital in Tanzania, in young children severe scald burns are the most common cause of contractures on the thin-skinned dorsal side of the hands. This example shows a child with a contracture on the ulnar side of the wrist and hand that was caused by an open fire in the house.