Overview of case studies

We have collected 32 visual case examples of burn injury and scar and contracture surgery. These cases are a collection of real-life patient stories that demonstrate the various treatment options available for burn patients.

Real-life visual patient stories

Each case provides an overview of the patient’s burn injury, including the extent of the burn, the patient’s medical history, and the treatment plan.
Cases are accompanied by photos that showcase the progression of the patient’s recovery.

Burn injury cases

Shoulders, upper arm and back

This example shows a young boy with large burn wounds, including a circular burn on the right upper arm. The parents took the child quickly to the hospital where an emergency escharotomy was performed. Adequate treatment for a severe burn like this requires a foundation of good knowledge in the family/community on what needs to be done after a burn happens.

Knee perforator flap

The patient in this example sustained a burn wound to his left knee. He was referred to the outpatient department of Burn Center Beverwijk in the Netherlands, three weeks after the burn injury. The burn wound was debrided and the defect closed by an islanded perforator-based flap.

Trunk, arms and legs

This patient sustained burn wounds due to hot water and was treated at a hospital focused on mother and child care in Pujehun, Sierra Leone. Caring for patients with large burns can be challenging in resource-limited settings.

Shoulders, back and buttocks

This example shows a 9-year-old girl with a severe burn of the posterior trunk. Most of the deep burn injuries affecting the posterior of the trunk, encountered in rural Tanzania, were caused by burning clothes, a cause of severe mortality and morbidity in patients. Patients with a TBSA burned > 40% have a high mortality risk in low-resource settings.

Lower leg

A 25-year-old woman was brought to the emergency department of the Haydom Lutheran Hospital, Tanzania. She was known to suffer from epilepsy and had sustained extensive burns after falling into a fire during a seizure. Epilepsy is a common cause of burn injuries in low- and middle-income countries. This example focuses on the deep burn wound on the lower leg with bone exposure.


A 5-year-old female patient from Tanzania. Her clothes started to burn when she was playing too close to the fire. Upon admission, an estimated 8% full thickness burn was observed on the abdomen and chest.

Foot and toes

This example shows a young child with severe burn wounds that did not receive adequate burn care. After a delay, the patient and his parents arrived at a hospital offering surgical burn care. Unfortunately, they disappeared before surgery could be performed. Later, they explained that they were afraid of the hospital bills.

Knee gastrocnemius flap

A 48-year-old epileptic patient had sustained burn wounds after falling into the fire in rural Tanzania. He did not come to the hospital immediately but went to a traditional healer first. This case demonstrates the treatment of the deep burn wound on the upper leg and knee with the patella exposed.

Groin and upper leg

A 5-year-old girl was presented at the emergency department of the Haydom Lutheran Hospital in Tanzania, after a fire-related burn injury involving the groins, extending to the abdomen and lower extremities.


This case focuses on a 2-year-old boy from Mbulu, Tanzania, who sustained a burn injury from hot porridge. As the local hospital lacked the capability for skin grafting, the boy was transferred to Haydom Hospital after ten days via a public Landcruiser.


This 5-year-old boy had sustained burn wounds to the arm, face and the chest. The treatment of the face has already been presented in the head and neck section. This example focuses on the right arm. How the delayed grafting strategy was performed in Haydom Hospital, Tanzania is shown for this patient.

Ear, frostbite

This example shows thermal injury caused by cold. The patient sustained a cold injury while he was on a ski mountaineering trip in Switzerland. He was treated at a general hospital in Switzerland.


This case shows a patient with burns of the face, neck and left shoulder. In this example from Tanzania, the surgical treatment provided was excision and grafting. The scars healed with no further cosmetic treatment in this setting. The development of the scars over time is presented, over a 2-year follow-up period.

Scalp, electrical burn

A 25-year-old man was injured by a high voltage electric shock. His scalp, right wrist and left thigh were affected. The patient presented at an emergency department of a large regional hospital in the Netherlands. Initially, it was not known that the patient had sustained a high voltage injury.

Face, 5 year-old

This 5-year-old boy had sustained burn wounds to the face, the focus of this example. The right arm and chest were also involved. This case shows how choices need to be made with regards to where to start with grafting when patients are not fit to undergo grafting of all areas affected at once.

Scar and contracture cases

Wrist and fingers, dorsal side

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.

Axilla 2

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. With contractures in both axillae.

Axilla and elbow 3

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.

Axilla and elbow 1

A 9-year-old girl had accidentally fallen onto a burning stove—an unfortunate and common occurrence in the area.

Neck contracture

Two years before seeking surgical evaluation for her scars, the patient suffered severe burns due to a flash incident. The affected area accounted for 20% of her total body surface, with 9% being deep burns.

Ankle and toes

Treatment of a post-burn contracture in an approximately 50 year-old man in Bangladesh 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.

Knee contracture

A severe contracture of the left knee, after a burn wound of a 5-year old girl. 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. She survived and was treated with three sessions of skin grafting.

Fingers, palmar side

A young boy with flexion contractures of four fingers on the palmar surface of the hand. Treatment included a release and coverage with local flaps and FTGs.

Wrist and fingers, ulnar side

A 5-year-old boy, who came to the hospital 3 years after sustaining a burn injury that had led to an extension contracture of the wrist and fingers.

Elbow, wrist and fingers

This young girl was presented with a contracture with a clear fold, but the fold had scarred skin on both sides and the contracture was extending over three joints (elbow, wrist and MCP joints of the fingers).

Axilla 1

A severe broad contracture of the left axilla. The boy presented in this example required skin grafts and Z-plasty.

Axilla and elbow 2

The child sustained a burn injury at the age of 2 during the night, when the ashes of the fire were still hot. The burn wound he sustained to his left arm was deep, and without skin grafting took many months to heal. This time, the surgeons choose a large Z-pasty combined with a jumping man instead of two jumping mans in a row.

Axilla, elbow, wrist and fingers

This example shows a girl with a severe contracture involving the axilla, elbow, and dorsal side of the wrist and fingers. Prior to presentation, two operations had been performed to improve the function.

Inframammary region

The 17 year-old patient in this example had sustained an extensive burn 14 years prior. When her breasts developed, the scar tissue on the right side of the chest became tight. The focus of this example is a scar in the inframammary region.


The patient in this example is a boy from Nigeria who was adopted by a couple from the Netherlands. Over the past few years, he has been treated by reconstructive surgeons for severe microstomia with extensive scarring in and around the mouth.

Facial burn contracture: eye and mouth

This case highlights the transformative impact of surgical intervention on a 4-year-old boy who had suffered from facial burn injuries two years prior. Deep burns to the face can result in disfiguring scars and contractures.