Fahmina Buriro, Mazhar Nizam , Ahmed Rahim Bux
Objective: To determine the success & failures &problems in the management of post burn contractures. Methods: Retrospective study carried out to evaluate release of contracture cases in Burns and Plastic surgery unit Patel hospital from January 2011 to October 2014. Information was obtained about age of patient, type of burn, region and type of contracture, type of release, initial and late outcome and recurrence. Results: A total of 65 patients underwent release of contractures. Age ranged from 6 months to 53 years. 35 patients were under 12 years age group. Most common reason of burn was fire in 33 patients followed by scalds in 20 patients. Most common area involved was Hand and wrist in 23 patients followed by eyelids and elbow. Total of 76 contractures released in these 65 patients. Split thickness skin grafts were used in 30 contractures and full-thickness skin grafts in 26 contractures, local transposition flaps (z plasties, v-y plasties and commissuroplasties) in 16 and loco regional flap in 4 contractures. Initial result was good in 62 patients. Two patients had partial graft loss and one had complete graft loss. Late result was satisfactory in 39 patients, 17 patients had no follow up record. 9 patients developed recurrence, among them 6 were treated with STSG and 3 with FTSG, two of them had good result after repeat surgery. 5 patients had stiff hands. Good results were observed in patients treated with FTSG and flap and also in those patients treated with STSG who followed use of splints and physiotherapy. Lack of follow up and lack of compliance is found to be most common problem in management. Pediatrics post burn contractures are difficult in terms of post- operative therapy. We found that donor area availability is major limitation of not doing flap
coverage. Conclusion: Post burn contractures are difficult to treat specially in children. There are many problems associated with their treatment. Skin grafts are good and reliable options and provide good results if post-operative therapy is followed properly.