Leg Burn Reconstruction

Synopsis

Over 200,000 patients are treated yearly in the United States for burns, and yearly millions suffer from burns overseas. Due to the large surface area and dependent position of the lower extremities, burns are very common and can range from small, superficial burns to extensive, deep burns resulting in amputation. Burn scar contracture release is the most commonly performed lower-extremity burn reconstructive procedure in our practice. The key to successful lower-extremity burn contracture release is an understanding of the advantages and limitations of the available techniques for contracture release. This chapter is divided into pre-operative management of the burned and contracted lower extremity, surgical techniques, post-operative care, and management of the complications. The purpose of this review is to display the treatment strategies in leg burn reconstruction in the global surgery setting.

Clinical Problem

Leg burn reconstruction encompasses a wide range of clinical problems and solutions. These include everything from debriding a small burn to managing a catastrophic injury resulting in amputation. Of all the lower-extremity problems we see in our burn surgery practice, burn scar contractures are by far the most common.

Burn scar contractures can present anywhere from the groin to the toes. Their severity varies from mild discomfort due to loss of elasticity in the scarred area to severe deformity, loss of function, pain, and disability. The flexor surfaces are more commonly affected, because the flexion creases under the joints tend to have thinner skin than the extensor counterparts, so burns tend to result in deeper injuries and more scars. The strong muscle mass of the lower extremities can sometimes overwhelm the strength of the scar bands, resulting in auto-releases leading to recurrent areas of ulceration in the scar.

Burn contractures can present in patients of any age, but recurrences are more common in children, because they are still growing and often outpace the growth of their scars. Intervention of burn contractures in a timely fashion can prevent joint stiffness and potentially irreversible functional deficits. Regular follow-up for patients who have undergone lower-extremity contracture releases can help detect recurrences early, especially in children.