Elbow and Wrist Burn Reconstruction

Synopsis

Burns continue to be a significant source of morbidity and mortality in low- and middle-income countries. Patients that survive the original injury often develop burn scar contracture because burns across the neck, axilla, elbow, and wrist are forced to heal by secondary intention. The physical examination is the most important part of evaluating a patient with wrist or elbow contracture. The surgeon must identify scar bands causing contracture, inspect soft tissue quality surrounding the joint, and examine donor sites (groin, back, thighs, etc.) for possible grafts and/or flaps. Local tissue, compared with skin grafts, is preferable for joint resurfacing after contracture release, as it is more resistant to recurrent contracture. Compliance with splinting and post-operative physiotherapy is paramount in preventing recurrent burn scar contracture.

Clinical Problem

According to the World Health Organization, burns account for an estimated 265,000 deaths every year, the majority of which occur in low- and middle-income countries. Those who survive the acute burn injury often suffer significant lifelong morbidity. Burn patients living in remote villages do not have easy access to health care, let alone the specialized resources necessary to acutely treat a burn. Without early burn excision and skin grafting, splinting, and physiotherapy, burn scar contracture is inevitable for patients with deep partial-thickness and full-thickness burns. Although the ultimate solution for preventing burn scar contracture is to eradicate all burns, this is not today's reality. Flame burns occur commonly because people of all ages are exposed to open flames for cooking, warmth in the home, and prayer. Whereas women and children are more likely to sustain flame or scald burns related to cooking in the home, men are more likely to sustain flame, scald, electrical, or chemical burns in the workplace.

Most cases of post-burn scar contracture present years to decades after the original burn injury. It is common to see teenage patients with burn scar contracture, possibly reflecting the high incidence of burn injuries sustained by children at home; the teenagers are now of working age and desire a functional limb. The patient will present with a gross deformity and limited range of motion about the affected joint. Epilepsy can be associated with post-burn scar contracture because patients can fall into flames and/or scalding liquids during a seizure. More commonly associated conditions include malnutrition and anemia.