Algorithms For Management Of Post-Burn Contracture In Upper Extremity In Children
H Terziqi1,2,3, I Sopjani3, B Gjikolli3,4
1Clinic of Plastic Surgery, University Clinic Centre Pristina, Kosovo.
Insights
This study details surgical management for pediatric upper extremity post-burn contractures, developing an algorithm to guide treatment for improved joint motion and aesthetics.
Area of Science:
- Plastic and Reconstructive Surgery
- Pediatric Surgery
- Burn Management
Background:
- Post-burn contractures in the upper extremities of children significantly impair function and aesthetics.
- Effective surgical management is crucial for restoring mobility and appearance.
Purpose of the Study:
- To describe the surgical treatment outcomes for pediatric upper extremity post-burn contractures.
- To develop a decision-making algorithm for surgical approaches to contracture management.
Main Methods:
- Retrospective study of 144 pediatric patients (0-18 years) with upper extremity post-burn contractures (2014-2019).
- Surgical interventions included skin grafts (STSG, FTSG) and various local flaps (advancement, Z-plasties, V-Y, pedicled, cross finger, radial forearm).
- Anatomical division into axilla, elbow, wrist, and hand; follow-up for 6 months to 3 years.
Main Results:
- Hands were most affected (68%), followed by elbows (18%), axilla (8%), and wrists (6%).
- A classification and treatment algorithm was developed.
- Significant improvements in joint motion and aesthetic deformities were observed.
Conclusions:
- A structured approach utilizing a reconstructive ladder and a decision algorithm improves outcomes for pediatric upper extremity burn contractures.
- The developed algorithm serves as a valuable guide for surgical decision-making in managing these complex cases.
Abstract:
The aim of this study is to describe the management and outcome of surgical treatment for post burn contractures in different parts of the upper extremities in children, and provide a final decision algorithm that can be a useful guide for the Resident regarding surgical approach to contracture management. This was a retrospective study conducted in the Clinic of Plastic and Reconstructive Surgery, Pristina-Kosovo, between 2014-2016. All cases continued check ups in the Gentiana-Grelor private clinic in Pristina until 2019. Followups were conducted for no less than 6 months with respect to the viability and healing of the repaired area. Patients of both genders, aged from 0 months to 18 years with post-burn contracture in upper extremity, were included in the study. For the sake of presentation, we divided them anatomically into four main areas: axilla, elbow, wrist and hand. We start with a reconstructive ladder using skin grafts (STSG, FTSG), and local flaps such as advancement flaps, Z-plasties, V-Y or Y-V advancement flap, abdonimal/groin pedicled flap, cross finger flap, radial forearm flap were used. Patients were called for follow-up lasting a minimum of one to up to three years. The study included 144 patients. Their age ranged from 9 months to 18 years, the mean age being 12 years. Ordering them by location, post-burn contracture percentage in upper extremity in children was 68% on the hands, 18% on the elbows, 8% on the axilla and 6% on the wrist. A classification and treatment algorithm aids in achieving significant improvements in both joint motions and aesthetic deformities.
