DefinePK

Abstract

Background: post-burn contractures of the upper limb remain a significant cause of disability despite advances in acute burn management. Functional impairment of the hand, wrist, elbow, and axilla limits activities of daily living and reduces quality of life. Surgical management strategies, including Z-plasty, split-thickness skin graft (STSG), and full-thickness skin graft (FTSG), are commonly employed to restore function. Aim: To evaluate the effectiveness of individualized surgical techniques in the management of upper limb post-burn contractures over five years at Sheikh Zayed Hospital, Lahore, Pakistan. Methods: A prospective randomized study was conducted from January 2018 to December 2022, including 93 patients aged 5–71 years with upper limb post-burn contractures. Demographic details, sites of contracture, etiology of burns, type of surgical procedure, length of hospital stay, and outcomes were analyzed. Surgical procedures performed included Z-plasty, Z-plasty with graft, contracture release with STSG, and FTSG. Patients were followed up for six months postoperatively, and functional recovery and recurrence were assessed. Results: The hand was the most affected site (91.6%), followed by the elbow and forearm (21.7%), the wrist (21.7%), and the axilla (13.3%). The major etiologies were flame burns (78.5%), electrical burns (62.4%), and hot fluid scalds (50.5%). Z-plasty was performed in 16 patients, Z-plasty with graft in 12, STSG in 57, and FTSG in 6. Average hospital stay ranged from 9 days for Z-plasty to 14–15 days for graft-based procedures. No recurrence was observed in the Z-plasty or FTSG groups, while one recurrence occurred with STSG. Conclusion: Individualized surgical management, particularly Z-plasty and FTSG, provided excellent functional outcomes with minimal recurrence. Emphasis on postoperative rehabilitation is essential to maintain long-term results.