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Factors Affecting Burn Contracture Outcome in Developing Countries

A Review of 2506 Patients

Garcia, Lauren P. MS; Huang, Alice MD, MBA; Corlew, Daniel Scott MD, MPH; Aeron, Kush MD; Aeron, Yogi MD; Rai, Shankar Man MD; Jovic, Goran MD; Agag, Richard L. MD

doi: 10.1097/SAP.0000000000000856
Burn Surgery and Research

Introduction Burn contractures hinder joint mobility, resulting in functional impairment and reduced quality of life. This is of greater significance in developing countries where there are fewer resources for assistance with such impairments. Contracture release reduces deformity, but multiple factors affect the extent of postsurgical improvements and outcomes. Elucidating these factors may enable surgeons to better care for burn patients. This study assesses factors that impact burn contracture resolution in developing nations.

Methods A retrospective review of 2506 burn contractures was performed using information extracted from a large nongovernment organization (ReSurge International) database from Nepal, India, and Zambia. Data points included age, type of burn, time elapsed between injury and release, and extent of final release achieved based on preoperative and postoperative images of hand (n = 1960), elbow (n = 371), and knee (n = 176) contractures. Hand improvement was scored based on digit/wrist involvement (severity of dysfunction) and joint extension capability (functionality); elbow and knee improvement were calculated using preoperative and postoperative joint angles. Multivariate analysis was performed.

Results Hands burned by hot liquid had greater functionality after surgery than open-fire burns (P < 0.01). Improvement in severity of dysfunction and functionality were inversely correlated to age (P < 0.01) and time until surgery (P < 0.01). Elbow improvement decreased as age increased (P < 0.01). Postoperative increase of knee extension decreased for each year elapsed between injury and surgery (P < 0.01).

Conclusions Burn type, age when burned, and timing of surgery were significant factors affecting hand outcomes, whereas age affected elbow outcomes, and time elapsed until surgery affected knee results. An algorithm was formulated to enable physicians in developing countries with limited resources to triage patients and optimize patient outcomes.

From the *Albany Medical College, Albany, NY; †Middle Tennessee Medical Center, Murfreesboro, TN; ‡Helping Hands Hospital; §Uttarakhand Medical & Health Department; ∥ReSurge International, Dehradun, India; ¶National Academy of Medical Sciences; #Kirtipur Hospital; **ReSurge International, Kathmandu, Nepal; ††University Teaching Hospital; ‡‡ReSurge International, Lusaka, Zambia; and §§Albany Medical Center, Albany, NY.

Received September 7, 2015, and accepted for publication, after revision May 17, 2016.

Abstract presented at NYRSPS Residents' Night 2015 and at the ASPS Meeting 2015 with subsequent abstract publication in PRS special supplement issue (Garcia LP, Huang A, Corlew DS, Agag RL. A prospective review of 2506 burn contractures in developing countries: factors affecting improved function. Plast Reconstr Surg. 2015;136(4 Suppl):147–8).

Conflicts of interest and sources of funding: none declared.

Reprints: Richard L. Agag, MD, Albany Medical Center, 43 New Scotland Ave, MC 190 Albany, NY 12208-3479. E-mail:

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