Who will benefit from the surgery camp?
Pediatric population (less than or equal to 18 years old and more than 2 years old) with burn scars who have significant functional impairment. Also older individuals can be addressed on case by case basis. Those seeking just the aesthetic aspect due to burn scars are initially not included in the treatment. However, they can be considered based on the total number of cases and medical resources available on that day.
Besides burn contractures releases, other congenital/acquired non-emergent backlog cases such as syndactyly, hydrocele, hernia etc. can also be addressed during the camp – if the total number of surgical cases during the camp period are less than expected.
Targeted number of cases: Approx. 20-30 cases per camp.
Burn injury
An extensive burn is the most devastating injury a person can sustain and yet hope to survive. Survival is no doubt the immediate concern, it is the restoration to pre-injury status, and return to society becomes important for the victim and the treating team. A healed burn patient may be left with scars have varying degrees of functional and aesthetic components. Development of post burn scars is inversely proportional to the standards of initial treatment with patients receiving best of care having minimum number and severity of these problems.
Post-burn scars Post-burn scars are inevitable even with the best of treatment because they depend upon the depth of burn injury. Except for the superficial dermal burns, all deeper burns (2nd degree deep dermal and full thickness) heal by scarring. This scarring can only be minimised by various physical therapy measures and plastic surgical procedures but not eliminated completely.
Post-burn scar contractures A burn patient who receives the best of treatment is expected to heal without any contractures. The incidence of post-burn contractures is extremely high in LMIC. Quite often, they are not only multiple in a given patient but also very severe and diffuse. The number of trained burn surgeons is very very low in Nepal.
Contraction is an active biological process by which an area of skin loss in an open wound is decreased due to concentric reduction in the size of the wound. The reduction in size of wound causes lesser degree of connective tissue deposition and the amount of epithelialisation needed is decreased. Wound contraction involves an interaction of fibroblasts, myofibroblasts and collagen deposition and is a satisfactory mechanism when the tissue loss is small, in a non-critical area and surrounded by loose skin.
(https://pubmed.ncbi.nlm.nih.gov/21321660/)
Burn Scar Excision (BSE)
Thick and disfigured burn scars are usually excised and closed primarily or with local tissue rearrangement (LTR).
If the closure is not possible primarily or LTR, then next step is to use full thickness skin graft (FTSG) or split thickness skin graft (STSG) to cover the defect. And in some cases flaps are used.
Classic Z-plasty
BSE and primary closure
Reconstruction of scar contractures by using multiple z-plasties.
a Preoperative view. b Design of the z-plasties. c Immediate postoperative view. d Eighteen months after surgery. A major benefit of z-plasties is that segmented scars mature faster than long linear scars. (https://rdcu.be/cK3gX)
Traumatic scar on pamlar aspect of the left hand was released by BSE and Z-plasties were placed over the joints and the main crease in the palm. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8687618/)
