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      • Record: found
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      The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries

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          Abstract

          Supplemental Digital Content is available in the text.

          Background:

          Worldwide, many scar contracture release surgeries are performed to improve range of motion (ROM) after a burn injury. There is a particular need in low- and middle-income countries (LMICs) for such procedures. However, well-designed longitudinal studies on this topic are lacking globally. The present study therefore aimed to evaluate the long-term effectiveness of contracture release surgery performed in an LMIC.

          Methods:

          This pre-/postintervention study was conducted in a rural regional referral hospital in Tanzania. All patients undergoing contracture release surgery during surgical missions were eligible. ROM data were indexed to normal values to compare various joints. Surgery was considered effective if the ROM of all planes of motion of a single joint increased at least 25% postoperatively or if the ROM reached 100% of normal ROM. Follow-ups were at discharge and at 1, 3, 6, and 12 months postoperatively.

          Results:

          A total of 70 joints of 44 patients were included. Follow-up rate at 12 months was 86%. Contracture release surgery was effective in 79% of the joints ( P < 0.001) and resulted in a mean ROM improvement from 32% to 90% of the normal value ( P < 0.001). A predictive factor for a quicker rehabilitation was lower age ( R 2 = 11%, P = 0.001). Complication rate was 52%, consisting of mostly minor complications.

          Conclusions:

          This is the first study to evaluate the long-term effectiveness of contracture release surgery in an LMIC. The follow-up rate was high and showed that contracture release surgery is safe, effective, and sustainable. We call for the implementation of outcome research in future surgical missions.

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          Most cited references43

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          The perforasome theory: vascular anatomy and clinical implications.

          Michel Saint-Cyr, Corrine Wong, Mark Schaverien … (2009)
          A clear understanding of the vascular anatomy of an individual perforator relative to its vascular territory and flow characteristics is essential for both flap design and harvest. The authors investigated the three-dimensional and four-dimensional arterial vascular territory of a single perforator, termed a "perforasome," in major clinically relevant areas of the body. A vascular anatomy study was performed using 40 fresh cadavers. A total of 217 flaps and arterial perforasomes were studied. Dissection of all perforators was performed under loupe magnification. Perforator flaps on the anterior trunk, posterior trunk, and extremities were studied. Flaps underwent both static (three-dimensional) and dynamic (four-dimensional) computed tomographic angiography to better assess vascular anatomy, flow characteristics, and the contribution of both the subdermal plexus and fascia to flap perfusion. The perfusion and vascular territory of perforators is highly complex and variable. Each perforasome is linked with adjacent perforasomes by means of two main mechanisms that include both direct and indirect linking vessels. Vascular axis follows the axiality of linking vessels. Mass vascularity of a perforator found adjacent to an articulation is directed away from that same articulation, whereas perforators found at a midpoint between two articulations, or midpoint in the trunk, have a multidirectional flow distribution. Each perforator holds a unique vascular territory (perforasome). Perforator vascular supply is highly complex and follows some common guidelines. Direct and indirect linking vessels play a critical part in perforator flap perfusion, and every clinically significant perforator has the potential to become either a pedicle or free perforator flap.
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            ISBI Practice Guidelines for Burn Care.

            (2016)
            Practice guidelines (PGs) are recommendations for diagnosis and treatment of diseases and injuries, and are designed to define optimal evaluation and management. The first PGs for burn care addressed the issues encountered in developed countries, lacking consideration for circumstances in resource-limited settings (RLS). Thus, the mission of the 2014-2016 committee established by the International Society for Burn Injury (ISBI) was to create PGs for burn care to improve the care of burn patients in both RLS and resource-abundant settings. An important component of this effort is to communicate a consensus opinion on recommendations for burn care for different aspects of burn management. An additional goal is to reduce costs by outlining effective and efficient recommendations for management of medical problems specific to burn care. These recommendations are supported by the best research evidence, as well as by expert opinion. Although our vision was the creation of clinical guidelines that could be applicable in RLS, the ISBI PGs for Burn Care have been written to address the needs of burn specialists everywhere in the world.
            Article 0 comments Cited 69 times – based on 0 reviews     Review now
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              Short-term medical service trips: a systematic review of the evidence.

              Kevin Sykes (2014)
              Short-term medical service trips (MSTs) aim to address unmet health care needs of low- and middle-income countries. The lack of critically reviewed empirical evidence of activities and outcomes is a concern. Developing evidence-based recommendations for health care delivery requires systematic research review. I focused on MST publications with empirical results. Searches in May 2013 identified 67 studies published since 1993, only 6% of the published articles on the topic in the past 20 years. Nearly 80% reported on surgical trips. Although the MST field is growing, its medical literature lags behind, with nearly all of the scholarly publications lacking significant data collection. By incorporating data collection into service trips, groups can validate practices and provide information about areas needing improvement.
              Article 0 comments Cited 62 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Plast Reconstr Surg Glob Open
                Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open
                Journal ID (publisher-id): GOX
                Title: Plastic and Reconstructive Surgery Global Open
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Electronic): 2169-7574
                Publication date Collection: July 2020
                Publication date (Electronic): 15 July 2020
                Volume: 8
                Issue: 7
                Electronic Location Identifier: e2907
                Affiliations
                From the [* ]Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
                [† ]Global Surgery Amsterdam, Amsterdam, The Netherlands
                [‡ ]Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
                [§ ]Haydom Lutheran Hospital, Haydom, Tanzania
                []Association of Dutch Burn Centers, The Netherlands
                [∥ ]Burn Center, Martini Hospital, Groningen, The Netherlands
                [*** ]Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
                [†† ]Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
                [‡‡ ]Amsterdam Movement Sciences, Amsterdam, The Netherlands.
                Author notes
                Thom C. C. Hendriks, MD, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands, E-mail: t.hendriks1@ 123456amsterdamumc.nl
                Article
                Accession ID: 00031
                DOI: 10.1097/GOX.0000000000002907
                PMC ID: 7413812
                PubMed ID: 32802643
                SO-VID: 46d42da7-deca-4120-95a2-0e1adba34141
                Copyright © Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Date received : 20 February 2020
                Date accepted : 15 April 2020
                Categories
                Subject: Reconstructive
                Subject: Original Article
                Custom metadata
                SDC T
                OPEN-ACCESS TRUE

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