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Review of 2506 Burn Contractures of Developing Countries:
Prognostic Indicators of Burn Surgery Outcomes
Alice C. Huang, MBA, MS II, Richard Agag, M.D., Scott Corlew, M.D..
Albany Medical College, Albany, NY, USA.
PURPOSE: Burn contractures have a significant socioeconomic impact in developing countries. Factors involved in predicting successful outcomes after contracture release are complex. Determining what factors lead to improved outcomes will enable burn surgeons and international organizations to provide better care to this patient population.
METHODS: To determine the factors that influence the level of improvement from contracture release surgeries, a retrospective chart review was performed on patients with contractures of the hand (n=1960), knee (n=176), and elbow (n=371) in Nepal, Zambia and India. Functionality of the hand was measured through three outcome variables extracted from pre-operative and post-operative images: pre-operative and post-operative severity of dysfunction based on the number of digits involved in the burn contracture (1-5 fingers) and post-operative functionality of the hand (1-5 with 5 being fully functional). The level of improvement from surgical intervention for the elbow and knee were calculated from the difference between pre-operative and post-operative angle of maximum extension of the joint.
RESULTS: Multivariate analysis was performed on the burn contracture data. Hands burned from hot liquid had significantly more post-operative functionality (0.23 fingers ± 0.07; 0.56 fingers ± 0.14 respectively) than hands burned from open fire within a pre-operative severity of dysfunction from 3 fingers (p<0.01) to 4 fingers (p<0.01) when adjusted for the age of the patient. For every 1 year increase in the age of the patient, the improvement in severity of dysfunction decreased by 0.01 fingers ± 0.002 (p<0.01) and the level of post-operative functionality of the hand decreased by 0.01 ± 0.002 (p<0.01). For every 1 year the patient waited between the burn event and receiving surgery, the improvement on severity of dysfunction of the hand decreased by 0.02 fingers ± 0.002 (p<0.01) and the degree of post-operative functionality of the hand decreased by 0.01 fingers ± 0.003 (p<0.01).
The surgical outcomes from burn surgeries on the knee and elbow contractures were not significantly influenced by the cause of the burns. For every 1 year increase in age, the improvement seen from contracture release surgery decreased by 0.36 degrees ± 0.13 for the elbow (p<0.01); for 1 year addition to the time waited, the change in angle observed after surgery decreased by -1.25 degrees ± 0.35 (p<0.01) for the knee.
CONCLUSIONS: Significant factors to the surgical outcome were the time waited between the burn and surgery for the knee, age of the patient for the elbow, and age of the patient, time waited, and cause of the burn for the hand. Further research is necessary to discover additional prognostic factors in the outcomes of burn contracture release surgeries.
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