Annals of Burns and Fire Disasters - vol. XXV - n. 3 - September 2012

Despite advances in the overall management of burn injuries, severe post-burn contractures continue to be a formidable foe for reconstructive surgeons in developing countries like ours (Pakistan). Not only do we have a higher incidence of burn injuries, but we also lack ideal facilities for managing acutely burned patients. These factors are further compounded by ignorance, poverty, and inadequate utilization of available health care facilities. The resultant post-burn contractures are often severe, long standing, and with secondary complications. Management of these problems accounts for up to 50% of a general plastic surgeon’s workload. Once contractures develop, correction of both functional and aesthetic deformities is indicated. The goal is to ensure complete release of the contracture, resurface the raw area with skin grafts or flaps, and restore cosmesis as much as possible. Contracture release and resurfacing can be effected with local tissue rearrangement such as Z-plasties or transposition flaps. When the contracted tissue is of unacceptable quality, or too irregular, excision of scars is undertaken to achieve the best results. Burn victims often pose a surgical management challenge as extensive scarring may preclude local flap options.