Management of Acute Burn Wounds in Rural Areas of Low-Income Countries: Global Burn Surgery

Fig. 46.1

Lower face and neck contracture with oral incontinence—preoperative photos

Under general anesthesia, the burn contractures were released at the base of the neck contracture. When released, the soft tissues above incision managed to cover the lower face till marginal mandibular area. A thicker split thickness skin graft was applied on the anterior aspect of the neck and in the submental area. Quilting was required, and grafts were checked at 1 week (Fig. 46.2). Some epidermolysis and around 20% of the skin graft were lost after surgery. Regular dressings were carried out, and no further surgical intervention was required.

../images/188491_2_En_46_Chapter/188491_2_En_46_Fig2_HTML.jpg — Fig. 46.2

One week after neck contracture release: wound check with some epidermolysis

The patient was fitted with a soft collar for the next 6 months, and no pillows were allowed during the sleep. No orthodontic treatment was carried out.

He presented 6 years later to our surgical camp for release of his left axilla. At that time, we assessed the results of the neck contracture release (Fig. 46.3). Donor site had a good healing and no hypertrophic scars (Fig. 46.4).

../images/188491_2_En_46_Chapter/188491_2_En_46_Fig3_HTML.jpg — Fig. 46.3

Follow-up 6 years after initial release

../images/188491_2_En_46_Chapter/188491_2_En_46_Fig4_HTML.jpg — Fig. 46.4

Donor site: right thigh

46.2 Patient 2: Long-Term Right Side Lower Face and Neck Contracture Along with Right Axillary Contracture

During one of our surgical camp in India, a 17-year-old female presented with significant burn contracture affecting the right side of her lower face, neck, chest, and right axilla (Fig. 46.5). This was the result of a flame burn at the age 7 while helping her mother to cook on the open fire. The burn wounds were treated conservatively with regular dressings. The scar contracture was pulling significantly on the right corner of the mouth, and there was significant axillary contracture.