Burn contracture releases on the Africa Mercy: the basics.

Since my last blog post, I've had a question raised about the burn contractures... Why do they seem to get more burn injuries here than in the states and what causes the contractures.

One of our physio therapists working with
a patient on admission to see his
pre-operative range of motion

There is a high incidence of burn injuries here due to population density and poverty, I have read that burns account for greater than 50% of injuries in children under 5 years in developing countries. There are open fires that you often see throughout the streets at night here. It's not hard for a child to wander into a flame, or fall, or for a person to have a seizure near a fire and have the unfortunate consequence of getting burned as a result. Some of our patients also have said their clothes caught on fire or have experienced acid burns. 

Luic getting his
dressing changed!

   If they survive the initial burn injury, they are among the lucky ones. Some heal on their own, some seek traditional medicine for healing, and others may go to a local hospital. Often the result we see is the same. The skin contracts and heals onto itself, pulling the affected body part in a contorted position. For example, if the skin was burned to the wrist, there is an open area where no skin remains. Without grafting of extra skin to that area, as it heals, there is less skin left on the wrist now, so the healthy skin will heal and pull together from both edges of the open area. This might cause the hand to bend backwards as the skin from the back of the hand and from the arm pull towards each other, and the wrist might contract in that position. They are left with their hand bent in a backwards position down so the back of the hand may even be adhered to the arm. This is certainly not a functional position for any practical purposes. This occurs in wrists, elbows, armpits, necks, chins, knees, fingers, feet... Any joint you can think of. 

Our job here is to try to release the contracture to restore normal function. We aim to release that hand from the arm so they can once again bend their wrist. To allow them to feed themselves, to play an instrument, to write and go to school, to high five a friend. Function is the first priority with appearance coming as our second goal.

 How does the surgeon do this? He first will release the contracted extremity and attempt to straighten the joint. Then he takes a thin layer of skin from their thigh and uses that skin to cover the newly open area to allow for movement. After a few days post operatively, we start doing dressing changes and allowing for physical and occupational therapy to start working with them to achieve the best possible range of motion and function! This can be a very long and sometimes also very painful process. With muscles and joints that have not moved in years, combined with a build up of scar tissue, exercises can be very painful. 

The physical and occupational therapists here are amazing, and work so hard to help restore function for our beloved patients.

That's the process in a nut shell! If you have any further questions please don't hesitate to ask on here or email me!  The plastics patients are now almost all discharged from the hospital with healing wounds, coming back to the ship for their outpatients appointments for dressing changes and physical therapy as needed! Since there are so few left, I am now moving back on to the ward to work with patients with obstetric fistulas, as I did in Togo. These women are amazing and I feel so blessed to get to know them! Please keep them in your prayers, as well as the plastic surgery patients in their recovery and exercises that they can heal and have amazing range of motion results!

Jessica! Sweet and so joyful!

It has been a huge blessing to work with these patients among so many beautiful, intelligent, hard-working, loving individuals. This place leaves me feeling so thankful and I am so happy to be blessed with the opportunity to serve in this capacity. And just look at the faces of the patients, so beautiful and joyful! They are so wonderful. 

3 of us dressings team nurses and our plastics team
 leader cuddling baby Frida!