Abstract: Analysis of Burns Reconstructive Procedures in the Northern Cape Province

ANALYSIS OF BURNS RECONSTRUCTIVE PROCEDURES IN THE NORTHERN CAPE PROVINCE

M.Giaquinto-Cilliers, T.Mathe, S.Sheik, T.Van Wyngaard

Kimberley Hospital Complex

OBJECTIVES: To analyze the reconstructive procedures performed in the Northern Cape Province (NCP) in patients who sustained burn wounds and were previously treated in the Kimberley Burns Unit (KBU), aiming to improve the rehabilitation process of burn patients in the Province.

BACKGROUND: The rehabilitation of burn patients starts in the acute phase of the injury and includes active and passive physiotherapy, splinting of joints and extremities, early excision and grafting of the burn wound amongst other interventions. Despite the active intervention, minor and major deformities may develop, and further surgical reconstructive procedures must be performed in order to improve functional and cosmetic features and assist with the reintegration of the burn patients into their normal activities. The role of plastic reconstructive surgery is to perform the procedures through a realistic approach, combining timing and selection of techniques.

METHOD: A retrospective audit of surgical reconstructive procedures performed at Kimberley Hospital Complex from January 2006 to July2011was carried out. The ratio of reconstructive procedures done and the functional or cosmetic outcome was analyzed.

RESULTS: 2472 overall surgical procedures were performed in the period of the study. 61% of the operations were related plastic surgery procedures and 38.87% to acute treatment of the burn injury, including surgical debridement and skin grafting. From the total of reconstructive cases, around 10% were related to late reconstruction of burns related deformities. Amongst the reconstructive operations, the release of joint contractures was the most frequent performed in the following order: armpits, elbows, knees, fingers. Other procedures included: reconstruction of the eyebrows, ear reconstruction, release of contracted eyelids/lips, and correction of burn alopecia.

DISCUSSION: Despite the efforts taken to prevent deformities resulting from burn injuries, the occurrence of burn related deformities at Kimberley Hospital was high. Most patients do not search actively for functional reconstruction, as they rely on grants. Thirty percent of the NCP population relies on some type of grant, particularly disability grants.

CONCLUSION: To improve the rehabilitation of burn patients in the NCP, a better integration between physiotherapists, occupational therapists, burn surgeons and plastic surgeons is essential. The follow up of burn patients after the injury and the early referral to a plastic/ burn surgeon when deformities which can be corrected are detected, are the pillars to deliver good quality of burns reconstruction and rehabilitation of the burned patient in the Province.