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. 2015 Mar 31;28(1):46-9.

Management of complex pediatric burn scars in a humanitarian collaboration

F Bassetto  1 , A Staffieri  2 , F Reho  1 , F Facchin  1 , J Shehata  3 , D Maged  4 , C Tiengo  1
Affiliations

Management of complex pediatric burn scars in a humanitarian collaboration

F Bassetto et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success.

Les cicatrices de brûlures représentent toujours un défi pour le chirurgien de reconstruction. Leur gestion nécessite une expertise spécifique et la possibilité de réhabilitation à long terme, y compris le suivi. Les cas rencontrés dans les missions humanitaires présentent des problèmes supplémentaires. Souvent l’environnement local n’est pas adapté pour un plan de traitement approprié, et donc il faut transféré le patient dans un pays étranger pour des soins chirurgicaux dans le cadre d’une gestion internationale et multidisciplinaire intégrée. Nous présentons le cas d’un patient de trois ans blessé à cause de l’explosion d’une bombe pendant le printemps arabe. Ce patient souffrait de contractures graves qui limitaient le mouvement du membre thoracique et supérieure. Après une consultation initiale à distance, il a été transferé à notre pays où il a subi un programme de chirurgie et de réadaptation intensive qui a duré trois mois. Après cinq mois, le patient est retourné à son pays d’origine où un réseau de soutien a été mis en place pour continuer la réhabilitation, assurer un suivi de plus d’un an et le succès final.

Keywords: burn; humanitarian mission; plastic surgery; scar.

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Figures

Fig. 1
Fig. 1
A case of a 3 year-old child suffering from severe retracting burn scars of the anterior chest and upper limbs (left) determining functional impairment of arms abduction (right).
Fig. 2
Fig. 2
The retracting scars were released by multiple Z-plasties running from the chest to the elbows bilaterally. priority was given to full skin coverage of the anterior pillar of the axillae, leaving bare surfaces between the plasties flaps at the arms. These areas were initially covered with a dermal regenerative template. in the same operation, two skin expanders were implanted in the anterior chest.
Fig. 3
Fig. 3
Once full skin expansion was achieved (a), the two expanded skin flaps were raised (b) and rotated to provide functionally and aesthetically optimal repair of the axillary and chest regions (c).
Fig. 4
Fig. 4
This approach allowed a quick restoration of almost complete upper limbs function, stable at 1 year follow up (a). To prevent recurrence, stabilize the benefits in the long term, and improve the functional outcomes, custom made elastic garments were provided (b).
See this image and copyright information in PMC

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