Reducing the public health expenditure through a surgical method that facilitates early mobilization of lower limb burns

Abstract

INTRODUCTION & OBJECTIVES: Grafted skin in the conventional way tends to contract towards the midline bridging across the joints. Prolonged immobilization following skin grafting promotes contracture across the joints. In the advanced graft orientation technique (AGOT) devised by the Burns Unit of the National Hospital of Sri Lanka (BU-NHSL), the graft is orientated in a tension free direction. This method does not require prolonged splinting or immobilization. The aim of the study was to assess the impact of graft orientation on early mobilization and prevention of contracture in lower limb (LL) burn patients. METHODS: A total of 61 patients treated with AGOT for LL burns at BU-NHSL (study group-SG) were compared with 21 patients who were primarily treated with conventional skin grafting for LL burns at local hospitals and referred for reconstruction at BU-NHSL (control group-CG). Vancouver Scar Scale (VSS) and range of motions (ROM) of involved joints were measured one year following the date of burn in the SG. These were measured prior to reconstructive surgery in the CG. Comparison was done using independent t-test. RESULTS: Mean value of VSS in the SG and the CG were 2.8889 (SD+1.65878) and 9.4074 (SD+3.21366) respectively. Spared normal joint ROM was seen in 95.6% of the SG. 100% in the CG had reduced joint ROM. CONCLUSION: AGOT has a lesser possibility of contracture across the grafted joints. Lower VSS value in the SG suggests that the quality of grafted skin is closer to normal skin. This technique is beneficial in low and middle income countries where access to specialized burn rehabilitation and health budget is limited.