Optimizing burn contracture management: a systematic review of surgical techniques and rehabilitation strategies

Introduction: Burn contractures are a significant complication of burn injuries, causing impaired joint mobility, aesthetic concerns, and reduced quality of life. Effective management requires a combination of advanced surgical interventions and structured rehabilitation strategies. This systematic review aims to evaluate the effectiveness of surgical techniques and postoperative rehabilitation strategies in managing burn contractures, with a focus on clinical outcomes, including range of motion (ROM), complication rates, and patient satisfaction. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted across PubMed, ScienceDirect, Google Scholar, and the Cochrane Library for studies published from 2014 to 2024. Inclusion criteria encompassed studies involving surgical techniques such as surgical flaps, Z-plasty, Split-Thickness Skin Grafts (STSG), Full-Thickness Skin Grafts (FTSG), and dermal substitutes, alongside rehabilitation methods including physical therapy and advanced technologies like Negative Pressure Wound Therapy (NPWT) and Platelet-Rich Plasma (PRP). Data were extracted from five studies that met methodological quality and relevance criteria. Results: Surgical techniques, such as ADM and surgical flaps, demonstrated superior outcomes, reducing re-contracture rates (4.8% vs. 26.9% for FTSGs) and achieving up to a 90% improvement in ROM. Two-stage procedures (e.g., DRT and STSG) have proven effective for treating complex contractures with minimal complications. Structured rehabilitation—whether technology-based or community-driven—was critical in maintaining joint function and preventing stiffness. However, in low-resource settings, limited access to technology and skilled personnel led to higher complication rates (up to 52%). Conclusion: Effective management of burn contractures requires a multidimensional approach that integrates innovative surgical techniques and comprehensive rehabilitation. Investments in technology, medical training, and community-based strategies are essential for sustainable improvements in clinical outcomes and patient quality of life.