Context-appropriate management of paediatric post-burn hand contractures: Outcomes from a low-resource setting

Paediatric post-burn hand contractures are a major cause of preventable disability in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa. Limited access to microsurgical expertise, specialized equipment, and formal rehabilitation often constrains optimal management. This study evaluates the functional outcomes of a simplified surgical approach in a resource-limited setting. A prospective series of 27 children with post-burn finger contractures was managed at a regional referral hospital in East Africa. Surgical release was performed using volar Bruner incisions, meticulous scar excision, preservation of neurovascular structures, K-wire stabilization in full extension, and split-thickness skin grafting. Caregivers were instructed in structured home-based range-of-motion exercises in lieu of formal physiotherapy. Patients were followed for eight weeks after K-wire removal, with outcomes assessed by restoration of extension, grasp, and reported functional use. All patients achieved full or near-complete finger extension at final follow-up. Functional grasp was restored in every case. Complications were minimal, with no wound infections, graft losses, or neurovascular deficits. No contracture recurrences were observed within the follow-up period. Caregiver adherence to the home rehabilitation program was high. In resource-constrained environments, paediatric post-burn hand contractures can be effectively managed using simple, reproducible surgical techniques and structured caregiver-led rehabilitation. This approach requires minimal specialized equipment, is feasible in district-level hospitals, and yields substantial functional recovery, aligning with global surgery goals to expand access to essential reconstructive care in underserved regions.