Across borders, over time: epidemiology of post-burn injury patterns and late sequelae presenting to surgical outreach camps across three geographical regions

Post-burn contractures remain a major cause of long-term disability worldwide, particularly in low- and middle-income countries (LMICs) where early burn care and timely reconstruction are often limited. Delayed presentation for specialist care contributes significantly to functional impairment, psychosocial morbidity, and economic burden. Burn injuries pose a significant burden in LMICs, especially when initial treatment is delayed or inadequate. This study describes burn injuries, late presentation, and contracture patterns across three regions: the Middle East, Russia, and South Asia (India and Nepal). We performed an observational study using retrospectively analysed, prospectively collected data from six international humanitarian surgical missions undertaken between 2021 and 2024. Demographics, mechanism and context of injury, anatomical involvement, estimated total body surface area (TBSA), first-aid measures, delay to presentation, and contracture distribution were recorded. Descriptive and comparative analyses explored regional differences. A total of 167 patients were included: Middle East (n=45), Russia (n=33), and South Asia (n=89). Flame burns were most common (59%), and injuries occurred predominantly at home (82%). First aid was documented in only 7% of cases. South Asia showed higher TBSA and greater prevalence of lower-limb contractures. Females were disproportionately affected, particularly in chemical burn cases. Bilateral and multiple anatomical contractures were common (35% and 43%). Marked regional variations and prolonged delays highlight opportunities for region-specific prevention, public education, and strengthening early burn care.