INNOVATIVE SOLUTIONS TO FACE BURN VICTIMS, REHABILITATION IN HUMANITARIAN CONTEXT: A DESCRIPTIVE COHORT ANALYSIS​

P. Moreau¹, S. Ismail², M. Al Qatrawi³, E. Tauveron¹, S. Herfat^1,4

¹La Fondation Médecins Sans Frontières, Paris, France, ²Médecins Sans Frontières, Amman, Jordan, ³Médecins Sans Frontières, Gaza, Palestine, ⁴University of California San Francisco, San Francisco, United States

Background: Burns are a major global health burden. Living in resource-limited settings or areas of conflict and disaster increases the risk of burn injury. Among these injuries, facial burns lead to disfiguring outcomes such as hypertrophic and retractive skin complications. Comprehensive and high quality initial and follow-up care is required. International NGO Médecins Sans Frontières (MSF) provides medical, surgical and rehabilitation care to those patients in Low- and Middle-Income countries.

Purpose: Provision of customized orthotics and adapted care for facial burn victims is low or inexistent in humanitarian settings. In 2018, MSF launched a specific program to give access to this rehabilitation in the Middle East and Caribbean. These projects are using 3D technologies and telemedicine, in collaboration with the local MSF hospital projects that were previously established.

Methods: In Haiti, Jordan and Gaza, MSF patients with deep face and/or neck burns receive extensive rehabilitation sessions involving stretching, massage and pressure therapy provided by transparent compressive masks after their dressing periods. A 3D surface scan is acquired locally and processed locally or internationally by experts using CAD/CAM software. Molds are then digitally designed and 3D-printed on site, allowing local teams to manufacture the final transparent thermoplastic masks. From the Middle-Eastern patient cohort, clinical outcomes were collected at various stages of their follow-up care using the Vancouver Score Scale and Patient Observer Scar Assessment Scale. In addition, patient satisfaction with the orthosis was evaluated using the Orthotic Prosthetic User Survey and daily wearing time of the device was also surveyed.

Results: Since 2018, 232 patients received comprehensive care through this program. Only information from the Middle Eastern patient cohort could be analyzed (105 in Gaza, 74 in Jordan). TheJordaniancohort were from a wider range of clinical stages (mainly after reconstructive surgery) compared to the Gaza cohort (post-acute phase). Among the global cohort, patients were mostly children (71.5%) and victims of domestic burns (68.0%). Devices were provided 21.7 days (mean; N=167) following initial assessment and were worn an average of 12h30min daily for 6 months (N=73). After 6 months, clinical improvement was noticed by the therapist, as indicated by a 35.7% decrease in the Vancouver Scale Score (6.2 to 4.0; N=53), and by patients, as indicated by a 36.2% reduction in the POSAS score (40.2 to 25.7; N=53). User satisfaction with the devices was 90.1% at 6 months (N=69).

Conclusions: Positive results were observed in the patient cohort and should be considered as the comprehensive effect of multidisciplinary care (medical, surgical, rehabilitation, orthotic care and the patient’s commitment). This program demonstrates the feasibility of implementing 3D technologies and providing advanced burn rehabilitation care within challenging humanitarian settings. Such projects require robust local resources, and prior training is essential for any implementation.

Implications: MSF is currently conducting a study to better determine if there are advantages to using 3D technology for burns in humanitarian contexts. This would advocate for future project replications that could be implemented in other places to increase access to specialized care. Future directions are to expand the project to other patient populations.

Funding acknowledgements: This Project was funded by MSF Foundation donors.

Keywords:
face burn
humanitarian setting
3D technology

Topics:
Disability & rehabilitation
Innovative technology: robotics
Disaster management

Did this work require ethics approval? No

Reason: This project fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) and thus did not require MSF ERB review.