PHYSIOTHERAPY AND REHABILITATION OF POST SURGICAL SKIN GRAFT SCARS IN PATIENTS WITH BURNS. THE MSF EXPERIENCE IN THE GAZA STRIP

J. Bin Farahat¹, A.E.H. Qaradaya^2,3

¹MSF Epicenter, Research, New York, United States, ²Doctors without Boarders, Physiotherapy and Rehabilitation, Gaza, Palestine, ³Doctors without Boarders, Physiotherapy, Paris, France

Background: Treating Hypertrophy scars is a challenge especially when it is related to post-surgical skin surgery. Hypertrophy scars can be treated using surgical or nonsurgical intervention. In the Gaza strip there is a high incidence of domestic burn injuries. MSF France in Gaza is running a project providing care to burn patients, it consists of surgical and out-patient care. The aim of this study is to describe the group of patients and the outcomes for those who received rehabilitation/ physiotherapy care for post-surgical skin graft.

Purpose: Main objective:
To describe the group of patients who received rehabilitation/physiotherapy care for post-surgical skin grafts.
Specific Objectives:
- To identify possible gaps in the current literature that MSF physiotherapy and rehabilitation activities in Gaza might address in the future.
- To describe the use and application of silicon, soft putty and polyethylene foam insert material associated with garments for the management of the post-surgical skin graft scars.
- To describe the characteristics of patients who received rehabilitation/physiotherapy care for post-surgical skin graft.To describe outcomes of patients who received rehabilitation/physiotherapy care for post-surgical skin graft.

Methods: This study is a retrospective description of patients with post-surgical skin graft (SSG) scars affected by burns enrolled in the MSF-OCP physiotherapy/rehabilitation clinics in Gaza Strip between January 2018 to December 2020. The study cohort was 177 patients who matched the inclusion criteria and whose patient files contained all the necessary data. We used 5 measures for the outcome of physiotherapy treatment post-surgery including JPG reducibility score, Functional Activity for Burn score (FAB), Vancouver Scar Scale (VSS), Visual Analgesic Scale (VAS), and itching score.

Results: The study shows that the victims of burns in Gaza were mainly children below 18 years old (n=136, 76.8%), the main cause of burn was scalding due to liquid burns (n=119, 67.6%). The results show that the physiotherapy program depending on pressure therapy and insert materials is helpful and significant to improve the general wellness of the patient, it has helped to decrease the pain (average initial (SD) 5.3 (2.5) to average final (SD) 1.4 (1.8)), itching (average initial (SD) 3.7 (2.7) average final (SD) 2.7 (2.2), and scar pigmentation, vascularity, pliability and height (average initial VSS (SD) 7.1 (1.8) to average final (SD) 5.7 (1.7). It has also improved the patients over all functions (average initial (SD) 25.6 (7.1) to average final (SD) 34.6 (2.3),) and it reduced the skin contractures (average initial (SD) 2.3 (1.4) to average final (SD) 0.8 (0.9)).

Conclusions: Physiotherapy programs, depending on pressure therapy and insert materials, are helpful and significant for improving the general wellness of patients with post-surgical skin graft scars. Further studies should be done on this topic to support the best practices for physiotherapy programs and regimens to use with patients with burn scars. This could be done as an experimental study or case control trial to support the results.

Implications: Physiotherapy program depending on Scar tissue massage, mobilizations and stretching, pressure therapy with insert materials is significantly improve Skin elasticity improves ROM and also decrease scars hypertrophy.

Funding acknowledgements: Medicine Sans Frontier "Doctors without boarders" Operation Central Paris- Gaza mission

Keywords:
Skin Grafts
Hypertrophy scars
Pressure therapy

Topics:
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: Ministry of health Gaza palestine

Committee: Helsenki Ethical commity

Ethics number: PHRC/HC/907/21