​What kinds of symptoms do patients experience before receiving treatment?

The symptoms of a contracture include: pain in the affected area, inflammation, restricted movement or limited range of motion, shortened muscles. A skin graft is performed after a contracture release. Symptoms that indicate need for a skin graft include: open wounds, pain, inability/ difficulty in using limbs. A contracture develops when the normally stretchy (elastic) tissues are replaced by non-stretchy (inelastic) fiber-like tissue. This tissue makes it hard to stretch the area and prevents normal movement. Contractures mostly occur in the skin, the tissues underneath, and the muscles, tendons, ligaments, and joint areas. They affect range of motion and function in a certain body part. The condition is usually accompanied by pain.

​What is the impact on patients’ lives of living with these conditions?

A contracture limits the use of affected body parts. Without a skin graft, the impact would be open and non-healing wounds, infections, fluid loss, pain, inability/difficulty in using limbs, and social stigma. This affects the ability to work or perform normal daily tasks.

What cultural or regional factors affect the treatment of these conditions?

Burn contractures are very common in Tanzania, mainly due to accidents at home. Most of the cases that need skin grafting are as a result of burns. About 90% of the global burden of burns occurs in the low and middle income countries. In Africa it is estimated that between 17,000 and 30,000 children under five die each year due to burns. In Tanzania, there are few specialized burn centers. In most hospitals, burn patients are often managed in general surgical wards.

What does the treatment process look like?

The patient is seen by the surgeons and undergoes surgery within the next few days. The wound requires dressing changes every few days and heals within two weeks. Patients with limb contractures may also require physical therapy.

What is the impact of this treatment on the patient’s life?

Life of a patient is drastically improved. They regain the ability to use their limbs, and are therefore able to work and perform normal daily activities. A skin graft restores the skin’s normal function, preventing infection, pain and fluid loss. In the community, social stigma is reduced.

What potential side effects or risks come with this treatment?

A skin graft may fail or become infected.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are few quality plastic surgery centers in the region. Hospitals lack adequate resources and expertise to treat this condition. Burn patients are often managed in the general surgical wards in most hospitals.

What are the alternatives to this treatment?

For contractures, there are devices that can help stretch the soft tissue, but in many cases contractures are permanent in nature and require surgery. Without surgery, the contracture can become more problematic, severely limiting mobility and making the pain worse. For burns, the commonest pre-hospital first aid applied is honey. Specialized treatment in a hospitals is needed for conditions that need a skin graft.