Post-Surgical Scar Management and Rehabilitation in Burn Patients: Insights from Gazas challenging context - A Retrospective Descriptive Study

BackgroundIn the conflict-ridden Gaza Strip, burn injuries pose significant challenges for affected individuals. Often stemming from accidents involving generators and substandard gas cylinders, these burns can have profound physical and psychological impacts. Access to comprehensive medical care is limited in this context, making specialized burn treatment centers critical lifelines for those in need. This study seeks to explore the outcomes of rehabilitation and physiotherapy for post-surgical skin grafts in specialized burn treatment centers in Gaza, recognizing the crucial role such interventions play in improving the quality of life for burn survivors in this challenging environment. MethodsWe carried out a retrospective descriptive study of patients with post-surgical skin graft (SSG) scars subsequent to burns injury, and enrolled in the MSF post-op outpatient clinics in the Gaza Strip (Gaza City, Beit Lahia, and Khan Younis), between January 2018 and December 2020. Our analysis used five outcome measures to assess the effects of physiotherapy and post-surgical treatment: the reducibility score, which indicates the extent to which scars can be reduced in size or prominence; the Functional Activity for Burn (FAB) score, which evaluates the functional capabilities of patients following burn injury; the Vancouver Scar Scale (VSS), which assesses various aspects of scar appearance such as pigmentation, vascularity, pliability, and height; the Visual Analgesic Scale (VAS), which quantifies pain levels experienced by patients; and the itching score, which measures the severity of itching associated with scar formation ResultsA total of 177 patient records were examined, revealing that the majority of burn victims in Gaza were children under the age of 18 (n=136, 76.8%), with scalding from liquid burns being the primary cause (n=119, 67.6%). The outcomes of the physiotherapy program varied depending on the type of pressure therapy and insert material utilized. However, significant improvements were observed in various outcome measures following enrollment in the program. These improvements included reductions in pain scores (mean initial score: 5.3, SD: 2.5; mean final score: 1.4, SD: 1.8), itching (mean initial score: 3.7, SD: 2.7; mean final score: 2.7, SD: 2.2), scar pigmentation, vascularity, pliability, and height (mean initial VSS: 7.1, SD: 1.8; mean final VSS: 5.7, SD: 1.7). Moreover, treatment correlated with enhancements in overall function (mean initial score: 25.6, SD: 7.1; mean final score: 34.6, SD: 2.3) and a reduction in skin contracture (mean initial score: 2.3, SD: 1.4; mean final score: 0.8, SD: 0.9). ConclusionsOur findings underscore the important role of rehabilitation and physiotherapy in optimizing outcomes for post-surgical skin graft patients in conflict-affected regions like the Gaza Strip. Despite the challenging environment, MSFs clinic in Gaza has demonstrated the feasibility and effectiveness of delivering comprehensive care to burn survivors. Moving forward, further research is needed to refine and validate best practices in rehabilitation interventions tailored to the specific needs of patients in conflict zones, ensuring continued progress in enhancing the quality of care and quality of life for those affected by burn injuries.