Management of contractures: A five-year experience at Komfo Anokye Teaching Hospital in Kumasi

Background: Contractures are common complications of wounds healing by secondary intention; some cases are idiopathic and a few are congenital. Contractures cause significant morbidity to patients. Objective: The study was undertaken to document the pattern, spectrum and management of patients with contractures of various types and aetiologies presenting at a Plastic and Reconstructive Surgical Unit in Ghana. Design: Prospective study from January 2004 to December 2008. Setting: Komfo Anokye Teaching Hospital (KATH) in Kumasi Patients and Methods: The age, sex, site, extent and cause of contracture was documented. The patients were examined and functional impairment recorded. A clinical photograph was taken. Patients requiring surgery had their contractures released and the defect repaired with an appropriate reconstructive technique. Patients with minimal functional impairment underwent physical therapy without surgery. Results: Sixty-eight patients comprising 44 males and 24 females were seen. Male to female ratio is 1.83:1. Their ages ranged from 0.66 to 60 years, mean age was 22.53 years. Seventy-six contractures were studied. Fifty-eight of the lesions were in the upper part of the body. Burns, infections and trauma were the main aetiological causes. Seventy-one surgical procedures were performed including release and flap repair (33), full thickness skin graft (23) and partial thickness skins graft and splinting (six). Conclusions: Thermal burns and soft tissue infections are the commonest causes of contractures presenting at KATH in Kumasi. These causes of contractures are preventable by early and adequate treatment of the acute conditions.