Postoperative Care After Reconstructive Surgery for Burn Contractures in Communities Affected by War: A Retrospective Study in Iraq.

Abstract

Burn injuries are a major health concern in conflict-affected settings, where displaced populations such as refugees and internally displaced persons (IDPs) face limited access to surgical and rehabilitative care. Postoperative follow-up is often limited by socioeconomic and logistical barriers beyond the patient's control. This study examines follow-up adherence, rehabilitation participation, and complication rates after secondary reconstructive surgery for complications resulting from burn injuries performed by Swisscross teams in northern Iraq. A retrospective chart review was conducted for patients who underwent secondary reconstructive surgery for burn-related injuries between October 1, 2021, and February 6, 2025, through the Swisscross Foundation. A total of 147 episodes of care (EoCs) across 123 patients were included. Data on demographics, socioeconomic status, follow-up adherence, physical therapy participation, use of ad hoc care providers, and postoperative complications were collected and analyzed. Ethical approval was granted by the University of Toronto Research Ethics Board (protocol #00047579). Of the 123 patients, 59 were IDPs, 19 were refugees, and 45 were local residents. Full follow-up adherence was highest in locals (90%), followed by refugees (83%) and IDPs (64%). Overall noncompliance (< 20% adherence) was low at 4%. Formal physical therapy was prescribed in 34 cases, with the highest compliance among refugees (78%) and the lowest among IDPs (31%). Ad hoc care providers were used for rehabilitation in 47% of cases prescribed therapy, primarily among IDPs. Complications occurred in 36% of operations (53/147 EoCs), the majority being minor and manageable without surgery (35/147). Reoperation for immediate complications was required in 4% of cases and for relapse in 8%, with no significant difference between groups. Despite significant barriers, structured support and interagency coordination enabled meaningful follow-up and rehabilitation among displaced burn patients. Complex reconstructive care is both feasible and impactful in conflict settings, particularly when supported by transportation services and flexible rehabilitation strategies. These findings highlight the importance of targeted infrastructure to improve surgical outcomes in vulnerable populations.