Managing Pediatric Arm Contractures in a Low-Resource Setting

BURN SURGERY

This case-based lecture focuses on the assessment and management of pediatric multilevel upper extremity contractures following burn injury in low-resource settings. Using the case of an 18-month-old child from rural Nepal, the course explores early contracture formation, biopsychosocial risk factors, surgical planning principles, and the importance of complete multi-level release. Topics include grading scar severity based on functional impact, surgical decision-making across multiple joints (shoulder, elbow, wrist, hand), techniques for contracture release and defect coverage (skin grafts, dermal substitutes, local flaps, free tissue transfer), and the concept of cutaneous recruitment. The course also emphasizes postoperative rehabilitation, splinting protocols, family education, growth considerations, and strategies for long-term follow-up when access to care is limited.

Identify clinical findings that define multi-level upper extremity contractures in pediatric burn patients.
Assess contracture severity across multiple joints based on functional limitation rather than scar appearance alone.
Describe the principles of complete contracture release, including the need to release subdermal structures when indicated.
Select an appropriate reconstructive method (e.g., skin graft, dermal substitute, local tissue rearrangement) based on defect size and location after release.
Explain how proximal contractures can impair distal function through limitations in cutaneous recruitment.
Outline a basic postoperative rehabilitation plan, including splinting and caregiver-directed stretching.

Dr. Pham

Dr. Pham is Professor of Surgery at the University of Washington School of Medicine. He has worked in burn care for over 20 years. He is passionate about burn education and dissemination for lower resource settings.

Dr. Pham

Professor at University of Washington School of Medicine

Shankar Man Rai, MD

Surgical leader in Nepal

Shankar Man Rai, MD

Shankar Man Rai, MD, is a reconstructive surgeon and surgical leader in Nepal dedicated to expanding access to burn and reconstructive care in resource-limited settings. He has played a central role in strengthening local surgical capacity, training providers, and advancing sustainable burn care services in Nepal.

David Kulber, MD, FACS

David Kulber, MD, FACS, is a Professor of Surgery at Cedars-Sinai Medical Center and the Keck School of Medicine of the University of Southern California. He is Director of Hand and Upper Extremity Surgery and has extensive experience in plastic, reconstructive, and hand surgery, with a strong commitment to surgical education, global outreach, and advancing reconstructive care through research and innovation.

David Kulber, MD, FACS

Professor of Surgery at Cedars-Sinai Medical Center and Keck School of Medicine

Katie Osborn, RN, BSN, MSN, EdD

Professor Emeritus of Nursing

Katie Osborn, RN, BSN, MSN, EdD

Katie Osborn, RN, BSN, MSN, EdD, is a Professor Emeritus of Nursing. Dr. Osborn’s area of expertise includes both critical care burn and general critical care nursing. Dr. Osborn volunteered on 29 medical missions in the developing world.

Dharshan Sivaraj

Dharshan Sivaraj is a medical student at Stanford University School of Medicine.

Dharshan Sivaraj

Stanford University School of Medicine

What Learners Are Saying

Dr. Sarah Chen

This course completely changed how I approach femoral neck fractures. The live case discussions were invaluable, especially seeing how colleagues manage similar cases in resource-limited settings. Practical, evidence-based, and exactly what I needed.

Dr. James Omondi

Finally, a course that understands the real challenges we face! The global perspectives and expert insights have given me confidence to tackle complex cases. The certificate was a great bonus, and the 3-hour format fit perfectly into my schedule.

Dr. Maria Rodriguez

Outstanding quality from Harvard and SONA Global. I loved the high-yield videos and the detailed surgical approaches discussed. It's rare to find free education of this caliber that actually helps you in the operating room. Highly recommended!

Dr. James Omondi

Finally, a course that understands the real challenges we face! The global perspectives and expert insights have given me confidence to tackle complex cases. The certificate was a great bonus, and the 3-hour format fit perfectly into my schedule.

Dr. Maria Rodriguez

Outstanding quality from Harvard and SONA Global. I loved the high-yield videos and the detailed surgical approaches discussed. It's rare to find free education of this caliber that actually helps you in the operating room. Highly recommended!

Dr. Sarah Chen

This course completely changed how I approach femoral neck fractures. The live case discussions were invaluable, especially seeing how colleagues manage similar cases in resource-limited settings. Practical, evidence-based, and exactly what I needed.

ReSurge International

ReSurge International is a nonprofit humanitarian organization with over 55 years of experience providing reconstructive surgical care in developing countries. Our mission is to build, scale, and sustain reconstructive surgical capacity to provide life-changing care to those with the greatest need. We train and support local surgical teams across Africa, Asia, and Latin America to sustainably address gaps in surgical care.

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Professor Emmanuel Malabo Makasa is a Global Health/Global Surgery Consultant, an Academician, a Researcher and an experianced Clinician. He is the founding Executive Director of the Southern Africa Development Community’s University of Witwatersrand based regional-hub and collaboration Centre for Surgical Healthcare Improvement (WITSSURG) and its spoke, the Centre for Surgical Hdealthcare Research (CSHR) in the Republic of Zambia. He chairs SADC’s Technical Experts Working Group on surgical healthcare, the Partnerships Subcommittee of the Pan-African Surgical Health Forum (PASHeF) and he is the current Secretary General of the International Federation of Surgical Colleges (IFSC). Professor Makasa is a member of the Medical Education and Research Board of the Zambia Medical Association (ZMA MERB), he is a committee member of the Zambia Orthopaedics and Trauma Association (ZOTA) and he also on the board of Trustee for the Lusaka Orthopaedics Research and Education Trust (LORET), Community Without Boarders – Zambian Chapter and Africa Directions (AD).

Professor Emmanuel M Makasa has extensive experience in global health diplomacy, in regional and national surgical (peri-operative) health policy formulation and implementation and he has worked as a senior health systems manager, as honourary lecturer and as a specialist clinician in orthopaedics and Trauma Surgery. He is passionate about improving surgical healthcare in LMIC and has a track record of mobilising and coordinating multiple state and none-state actor stakeholders and partners within the United Nations Systems, in the Global Health/Global Surgery community, health professional groups and within clinical care around surgical systems and service delivery improvement. He has presented on and he has published on safe, timely, equitable, appropriate and affordable universal access to surgical (peri-operative) healthcare in Africa and beyond.

John G. Meara is the Kletjian Professor of Global Surgery, Director of the Program in Global Surgery and Social Change, and Professor of Surgery in the Department of Surgery at Harvard Medical School. Dr. Meara serves as the Plastic Surgeon-in-Chief of the Department of Plastic & Oral Surgery at Boston Children's Hospital. He was Co-Chair for the Lancet Commission on Global Surgery and was a commissioner on the Lancet Global Health Commission on High Quality Health Systems in the SDG Era and the Lancet Oncology Commission. In 2008 he created the Paul Farmer Global Surgery Fellowship program. He is also interested in value-based health care and implementation science research, including time driven activity-based cost research and outcomes research. Dr. Meara has led several ICHOM projects focusing on outcomes reporting and international benchmarking.

Dr. Meara's interests and innovation activities lie in the areas of craniofacial anomalies, cleft lip and cleft palate, but he has a particular interest in augmenting the delivery of quality surgical and anesthesia care in low-resource settings through long term capacity building. He is involved in multiple global surgery projects looking at the burden of surgical disease, the surgical capacity and health systems building in low-resource environments, surgical education and the economic impact of untreated surgical disease. He is also interested in value based health care and implementation science research, including time driven activity based cost research and outcomes research. Dr. Meara has led several ICHOM projects focusing on outcomes reporting and international benchmarking. Since 2008, he has directed the Paul Farmer Global Surgery Fellowship program in collaboration with Partners In Health. Its purpose is to strengthen global surgical systems through a combination of research, advocacy, and implementation science as well as train leaders who will further promote surgical care, education, and research pertinent to global surgery.

Dr. Atun is Professor of Global Health Systems at Harvard University and the Faculty Chair of the Harvard Ministerial Leadership Program. In 2008-12 he served as a member of the Executive Management Team of the Global Fund as Director of Strategy, Performance and Evaluation where he chaired the panel that oversaw annual investments of ~US$4 billion each year.

In 2006-2013 Dr. Atun was a Professor of International Health Management at Imperial College London, where he led the Centre for Health Management and was involved as founder, adviser and investor in biotech and health technology companies. He is a visiting professor at University of Kyoto, Japan.

Professor Atun’s research focuses on health system transformation, and innovation. He has published more than 350 papers in leading journals such as NEJM, Lancet, JAMA, Academy of Management Journal, Lancet Oncology, Lancet Global Health and Science Translational Medicine.

Prof Atun has advised more than 30 governments on health policy, strategy and health system reform, and has consulted for the World Bank, WHO and leading organizations such as Medtronic, Merck & Co, Novartis, Hoffman-La Roche. In 2019-20 he was a senior advisor to the G20 Presidency.

Professor Atun served as a member of the U.S. National Academy of Medicine Committee on Health Systems. He also served on the Advisory Boards of WHO Research Centre for Health Development in Japan and the Norwegian Research Council’s Programme for Global Health Research. He Chaired the STOP TB Partnership Coordinating Board in 2009-2011, and was as a member of the UK Medical Research Council’s Global Health Group. He is a member of the Longitude Prize Committee – the largest science prize in the world.

Professor Atun studied medicine at University of London as a Commonwealth Scholar and subsequently completed his postgraduate training in family medicine and public health. He obtained a Masters in Business Administration at University of London and Imperial College London. He is a Fellow of the Royal College of Physicians, the Faculty of Public Health, and the Royal College of General Practitioners.

Professor Atun was appointed President of the GSF Foundation Board in October 2021.

Professor Mark G. Shrime, MD, MPH, PhD, FACS previously served as the O’Brien Chair of Global Surgery at the Royal College of Surgeons in Ireland, as the founder and Director of the Center for Global Surgery Evaluation at the Massachusetts Eye and Ear Infirmary, and as Research Director for the Program in Global Surgery and Social Change at Harvard.

He is the author of seminal papers on the global burden of surgical disease, the financial burden facing surgical patients, and the number of people who cannot access safe surgery worldwide. He served as a co-author on the Lancet Commission on Global Surgery.

Dr. Shrime graduated summa cum laude from Princeton University in 1996 with a BA in molecular biology. He received his MD from the University of Texas in 2001, after taking a year to teach organic chemistry in Singapore. Medical school was followed by a residency in otolaryngology at the joint Columbia/Cornell program in Manhattan, followed, in turn, by a fellowship in head and neck surgical oncology at the University of Toronto in 2007. He completed a second fellowship in microvascular reconstructive surgery, also at the University of Toronto, in 2008. He was the first to identify a novel independent prognostic indicator in head and neck cancer.

To date, he has worked and taught in Liberia, Sierra Leone, Guinea, Benin, Togo, Congo, Haiti, Saudi Arabia, Cameroon, and Madagascar. In May, 2011, he graduated with an MPH in global health from the Harvard School of Public Health, where he was a finalist for both the Albert Schweitzer award and the HSPH Student Recognition award, and in May, 2015, he received his PhD in health policy from Harvard University, with a concentration in decision science.

His research has been supported by the National Institutes of Health, the Iris O’Brien Foundation, the Damon Runyon Cancer Foundation, an anonymous donation to the Center for Global Surgery Evaluation, the GE Foundation’s Safe Surgery 2020 project and the Steven C. and Carmella Kletjian Foundation.

Barnabas Alayande, MBBS, PgDTh, MBA, FMCS (General Surgery) is a general surgeon and Assistant Professor of Surgery with the University of Global Health Equity. He is passionate about equity-based solutions for global surgical care, and works to achieve surgical access for underserved areas within the Center for Equity in Global Surgery through surgical education, research, innovation and improvisation for Low and Middle-Income Countries with an emphasis on sub-Saharan Africa.

He has an academic background in Medicine and Surgery, Theology, and Business, and has specialty training in general surgery with interests in trauma care, and human factors. He has carried out pilot randomized control trial dissertations in thyroid surgery, and benign anorectal haemorrhoid treatments for variable resource settings. Following medical training at a WHO collaborating center for community-based education and service, and a surgically oriented internship in Southwest Nigeria, he served in the South East as a National Youth Service Corps Camp Medical Director, Community Health Team Chair leading a team of volunteer medics serving 4.9 million people of Imo State, and a medical officer covering 19 local government health facilities. He helped start an innovative private practice in North-Central Nigeria, and then transitioned into his surgical residency with training by the West African College of Surgeons and the National Postgraduate Medical College. He graduated from the National Postgraduate Medical College, and subsequently helped establish surgical systems for underserved HIV/AIDS patients in Northern Nigeria, as a volunteer surgeon with the Faith Alive Foundation. He completed a 2-year Global Surgery fellowship with the Harvard Program in Global Surgery and Social Change, serving as chief research fellow, before transferring into a faculty role at the UGHE. He is also a Fogarty Global Health Fellow at the Harvard T.H. Chan School of Public Health.

Dr. Barnabas has contributed to strategic surgical curriculum development for Rwanda, the design of non-technical skills for surgery curriculum for the Nigerian variable resource context, trauma care evaluation and training for the West African sub-region, surgical educational research in the East, Central and Southern Africa region, and the strategic implementation of UGHE’s regional Center for Equity in Global Surgery. His research has been funded by the National Institutes of Health, Fogarty International Center, The Royal College of Surgeons, Edinburgh, Association for Academic Surgery, The UGHE Dean’s Grant. He is the recipient of awards and scholastic honors including the Baxiram S. and Kankuben B. Gelot Community Surgeons Travel Award, poster award from the Trauma Association of Canada, the HBNU Fogarty Global Health Fellowship, the Faculty of Rural Remote and Humanitarian Health Care Fellowship Award, the Association for Academic Surgery Global Surgery Research Grant, the Duro Soleye Annual prize, nomination for the Dr Hamza Olayinka Braimah academic prize, the Shell University Scholarship Award, and the Mobil Producing Nigeria Unlimited Scholarship Awards. Dr Barnabas has contributed numerous presentations, abstracts, and publications within the Global Surgery space, with work in surgical ethics and equity, disparities in access to trauma care, grassroots advocacy, conference equity, surgical quality, surgical history, COVID and surgical care, surgical improvisation, surgical systems strengthening, baselining of surgical access, non-technical skills in surgery, and machine learning and surgery, among others.

He is a member of the Association for Academic Surgery Global Affairs Committee, the West African College of Surgeons, and the Nigerian Medical Association, a fellow with the National Postgraduate Medical College of Nigeria, an international associate fellow with the American College of Surgeons, and a fellow of the Royal College of Surgeons Edinburgh Faculty of Rural, Remote and Humanitarian Healthcare.