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Reconstruction of severe hand contractures: An illustrative series.

Tucker SC - Indian J Plast Surg (2011)

Bottom Line: The decision making process is presented as a flow chart indicating when and which flaps were used.Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function.Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage.

View Article: PubMed Central - PubMed

Affiliation: Green Pastures Leprosy and Rehabilitation Hospital, Pokhara, Nepal.

ABSTRACT

Aim: An overview of a series of severe burn contractures in 44 hands reconstructed over a 20 month period with an easy to follow algorithm.

Settings and design: The series was carried out by a single surgeon at Green Pastures Rehabilitation Centre in Pokhara, Nepal. All patients attending with severe burn contractures to the hand were included in the series.

Materials and methods: This is a retrospective review of burn contractures in a total of 44 hands. All the contractures involved limitation of movement by 60 degrees in two or more joints or by 80 degrees in one joint. The decision making process is presented as a flow chart indicating when and which flaps were used.

Results: Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function.

Conclusions: Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage.

No MeSH data available.


Related in: MedlinePlus

Severe dorsal contracture. This patient sustained a deep burn to the dorsum of the hand as a young adult. Healing by secondary intention has resulted in hyperextension at the MCPJs, with compensatory flexion at the PIPJs
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Figure 1: Severe dorsal contracture. This patient sustained a deep burn to the dorsum of the hand as a young adult. Healing by secondary intention has resulted in hyperextension at the MCPJs, with compensatory flexion at the PIPJs

Mentions: Secondary intention healing of unsplinted full-thickness burns to the dorsum of the hand frequently results in hyperextension contractures of the MCPJs, even if the burn area stops short of the dorsum of the joints themselves. The cam shape of the metacarpal head and the position of the collateral ligaments dorsal to the joint axis result in permanent shortening of the collateral ligaments even after relatively short periods of time in this position, particularly in the presence of the inflammatory response associated with the burn and secondary intention healing. Thus, release of the burn contracture to the skin alone is often not enough to correct this deformity, and release of the dorsal joint capsule and ulnar collateral ligament plus or minus release of the radial collateral ligament is required. The function of the hand is further compromised by the secondary effect that the MCPJ hyperextension has on the corresponding PIPJ [Figure 1]. However, it can be seen from the cases discussed here that even in the face of such severe deformities as these, it is possible to regain a functional hand with radical surgery and intensive physiotherapy.


Reconstruction of severe hand contractures: An illustrative series.

Tucker SC - Indian J Plast Surg (2011)

Severe dorsal contracture. This patient sustained a deep burn to the dorsum of the hand as a young adult. Healing by secondary intention has resulted in hyperextension at the MCPJs, with compensatory flexion at the PIPJs
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111127&req=5

Figure 1: Severe dorsal contracture. This patient sustained a deep burn to the dorsum of the hand as a young adult. Healing by secondary intention has resulted in hyperextension at the MCPJs, with compensatory flexion at the PIPJs
Mentions: Secondary intention healing of unsplinted full-thickness burns to the dorsum of the hand frequently results in hyperextension contractures of the MCPJs, even if the burn area stops short of the dorsum of the joints themselves. The cam shape of the metacarpal head and the position of the collateral ligaments dorsal to the joint axis result in permanent shortening of the collateral ligaments even after relatively short periods of time in this position, particularly in the presence of the inflammatory response associated with the burn and secondary intention healing. Thus, release of the burn contracture to the skin alone is often not enough to correct this deformity, and release of the dorsal joint capsule and ulnar collateral ligament plus or minus release of the radial collateral ligament is required. The function of the hand is further compromised by the secondary effect that the MCPJ hyperextension has on the corresponding PIPJ [Figure 1]. However, it can be seen from the cases discussed here that even in the face of such severe deformities as these, it is possible to regain a functional hand with radical surgery and intensive physiotherapy.

Bottom Line: The decision making process is presented as a flow chart indicating when and which flaps were used.Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function.Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage.

View Article: PubMed Central - PubMed

Affiliation: Green Pastures Leprosy and Rehabilitation Hospital, Pokhara, Nepal.

ABSTRACT

Aim: An overview of a series of severe burn contractures in 44 hands reconstructed over a 20 month period with an easy to follow algorithm.

Settings and design: The series was carried out by a single surgeon at Green Pastures Rehabilitation Centre in Pokhara, Nepal. All patients attending with severe burn contractures to the hand were included in the series.

Materials and methods: This is a retrospective review of burn contractures in a total of 44 hands. All the contractures involved limitation of movement by 60 degrees in two or more joints or by 80 degrees in one joint. The decision making process is presented as a flow chart indicating when and which flaps were used.

Results: Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function.

Conclusions: Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage.

No MeSH data available.


Related in: MedlinePlus