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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

Case 2 pre-op
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Figure 7: Case 2 pre-op

Mentions: This was a 42-year-old male who had sustained burns to the left upper limb at the age of 4 years [Figure 7], which had been treated with dressings at a local health post without the use of splinting. In the index procedure, he underwent release of contractures to the axilla, elbow and thumb and reconstruction with a combination of local flaps and split-skin grafting to the secondary defects. After this, he had a good range of motion at the axilla and 80–110 degrees at the elbow, but the thumb was unstable and unable to come into opposition with the other digits. He therefore underwent an opening wedge osteotomy of the trapezium with iliac bone graft insertion and FDS opponensplasty. This provided him with a stable thumb for use in grasping, which was able to meet the other digits, but opposition to the little finger was only to the tip [Figure 8].


Reconstruction of severe hand contractures: An illustrative series.

Tucker SC - Indian J Plast Surg (2011)

Case 2 pre-op
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Case 2 pre-op
Mentions: This was a 42-year-old male who had sustained burns to the left upper limb at the age of 4 years [Figure 7], which had been treated with dressings at a local health post without the use of splinting. In the index procedure, he underwent release of contractures to the axilla, elbow and thumb and reconstruction with a combination of local flaps and split-skin grafting to the secondary defects. After this, he had a good range of motion at the axilla and 80–110 degrees at the elbow, but the thumb was unstable and unable to come into opposition with the other digits. He therefore underwent an opening wedge osteotomy of the trapezium with iliac bone graft insertion and FDS opponensplasty. This provided him with a stable thumb for use in grasping, which was able to meet the other digits, but opposition to the little finger was only to the tip [Figure 8].

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