Flexion contractures of fingers: Contracture elimination with trapeze-flap plasty

Scar Management of the Burned Hand

Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Although nonoperative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars.

The Modification of Five-Flap Z-Plasty for Web Contracture

BACKGROUND

Web contractures are fairly commonly encountered in those who have suffered from burn injury or other trauma. Numerous local flaps have been adopted previously. The five-flap Z-plasty is one that has been used frequently. To release the scar as much as possible, based on the traditional design, we developed a modified technique of the five-flap Z-plasty to reconstruct the axillary and elbow web contractures. Hence, the length of the axis of the cicatrix could be much lengthened.

METHODS

Twenty patients (12 females and 8 males, 7 to 48 years-old) with 27 web contractures were arranged for the operation using the new flap. The contractures were formed on by burn injury in 17 patients, surgery in 2 patients, and traumatic cicatrix in 1 case. All patients were operated on using a modified five-flap Z-plasty to reach the aim of maximum contracture relaxation.

RESULTS

All flaps survived well. No flap tip necrosis occurred. Good function was gained in all patients postoperatively by the one year average follow-up. There was no recurrence. The contracture band was freed satisfactorily.

CONCLUSION

The technique is very easy to execute and can be used both in web and linear contractures. With the virtue of extending the length of the scar axis to a higher degree compared to the traditional method, we suggest this modified five-flap Z-plasty application.

LEVEL OF EVIDENCE IV

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Management of scar contractures of the hand using Z advancement rotation flap

Functional consequences of hand contractures may lead to extreme impairment in hand functions so repair of the contractures can solve the problems related to hand functions. Different forms of z plasties have widely been used for the release of scar contractures. In this study, a useful z plasty technique, z advancement rotation flap (ZAR) was adapted for the release of hand contractures in the way of using only local tissues. Fourteen consecutive patients who had hand contractures, were treated successfully with z advancement rotation flap technique. They suffered from hand contractures for at least one year which were localized in wep spaces, flexor surfaces of the digits, first wep space, palmar area and extensor surface of the hand. Contractures are all in mild severity, restricting some of the hand motions moderately. In all patients, hand contractures released completely and clinically normal joint motions were achieved, improving extension, flexion and abduction ranges of fingers without any difficulty. All advanced and rotated flaps healed uneventfully. No major complications appeared such as infection, hematoma, suture dehiscence, flap congestion or necrosis. When dealing with this technique for release of hand contractures, it may offer a versatile alternative to well known z-plasty methods used particularly for hand contractures.

Postburn shoulder medial-adduction contracture: anatomy and treatment with trapeze-flap plasty

BACKGROUND

Shoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern.

METHODS

Anatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed.

RESULTS

Eighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold.

CONCLUSION

Medial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty.