Classification and treatment of postburn proximal interphalangeal joint flexion contractures in children

Two hundred and sixty-four surgically treated proximal interphalangeal joint flexion contractures in children were reviewed. A classification system on the basis of contracture severity was devised to assess the efficacy of treatment. Contracture severity was determined from preoperative radiographs and physical examination. Eighty-eight percent of the digits were successfully treated (postoperative contracture less than 20 degrees). Unsatisfactory results (12% of digits) were directly proportional to the severity of the contracture and tended to occur in older children with large total body surface burns. The time interval between burn and contracture release did not correlate with contracture severity or therapeutic failure. The most common cause of an unsatisfactory result was failure to fully release the contracture.     

Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers

BACKGROUND: Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. PURPOSE: We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. METHODS: Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. CONCLUSION: The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.     

Treatment of cicatricial flexion contractures of the fingers]

The article discusses the results of treatment of 152 patients with cicatrical flexion contractures of the fingers consequent upon mechanical, thermal and gunshot injuries. The authors suggest their own classification of cicatricial contractures of the fingers according to the extent of the cicatricial process and restriction of the volume of movements and impairment of the grasp. Various methods of treatment were applied depending on the type of the pathological process. Analusis of the late-term results showed that the distraction method has advantages over the traditional skin plastics methods in the treatment of stable combined forms of contractures.     

扩张后交错换位头皮瓣治疗烧伤瘢痕性秃发

我们采用将扩张后呈球面的头皮分割，形成两个或几个皮瓣，以避免球面头皮难以充分展平发挥最大效益的缺点。共治疗大面积瘢痕性秃发８例，７例效果满意，１例因１个扩张器外露而被迫取出，降低了疗效。     

扩张后交错换位头皮瓣治疗烧伤瘢痕性秃发

我们采用将扩张后呈球面的头皮分割,形成两个或几个皮瓣,以避免球面头皮难以充分展平发挥最大效益的缺点。共治疗大面积瘢痕性秃发8例,7例效果满意,1例因1个扩张器外露而被迫取出,降低了疗效。     

The use of subcutaneous pedicle multiple rhomboid flaps in the treatment of long postburn scar contractures

The subcutaneous pedicle rhomboid flap is a relatively new technique in the treatment of linear, wide or quadratic postburn scar contractures with two or more contracture lines. The effectiveness of the rhomboid flap depends on lengthening the contracture band by relaxation incisions and closing the emerged defect by suturing the rhomboid flap in V-Y and Y-V advancement. The technique is simple, efficient and versatile. The broad subcutaneous pedicle of the flap is very reliable and postoperative flap necrosis is rare. Clinical results show that the gain in length provided by a single rhomboid flap ranges from 75-90%. However, the technique may not be efficient enough to release the whole band in cases of long contracture bands. Therefore, a new design of rhomboid flaps, called "multiple rhomboid flaps", may be needed. Twelve patients (aged 3-40 years) with long linear and wide scar contractures were successfully treated with subcutaneous pedicle multiple rhomboid flaps. Multiple consequent or adjacent rhomboid flaps were applied in the upper extremity (in nine patients), trunk (in seven patients), and lower extremity (in two patients). Complete relaxation and elongation of the contracture bands were achieved in all of the cases and all rhomboid flaps healed uneventfully. The results were functionally and cosmetically successful. The application of rhomboid flaps in this consequent and adjacent fashion is a new concept. Clinical results prove that the technique is versatile and effective in the release of long potstburn scar contractures. Since distortion of the surrounding skin or displacement of anatomical landmarks is not seen with the technique, color and texture matches are perfect. Designing and performing multiple rhomboid flaps is very simple and the operation time is short. As no undermining is carried out in the technique, the flaps are more reliable than commonly used multiple Z-plasty.     

Use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures

BACKGROUND: Multiple reconstructive methods have been used for the treatment of postburn scar contractures including skin grafting, geometric relaxation techniques, local flaps and free flaps. PURPOSE: In the present study, the authors evaluated efficiency of the use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures. METHODS: Twelve white male with postburn scar contracture were treated using rhomboid and double Z-plasty technique. The cause of burn, duration of contracture, postoperative follow-up period, preoperative and postoperative motion lag of joints and improvement in motion were recorded. CONCLUSIONS: All operations were successful. Severe contracture lines crossing flexion folds can be released effectively by using rhomboid flap and double Z-plasty technique without distorting the specialized flexion areas and with broken scar lines which is essential to avoid from recurrence.     

Use of dorsal ulnar neurocutaneous island flap in the treatment of chronic postburn palmar contractures

In the present study, the authors evaluated efficiency of the "dorsal ulnar neurocutaneous island flap" in the coverage of palmar defects resulting from radical release of selected chronic postburn contractures. Eight white male hands with palmar contracture were treated with this flap between November 2001 and December 2003. The mean follow-up period was 11.6 months. The flap, which was planned on the ulnar aspect of the forearm and the hand, is transferred to the palmar defect. The subcutaneous pedicle of the flap was skin-grafted to avoid tension. All operations were successful. Distal flap necrosis that healed by secondary intention was observed in one of the eight flaps. Seventy-five degrees was the maximum improvement in metacarpophalangeal (MP) joint extension achieved in the little finger. Grasp function of the hand dramatically improved and the bulk of the flap did not interfere with grasping. No recurrent palmar contracture was observed. The authors concluded that the dorsoulnar neurocutaneous island flap can be used effectively in the treatment of postburn palmar contractures. The safety of the flap can be enhanced by grafting the intervening skin between the pivot point of the flap and the palmar defect.     

The treatment of multiple contractures of the fingers]

Under analysis were results of treatment of 93 patients with multiple arthrogenic, dermatogenic and tenogenic contractures of fingers arising after mechanical, thermal and gunshot injuries. The method of distraction with the help of apparatuses developed in the clinic was applied to all the patients. Long-term results were followed-up in 79 patients during 1-12 years. In 73 of them positive results were noted which suggests high efficiency of the method.