Correction of long-standing flexion contracture of digits with surgical release and distraction histogenesis

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ABSTRACT Introduction: Longstanding contractures of the hand especially the digit significantly impair the function of the hand due to contracture of all the anatomical structures, including the skin, subcutaneous tissues, tendon sheath, tendons, and ligaments. The common mode of treatment like incision release and split skin graft (SSG) is not possible in long-standing contractures due to the risk of exposure to the tendon, neurovascular compromise of digits, and re-contracture. To avoid these risks and to correct the flexion contracture to get an extension of the digit without the requirement of the flap in long-standing postburn contractures of digits, we do the surgical release of skin and subcutaneous tissue and distraction histogenesis of the short or contracted tendons, ligaments, and neurovascular bundle. Materials and Methods: From June 2017 to June 2022, a prospective study was carried out at a single institute. Patients of all age groups and gender presented with long-standing (≥3 years old) severe postburn contracture. Single or two digits were included in the study. 16 digits in 15 patients with long-standing contractures were operated on by the surgical release of skin and subcutaneous tissue. The resultant skin defect was covered with either a split-thickness skin graft or multiple Z plasty as the broad scar or band-like scar was present respectively in the surrounding area. Contracture of the neurovascular bundle and tendons ligament and capsule was dealt with distraction histogenesis with the application of a distractor simultaneously. Results were assessed – improvement of range of motion (ROM) as excellent, good satisfactory at proximal interphalangeal (PIP) joint (90–110), (60–89), (<59) at distal interphalangeal (DIP) joint (51–60), (41–50), (<40) metatarsophalangeal (51–60) (41–50) (<40) and improvement of flexion contracture. Results: The mode of burn injury was thermal burn in 53.3%, electric burn in 40%, and scald burn in 6.66% of patients. The mean duration of contracture of patients was 5 years and 2 months. All the patients presented with flexion contracture but one with ulnar flexion contracture, one with radial flexion contracture, and one dorsiflexion on the medial side at the great toe. Only PIP joints were involved in 62.5%, while PIP + DIP joints in 12.5% and DIP joints in 18.7%. Index finger and little finger each were 31.12% of patients. Z-plasty was done in 37.3% of patients, and SSG was covered in 62.6% of patients after the surgical release of contracture. Average days of distraction were almost equal in both Z plasty and SSG cover patients. In 50% of patients with Z plasty distraction time was <15 days. Failure of operation was in one patient where flexion contracture of the little finger at the PIP joint was only improved up to 30° and the patient developed re-contracture. Complete extension of digits was achieved in 75% of patients. Conclusion: For long-standing digital contractures-surgical release with the distraction histogenesis technique seems to be a reasonable option to obtain a satisfactory extension of contracted digits, good ROM, lesser complications, short hospital stay, preventing the risk of neurovascular compromise to fingers, exposure of tendons and without the need for any flap cover.