Split-Thickness Skin Graft Coverage following Release of Postburn First Web Space Adduction Contracture

Abstract

Twelve patients from 11 to 57 years of age who underwent surgical release of postburn first web space thumb adduction-pronation contracture had the resulting defect resurfaced successfully with a medium-thickness, unmeshed, split-thickness skin graft (STSG). This procedure provided satisfactory, durable cover and maintained the gain in thumb abduction. All hands had combined dorsal and volar scarring that required incision. If indicated, partial division of the midbelly of the distal border of the adductor and distal midborder of the first dorsal interosseous was performed to increase both radial and palmar thumb abduction. Immediate or delayed skin grafting, the latter with a dynamic grafting splint, was carried out. Fifteen hands (from 12 patients) were assessed one year or more after surgical release. The mean postoperative radial abduction angle measured on photographs between the first metacarpal shaft and index proximal phalanx was 42°±13°, which was greater than the preoperative mean of 23°±12° (P=0.001) but less than the mean of 57°±12° for 20 nonburned control subjects (P=0.002). The mean postoperative palmar abduction angle measured between the first metacarpal and the proximal phalanx of the index finger was 54°±19°, which was greater than the preoperative mean of 18°±21° (P<0.001). An STSG was simple and quick to harvest for the burned hand at or near full growth size, and was successful in maintaining the increased abduction gained in the first web space for most of the patients who were treated.