Flexion Contractures Of Fingers Research Articles

Fractional Lengthening of Forearm Flexor Tendons: A Cadaveric Biomechanical Analysis

Multiple procedures have been described for wrist and finger flexion contractures and spasticity. Fractional lengthening of forearm flexor tendons involves making parallel transverse tenotomies at the musculotendinous junction to elongate the muscle. Currently, there is limited literature to define the biomechanical consequences of this lengthening technique. Forty-eight flexor tendons were harvested from eight paired upper limbs including flexor carpi radialis, flexor carpi ulnaris, flexor pollicis longus, and flexor digitorum superficialis tendons. Each tendon that was lengthened was paired with the contralateral tendon as a control. A pair of transverse tenotomies were completed for the fractional lengthening. The first tenotomy was performed at the musculotendinous junction where the tendon narrowed to 75% of its maximal width. The second tenotomy was made 1 cm distal to the first. Tendon length was measured before and after fractional lengthening at a constant resting tension of 1 N. The maximum load at failure of each tendon and the mechanism of failure were each measured and compared with the contralateral side. After fractional lengthening, the mean increase in resting tendon length was 4 mm. When loaded to failure, the mean maximum load of fractionally lengthened tendons was 42% of the mean maximum load of intact tendons. All lengthened tendons failed at the distal tenotomy site. Fractional lengthening resulted in an increase of 3-6 mm (mean: 4 mm) in tendon length at resting tension. There was a significant loss in tensile strength and load to failure following fractional lengthening compared with an intact musculotendinous unit. The reduction in tensile strength following fractional lengthening results in loads at failure that are, in some cases, lower than the estimated forces required to perform basic tasks. Caution during the healing and rehabilitation period is warranted.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease

To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases. Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard. All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively. The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Mathematical analysis in the design of digital artery-based V–Y advancement flap in treating proximal interphalangeal joint flexion contracture

BackgroundThe digital artery-based V–Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V–Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery.MethodsAccording to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V–Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method.ResultsThe middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V–Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V–Y flap design for the 120 fingers.ConclusionsOur flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V–Y advancement flap.

Reconstruction of post-burn hand contractures with Trapeze flap.

Finger scar flexion contractures are a leading cause of hand disability and a serious complication of hand burns. There are numerous reconstructive procedures available nowadays. Nevertheless, a large number ofthem produce disappointing results. The goal is to assess the Trapeze flap's ability to repair post-burn finger flexion contractures. Also, the stromal cell-derived factor 1 (SDF1) gene expression was examined for further evaluation. From April 2014 to February 2020, a prospective investigation was undertaken at Rizgary teaching and CMC private hospitals in Erbil (in Iraq) to consider the effect of Trapeze flaps on the correction of postburn flexion contracture of fingers and first web space in 67 patients (112 fingers). The viability of flaps, complications, skin graft take, and also surgeon/patient satisfaction were all recorded. Follow-up outcomes were collected from 6 months to a year after the operation. Further, the qPCR technique was used to evaluate the expression of the SDF1 gene in two groups of patients. The first group included those 67 patients treated with the trapeze flap method. The other group consisted of 50 patients with post-burn hands who were not treated by this method. Our survey found that approximately 97 percent of patients were satisfied (65 out of 67). A rare consequence included partial flap loss (one patient, 1.5 percent), and infection was detected in one case (1.5 percent ). Both wounds healed with conservative treatment. The postoperative scars were practically imperceptible, withouthypertrophic scars or keloid construction, and the surface texture of the flaps was similar to the texture of healthy fingers. The contractures did not occur again. Also, the expression of the SDF1 gene showed that the trapeze flap method caused a statistically increased expression. This gene stimulates collagen production during the repair of injuries. Generally, the trapeze flap is a dependable and successful local flap in recreating hand post-burn contracture, resulting in extreme patient satisfaction and achievement.

Conversion to Extension Contracture as a Means of Correction of Severe Flexion Contracture of the PIP Joint Using a Modified Dynamic External Fixator.

Background: This is a retrospective case series investigating the outcomes using a dynamic external fixator (DEF) for treatment on severe flexion contractures at the proximal interphalangeal (PIP) joint. Severe flexion contractures of the PIP joint occurring after multiple operations and neglected over a long period of time are difficult to treat. The recurrence of contracture, even after successful treatment, is inevitable in patients with severe cases. In this study, we defined the severity of PIP joint contracture based on the active range of motion (ROM), soft tissue condition, and duration of the contracture. We also illustrated the strategy, results, and complications of using a DEF with rubber bands in these severe cases. Methods: We studied 11 fingers of 10 patients with PIP joint contracture treated by DEF. These were fixed at a small arc and neglected for an average 4.1 years (range, 1-9 years). The temporal Kirshner wire (K-wire) fixation after achieving an extension via DEF was maintained for 9.1 weeks on average. We retrospectively reviewed the results of these patients with an average 2-year follow-up. Results: Our method yielded favorable results upon retrospective evaluation. The average active ROM of the affected PIP joint improved from 90/96° to 34/83° with a functional arc and good patient satisfaction. The elastic force induced by strong rubber bands was safe and effective. The first step of joint space widening was the key to obtaining a successful joint extension afterwards. Serious progression of osteoarthritis at the PIP joint and pin-site fracture were a complication in each one case. Conclusions: In this study, we evaluate the surgical strategy of using DEFs powered by elastic torque from rubber bands to treat severe cases of flexion contractures of fingers. We first created extension contracture intentionally, followed by promoting flexion movement during follow-up in this group of patients.

Fingertip injuries managed by a thenar flap: Follow-up and long-term outcomes of 32 cases

While various techniques are used for the reconstruction of fingertip injuries, the main goals remain the same: preserve finger length, sensation, and function. The thenar flap is a well-described technique and simple procedure in fingertip amputations. This study aimed to evaluate the long-term functional and esthetic outcomes along with patient satisfaction of thenar flaps done for fingertip defects. Thenar flaps used in 32 patients operated between January 2010 and December 2016 were analyzed retrospectively to assess sensory recovery, range of motion, cold intolerance, pain relief, appearance, patient satisfaction, and QuickDASH score. All flaps survived, without adverse events. The flap was detached after 10–14 days (mean 12.5 days). The mean follow-up was 31 months (range, 20–45 months). According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 25 patients (78%). The mean static 2-point discrimination was 6.1 mm. There were no functionally significant finger flexion contractures at the final follow-up. Complications such as pain, donor site morbidity and cold intolerance were not encountered. The thenar flap is an excellent technique for coverage of total or subtotal tissue loss of radial-side fingertips that is not accessible to local flaps. It provides good sensory function and appearance when fundamental technical principles (flap design, timing of division, and early mobilization) are respected.

Biological Targets for Dupuytren Disease.

Dupuytren disease is a connective tissue disorder occurring on the palm, causing flexion contractures of fingers. There is a pressing need for therapeutic interventions that can slow, stop, or even incrementally reverse the progression of the disease. Numerous in vitro studies have shed light on cellular and molecular agents that contribute to contractures. This article comprehensively reviews various growth factors that can be targeted to prevent and limit the progression and recurrence of Dupuytren contracture (DC). Fibroblasts are the major cell population that has been reported for the contractures in DC, and they are also known to exacerbate the cytokine production. Limiting the fibroblast function by targeting the growth factor production will be of great benefit in treating DC. This review will focus on the studies that have shown to limit the exaggerated function of fibroblasts by reducing the expression of profibrotic growth factors by using antagonizing agents.

Ichthyosiform lesion at birth demystifying familial short stature

Conradi-Hunermann syndrome is a rare genetic condition characterized by skeletal malformations, skin abnormalities, cataracts and short stature. We report a term female infant presenting with a diffuse ichthyosiform erythroderma at birth. Physical examination also showed sparse lusterless hair with cicatricial alopecia, dystrophic nails, facial dysmorphism, and flexion contracture of fingers. Radiological examination revealed a shortening of the right femur and humerus, vertebral defects, scoliosis, and epiphyseal stippling of long bones on the right side. The infant's sister and mother had short stature and bony joint swellings. A clinical diagnosis of X-linked Conradi–Hunermann syndrome was considered based on clinical suspicion and radiological survey. Dermatologists and pediatricians should consider this diagnosis in children with suggestive features.

Keystone Flap for Postburn Finger Flexion Contracture Release.

Flexion contracture of finger is a major cause of disability in postburn patients. Various methods have been described to cover the resultant defect after surgical release of finger flexion contracture. Local flaps are used when there is sufficient tissue available on lateral sides of the finger to recruit into the defect. Keystone flap can be designed on volar aspect of finger to cover the post contracture release defect. Use of local flap reduces need of skin graft and donor site morbidity. Here we discuss a case of postburn finger flexion contracture release using type-3 keystone flap. Postoperative results are satisfactory. Various pros and cons of the technique are discussed. Keystone flap is a new addition to the armamentarium of plastic surgeons for release of postburn flexion contracture of fingers.

Treatment of Chronic Severe Flexion Contractures of Fingers with Bilateral Side-Finger Flaps (Wing Flaps) and Full-Thickness Skin Graft.

Background: Severe flexion contractures of proximal interphalangeal joint of fingers can significantly impair hand function, typically after burn injury recovery. Extensive surgical release exposes deep vital structures, which subsequently requires significant skin coverage. The author presents the results of using bilateral side-finger flaps (wing flaps) and full-thickness skin graft for coverage of the defects. Methods: Seven patients (8 fingers) with chronic severe flexion contractures of fingers resulting from burn injury were included. Results: Mean flexion contracture and full flexion angles of the joints were improved from 84.4°/93.7° to 4.7°/92.5° at the last follow-up visit. No major complications were observed during the postoperative follow-up period (range, 6-16 months). Conclusions: This alternative surgical technique can be successfully applied for the treatment of chronic severe flexion contractures of fingers. The advantages of this approach are the use of local flaps from injured digit, and that it can be performed as a one-session procedure.

On eponyms and disease: Dupuytren’s or Dupuytren?

Throughout medical history, eponyms have been oft-used to describe disease. Acknowledging the ongoing debate regarding eponym use, we aim to address a facet of this topic. Flexion contracture of the fingers from superficial palmar fibromatosis, named for Guillaume Dupuytren, exists as three variations of nomenclature within literature—Dupuytren’s, Dupuytren and Dupuytrens disease. This article comprises a linguistic exploration of this nomenclature; we aim to ascertain which form is most common, and most linguistically correct, using a review of the literature. A literature search of the PubMed database (limited to English articles from 1988 to 2018) was performed using keywords Dupuytren, Dupuytren’s and Dupuytrens. From 1195 papers, “Dupuytren’s” was by far the most common form, followed by “Dupuytren”. “Dupuytrens” was rare. USA published using both Dupuytren’s and Dupuytren, while UK almost exclusively used Dupuytren’s. Dupuytren was also popular in the Netherlands. There are two schools of thought regarding use of the possessive form in medical eponyms. Dupuytren was neither the first nor the only person to describe the disease, and though his contribution was significant, should an eponymous disease “belong” to its discoverer? While the possessive is currently most commonly used, a recent shift towards non-possessive eponyms is reflected in our data. Nomenclature of flexion contracture of fingers takes several forms both clinically and in literature. Arguments exist for both possessive and non-possessive forms of the eponym. While Dupuytren’s disease is currently the more common term, changing medical conventions and terminology have potential to guide transition to the non-possessive form, Dupuytren disease. Level of evidence: Not ratable.

Trapeze Flap for Correction of Post Burn Finger Flexion Contractures

Background and Objective: Scar flexion contractures of the fingers are a significant complication of burns of the hand, and they are a common cause of hand disability. Many reconstructive techniques are currently used however: the results are unsatisfactory in many of them. The objective is to evaluate the Trapeze flap for correction of post burn finger flexion contractures

Ultrasound findings in finger flexor tendons in systemic sclerosis: A cross-sectional pilot study.

Finger flexion contractures are an important cause of disability in patients with systemic sclerosis; however, their pathophysiology is poorly understood. Our aim was to assess the feasibility of scanning finger flexor tendons in patients with systemic sclerosis and explore the ultrasound findings in these tendons, including measurement of finger flexor tendon complex. Grey-scale and power Doppler ultrasound assessment of the finger flexor tendon complex including tendon structure and surrounding soft tissue. Measurements of the finger flexor tendon complex (A1 pulley, tendon and palmar plate) were made. Feasibility was assessed by the number of fingers which could be measured. We studied the second to fifth flexor tendons (n = 160) of both hands in 20 patients with systemic sclerosis, including early and established disease. We were able to assess the finger flexor tendon complex and make measurements of the flexor tendon and palmar plate in all (n = 40) and A1 pulley in almost all (n = 39) of the studied fingers. Common pathologies identified included peritendinous (n = 12) and soft tissue (n = 8) calcification. Tendon thickening was seen in six patients, but synovitis/tenosynovitis was rare. The A1 pulley was thickened in patients with systemic sclerosis (0.46 mm), in particular, those with diffuse cutaneous systemic sclerosis (0.50 mm). We were able to successfully assess, including making measurements of, the finger flexor tendon complex in patients with systemic sclerosis. Our study showed calcifications in the peritendinous areas and soft tissue and thickening of the A1 pulley. These findings may play a role in the pathophysiology of systemic sclerosis-hand contractures by causing mechanical impingement of the finger flexion mechanism. This pilot study will guide future research to look for potential (treatable) causes of finger flexion contractures in patients with systemic sclerosis.

Plastic Replacement of Palmar Defects

Material and Methods. The authors have developed a two-step method of plastic substitution of the palmar defect, which had consisted in the preliminary preparation of the tissue complex on the own fascia of the forearm and then transposition it to the hand as island flap on the radial vascular bundle after the excision of the scar and eliminate flexion contractures of the fingers. According to the proposed method, 7 patients with vicious scars of the palmar surface of the hand and flexion contracture of the fingers were operated. Males prevailed, the mean age of patients was 39±12.4 years. In 5 cases, the cause of scar contracture of the hand was an open trauma with a tissue defect, in other cases, contact bum. Results. Patients were examined in 3,6 and 12 months. The complication was noted in one case, which was a partial necrosis of the skin part of the flap, which required additional plasty with a split skin graft, which did not affect the final result. The flaps were stable and resistant to mechanical stress, no correction was required in any case. By 6 months protective sensibility in the hand recovered in all cases. Conclusion. The described method of substitution of extensive deep palmar defects can be applied after correction of scar deformation and elimination of flexion contracture of fingers. Prelamination provides reliable engraftment of a full-layer or thick split skin graft taken from any area of the human body. Strong fixation of the skin graft to the fascia provides a small displacement of the skin and and the lack of excess tissue. The flap is resistant to mechanical stress and provides restoration of protective sensitivity. The damage to the donor area is insignificant, as the scar on the forearm remains hardly noticeable. The disadvantages of the proposed method include the need to perform two surgical interventions.

Iterative percutaneous needle aponeurotomy for Dupuytren's disease: Functional results at 5-year follow-up

Treatments of Dupuytren's disease are currently not aetiological but symptomatic. They aim at reducing the flexion contracture of fingers and improving hand function, without excluding the possibility of recurrence. Percutaneous needle aponeurotomy (PNA) can be used as an iterative treatment for repeated recurrences. However, it has only been assessed as a unique therapeutic sequence and its long-term functional results have not been described. The aim of the study was to assess functional results of iterative PNA for Dupuytren's disease at 5-year follow-up. Patients with digital flexion contracture due to Dupuytren's disease were prospectively included and treated using PNA. Iterative treatment was performed as necessary during the follow-up. Assessment criteria were Tubiana score at 1 month, URAM functional score at 1-month and 5 years, satisfaction and need of second line open surgery at 5 years. Primary outcome was URAM functional score at 5 years in patients who did not undergo second line open surgery at follow-up. Thirty patients were included: age 72 ± 10, ratio Female/Male 0.2, diabetes 3, Tubiana score 7 ± 3, URAM score 13 ± 10. Three sessions of PNA were performed per patient in mean at 5-year follow-up. Two adverse events were observed: skin fissure recovering in one week (1 case), digital paresthesia recovering in 2 years (1 case). PNA reduced flexion contracture (Tubiana 2 ± 3, range 0–13, n = 30, P < 0.05). The URAM score was improved at 1 month (7 ± 9, range 0–35) and at 5 years (10 ± 12, range 0–41, n = 27, P < 0.05). Three patients underwent second line open surgery. Seventy-two percent of patients were satisfied by PNA at 5 years and 83% recommended the treatment. Iterative PNA is safe, reduces flexion contracture and improves hand function in patients with Dupuyren's disease. Functional improvement persists at 5 years in 90% of cases. Only 10% require second line open surgery.

Successful treatment of postburn flexion contracture in fingers of early childhood with dynamic splint therapy after operation: long-term follow-up

Infants or early childhood individuals are prone to be burned on the palm and fingers, since they tend to extend their hands to the heat source. Wounds with more than 3-week-prolonged ulcers frequently result in flexion contracture. Despite successful surgery, the outcome might be unsatisfactory because of postoperative contracture. This study aims to investigate the effectiveness of our dynamic splint therapy following operation of postburn flexion contracture of fingers in infants or early childhood. Ten patients with postburn flexion contractures were enrolled in this study. After epithelialization of wounds had been completed, surgery was planned. Contracture was released by scar incision, and full-thickness skin was grafted. Postoperatively, the finger joints were fixed at the extended position with the Kirschner wires for 3 weeks. After the fixation was released, Capener-type dynamic splints were worn for 2 years. The functional outcome was assessed by measurement of total active motion (TAM). The aesthetic outcome was assessed using Vancouver scar scale (VSS). The mean postoperative follow-up period was 49.6 months (range 31–81 months). In all cases, contractures were released, and all skin grafts were completely taken. None developed late contracture. The mean postoperative TAM of the fingers (259.6 ± 2.54) was significantly higher than the preoperative one (148.0 ± 51.5). The mean postoperative VSS (1.40 ± 1.14) was significantly lower than the preoperative one (5.53 ± 0.50). Our treatment protocol provided the excellent functional result and improved the aesthetic appearance. Level of Evidence: Level IV, therapeutic study.

Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization

Rationale:For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm.Patient concerns:In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually.Diagnoses:localized type Volkmann's contracture.Intervention:Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started.Outcomes:Within 9 weeks after surgery, full ROM had been regained.Lessons:Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner.

A Study of Outcome of Limited Fasciectomy in Patients with Dupuytrens Contracture

Background: Dupuytrens contracture is a fibro proliferative disorder of hand resulting in slowly progressive thickening and shortening of palmar fascia leading to finger flexion contractures. The disease usually affects the fourth and fifth fingers and common in elderly males. The disease progresses in 3 stages with varying clinical severity. The aim of treatment is to remove the contracture of the fascia, correct the flexion deformity and regain the finger function. The treatment options include nonsurgical and surgical methods. The surgical methods include fasciotomy, fasciectomy, dermofasciectomy. Fasciectomy is the commonly done surgical procedure and it can be either limited or radical fasciectomy. Aims and Objectives: To study the outcome of limited fasciectomy in patients with Dupuytrens contracture Observations: It is a prospective study conducted in this institute in 25 patients with Dupuytrens contracture operated by limited fasciectomy, between January 2013 and December 2015. All 25 patients of Dupuytrens contracture who presented to us were admitted, evaluated for their severity and operated by limited fasciectomy. Patients were followed up for a period of 6 months to 2 years and evaluated for finger extension and range of movements. 20 of the 25 patients who were operated by limited fasciectomy had complete release of the contractures with normal wound healing and complete extension of fingers. No recurrence of disease was seen in all of these patients on regular follow up and active physiotherapy. Normal range of finger movements were present. 5 of the patients had minor surgical complications in the form of flap necrosis, partial skin graft loss and wound dehiscence, which resolved with conservative dressings and splinting and 2 of these patients developed flexion contractures at 6 months of followup. Conclusion: Limited fasciectomy is effective in all severity of Dupuytrens contractures with complete relief of symptoms and complete extension of fingers. No recurrence of contractures were seen in 92% of these patients. Limited fasciectomy being less morbid compared to radical fasciectomy or dermofasciectomy is a preferred surgical option in patients with Grade 1 and grade 2 Dupuytrens contractures. Keywords: Dupuytrens contracture, Limited fasciectomy, Recurrence and outcome.

The modified antegrade digital artery island flap for severely flexion contracture of the burned finger

Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger. Methods Between August, 2013 to August, 2015, 21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment. According to the Stren classification standard for the interphalangeal joint flexion contracture, all the patients were rated as type Ⅲ. The volar soft-tissue defect with exposed tendons, nerves, vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation. The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm, respectively. The wound were reconstructed with the modified antegrade digital artery island flap. The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound. The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm. All the cases were called back for postoperative follow-up. Results All the reconstructed fingers and flaps survived completely without vascular problems. The donor skin graft survived and wound healed by first intention. All the patients were followed up with 11.5 months (range, 6-22 months). The finger appearance was satisfactory. The texture and color of flaps in all cases were good. There was no pigmentation and contraction relapse. The contracted fingers received no cold intolerance. At the final examination, the average values of static 2-point discrimination were 5.2 mm (range, 4.3-6.5 mm) of the flap. In the series, based on the Michigan Hand Outcome Questionnaire, 18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance. Conclusion The modified antegrade digital artery island flap, which is easy to raise with large flap size and can result with the good finger appearance and function, is an ideal technique for reconstruction of the severe flexion contracture of the burned finger. Key words: Finger; Burn; Finger flexion contracture; Proper palmar digital artery; Island flap; Microsurgical operation