Postburn Contractures Research Articles

Outcome of Knee Reconstruction using Saphenous Artery-Based Fasciocutaneous Flap: A retrospective study

Background and Aim: The soft tissue defects around the knee are common and represents a challenge for surgeons due to its complexity and desired outcome. Many reconstructive treatment options are available and flaps are recommended. The current study aimed to evaluate the outcome of using saphenous artery (SA)-based flaps for the management of soft tissue defects around the knee.
 Methodology: Files of 34 patients treated by SA-based flaps were reviewed for outcome and complications. Collected data included patient demographics, etiology, size, site and side of the defect and outcome (flap survival and complications) at the end of the 6th postoperative month.
 Results: There were 26 males and 8 females. Their age ranged from 18 to 45 years; the mean age was 33.18±6.58 years. The commonest etiology was posttraumatic (64.7%) then post-burn contracture (20.6%). The majority of defects were on the right side (82.4%). The maximum length of the defect ranged between 14 and 20 cm (mean ± SD were 16.56±1.62) while the maximum width ranged between 6 and 10 cm (mean ±SD were 8.59±1.05). The flap survival rate was 97.1%. The overall complications rate was 14.7%, distal flap necrosis reported for 5.9%, wound dehiscence for 2.9% and seroma for 5.9%. All treated conservatively, except that of distal flap necrosis which need reintervention.
 Conclusion: The saphenous artery-based fasciocutaneous flap is an effective, feasible and safe option for the management of soft tissue defects around the knee.

Infected post-burn contractures and their elimination

This article presents a case of successful treatment of a patient with infected post-burn contractures of both knee joints using sequential closed multistage knee joint redressing and targeted antibiotic therapy.

Staged Management of Severe Postburn Contracture of Elbow and KneeA Prospective Interventional Study

Introduction: Long-standing burns at major joints like the elbow and knee often lead to contractures, despite of best treatments and their management poses a great challenge owing to underlying contracted tendons, neurovascular bundle, and joint ligaments. Attempts at release and correction of contractures may lead to injury to the adjacent neurovascular structures. Aim: To evaluate the effectiveness of staged release as a means of definitive treatment of severe burn contracture. Materials and Methods: A prospective interventional study was conducted on 30 patients in the Department of Burns, Plastic and Reconstructive Surgery Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India, from December 2018 to December 2020. In the first stage, the maximum excisional release of contracture was done, avoiding any stretching of the neurovascular bundle, then bedside graded traction was applied at the joint until the complete release of contracture was observed. The resultant raw area was covered with a split-thickness skin graft in the second stage. The collected data included- site and side of the contracture, cause of initial burn, Improvement in flexion arc (in degrees), duration of splintage after surgical release, complications and Patient and Observer Scar Assessment Scale (POSAS). Paired t-tests were performed to analyse changes in preoperative versus postoperative measurements. Results: Eighteen cases of knee contractures and 12 cases of elbow contractures were included in the study. Among the patients that were analysed, 17 were females and 13 were males, with a female-to-male ratio of 1.3:1. The age range was 18-50 years, with a mean age of 36±8.79 years. The mean Range Of Motion (ROM) of elbow contracture with a severe degree of contracture improved from 25% of functional ROM to 124.29% at 6 months postoperatively. Similarly, the mean ROM of knee contracture with a severe degree of contracture improved from 25.76% of functional ROM to 102.58% at 6 months postoperatively. For both elbow and knee contracture cases the differences in mean ROM were statistically significant with all p-values <0.05. The average time at which the patients reported to the hospital, after developing contracture was 36.8 months, and it ranged from 24 months to 62 months. According to POSAS patient scale, the overall score was 6 and 5 for the elbow and knee respectively and the POSAS observer scale overall score was 6 for both the elbow and knee, respectively. Conclusion: The staged release procedure applied in the present study was an effective way of dealing with long-standing contractures with minimal complications.

Role of Low-Level Laser Therapy as an Adjuvant in Functional Rehabilitation of Patients with Joint Stiffness in Post-Burn Contracture

Introduction Post-burn contracture is a known sequelae of burn injuries involving neck, axilla, elbow, and hand. There are many methods which are used as adjuvant in rehabilitation of post-burn contracture patients. The low-level laser therapy (LLLT) is one of the methods that can be used as an adjuvant in rehabilitation of joint stiffness following burns and but with very few data available from India. In this article we share our experience of using LLLT for functional rehabilitation of a patient with joint stiffness following postburn contracture. Materials and Methods This study was conducted in a burns centre in a tertiary care institute in South India. Informed consent and departmental ethical committee clearance were obtained prior to study. The subject was a young boy with no known co-morbidities with stiffness of metacarpophalangeal and interphalangeal joint of index and middle finger of right hand. Patient was treated with contracture release with full thickness skin graft. The patient received low-level laser therapy to induce collagenolysis and to increase the movement of the joints. Each joint received laser therapy for duration of 125-second every time for 15-minutes for 2 sessions in a span of 4-days. Result LLLT has been found to be useful in early rehabilitation of post-burn contracture patients with joint stiffness. No side effects were observed during the study. Conclusion The LLLT is an effective, safe, and non-invasive adjuvant in functional rehabilitation of our patient with joint stiffness following post-burn contracture. We suggest further study including multiple subjects and a control group for validation of the result.

Postburn Reconstruction of the Face and Neck.

After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases. Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.

Role of split thickness skin grafting in post burn contracture neck

Optimizing functional and aesthetic outcomes in post burn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion, and disfigurement because of disruption of the aesthetic subunits of the face, can result in poor patient satisfaction and ultimately, contribute to social isolation of the patient. Despite advancements in post burn head and neck reconstruction, such as the advent of free-tissue transfer, split thickness skin graft remains the mainstay of cover in most burn care institutions around the world. Usually skin graft is required to cover raw area after release of contracture. But in case contracture is associated with non-healing ulcer which may become source of infection then skin grafting for non-healing ulcer should be done before release of contracture. In this study we are sharing our experience of post burn neck contracture associated with non-healing ulcer in which first skin grafting was done for ulcer & then release of contracture & skin grafting was done.

Z-Plasty with Skin Grafting for Post-Burn Contracture - Study of 30 Cases

Introduction: Postburn contracture is a very common problem in case of undertreated and neglected cases of burns involving the flexor surface of joints of limbs. Satisfactory treatment of postburn contracture needs surgical excision of scar followed by Z-plasty. In case of a severe contracture of joints, Z-plasty is combined with skin grafting for the tension-free treatment of post-burn contracture. Methods: The study was conducted in Sadar Hospital, Sunamgonj and several private clinics in selected districts during the period from 2008 to 2020. Thirty (30) patients with contractures involving flexor surface of Elbow, Knee, and Metacarpophalangeal joints of hands of mild to severe degrees and various durations were treated with Z-plasty plus Split thickness Skin grafts. The operated limbs were immobilized with POP casts. Perioperative Parenteral Antibiotics were prescribed along with adequate Analgesics, Autiulcerants and vitamins, and proper nutrition. Both the operative sites (Recipient and donor areas) were examined by check dressing after the 7th to 14th postoperative days. Result: 5 and 12 patients had complications like infection, flap tip necrosis, and recurrent contractures respectively. But overall results were satisfactory in terms of joint extension, mobility, cosmetic appearance, and patient satisfaction. Very naturally in case of severe contractures, full correction was not possible by single-stage operation. Conclusion: Tension-free flap must be used in patients with mild to severe contractures. Combining skin Grafting with Z-plasty is easy and has better results than Z-plasty alone. It is recommended in patients of Z-plasty with intraoperative flap tension.

Comparison of soft tissue mobilization versus static stretching in post-burn contractures at elbow and wrist, A pilot study

BACKGROUND & OBJECTIVE: Post-burn contracture is the tightening of the skin after a second or third-degree burn with the formation of contracture. Post-burn contractures result in the limitation of movement around a burn area. Burns contractures, if left untreated, may cause limitations in the range of motion and daily living tasks. The purpose of this study was to compare the effects of soft tissue mobilization versus static stretching in post-burn contractures at the elbow and wrist.
 METHODOLOGY: A pilot study was conducted, and 36 patients were enrolled. Patients with post-burn contracture were divided randomly into two groups. Allocation of patients in both groups was done by computerized generated list. The treatment frequency was 3 times a week. Numeric pain rating scale (NPRS) and Katz index ADLS scale were used for scoring. Paired t-test was applied to evaluate the data.
 RESULTS: The mean age in group A and B were 26.16±7.46 and 28.05±1.27, respectively. Mean score for pre-Katz Index of Group A and B (2.47±0.87, 2.16±0.98), post-Katz Index group A and B (3.29±1.68, 3.05±1.47) with a p-value 0.12 and 0.03 group A and B respectively. The mean score group A and B for pre-NPRS (7.61±1.37, 7.94±1.10), post-NPRS (2.27±1.01, 1.72±1.22) with a p-value<0.001 .
 CONCLUSION: It was concluded that static stretching is more effective than soft tissue mobilization.

Choice of the method for eliminating postburn shoulder joint contractures

BACKGROUND: In the Russian Federation, over 400,000 patients with thermal injuries are registered yearly, with approximately 30% of them requiring hospitalization. Physicians pay special attention to the rehabilitation of patients with complications of deep burns. According to several authors, deep burns occur in 47% of cases. The most common complications of deep burns are contractures and limb deformities. Shoulder contractures occur in over 50% of patients. The outcomes and terms of a patients return to active social and working life depend on the timeliness and selection of an optimal surgical intervention from a wide range of reconstructive and plastic techniques.
 AIM: This study aimed to improve the functional and esthetic results of surgical treatment in patients with postburn shoulder joint contractures.
 MATERIALS AND METHODS: From 2011 to 2020, 198 patients underwent surgery, including 59% women and 41% men. Right shoulder, left shoulder, and right and left shoulder simultaneous joint contractures occurred in 54.5%, 38.5%, and 7% of cases, respectively. The patients age ranged from 18 to 72 years, and 99% of them were of working age. The scope of preoperative examination included clinical data, photographic documentation, duplex vascular scanning, and determination of the degree of contracture using a mechanical goniometer. Patients with grade I, II, and III shoulder joint lesions accounted for 29%, 60%, and 11% of the total number of cases, respectively. Early surgical rehabilitation prevents the development of secondary myogenic and arthrogenic contractures and accelerates the patients social reintegration. Local tissue plasty using the armpit adipodermal tongue-shaped flap, a nonperforated full-layer or split skin graft, a rotated flap based on perforating vessels, and the expander stretching method were used to eliminate contractures.
 RESULTS: Bacterial infection, total and marginal necrosis, hematomas, and seromas were not observed in the immediate postoperative period. Complete elimination of the shoulder joint contracture was achieved in 63% of cases, whereas joint mobility increased by over 60 in 30% of patients.
 CONCLUSIONS: The algorithm presented for choosing a method of surgical rehabilitation for patients with shoulder joint contractures leads to an increase in the efficiency of reconstructive surgery after burn injuries.

The Treatment of Chronic Postburn Scar and Contracture: A Case Report

The Treatment of Chronic Postburn Scar and Contracture: A Case Report

Comparison of the effect of Range of Motion exercises versus stretching techniques in prevention of burn contractures of upper limb; RCT- A Randomized clinical trial

Background: Burn is an injury which affects approximately all systems of body and is very common among accidental injuries which causes burden on hospitals. A lot of treatment interventions are introduced until now for the management of burn to lessen complications and increase quality of life in survivors. Methodology: Forty-eight patients who complete selection criteria were included in this study. Written informed consent was obtained from every participant in this study before starting any physical examination. Participants was allocated into two groups randomly. On 1stday range of motion at involved joints was assessed using goniometry. Group A is treated with stretching techniques, while group B is treated with Range of Motion exercises. Conventional treatment for both groups’ participants includes isometrics exercise and anti-contracture positioning. Treatment frequency was 3 times a week. Results: Comparison of all upper extremityjoint movements at baseline and 4th week has shown that there was a significant difference between post treatment range of motion with p value of less than 0.05 showing that group A is more effective in improving shoulder flexion after burn injury.Comparison of mean of all measured range of motions in group A and B was 57.08 degree ±28.29 and 59.25 degree±33.52 in pre-treatment and 96.66 degree ±36.35 and 81.49 degree ±33.10 post-treatment. Conclusion: Stretching techniques are more effective in the prevention of post burn contractures than Range of Motion exercises, as more improvement was noted in range of motion at joints of upper limb in patients after stretching. Keywords: ROM (Range of motion), RCT (randomized controlled trail)

Pain assessment and clinical profile of burn patients

Background: Burn injuries are a major global public health concern with up to 52% of burn patients suffering from chronic pain. The aim of the study was to asses clinical profile and management of pain in burn patients.Methods: The study was a prospective hospital-based study on a total of 300 patients admitted in burn unit of the department of surgery over a period of two years. BSA burns was determined by Wallace's rule of nine in adults and in children by Lund and Browder chart. Pain was assessed using Wong-Baker FACES pain rating scale. Statistical analysis was done using SPSS program.Results: In the present study, most of the burns i.e., 46.7% were seen in <20 years age group, and more in male (58.7%) subjects. Accidental burns and superficial burns were the most common. There were 113 (53.3%) patients with pain score of 2 followed by 160 (53.3%) with pain score 3, 22 (7.3%) pain score 4 and 5 (1.7%) with pain score of 1. For pain management, 171 (57%) patients were given NSAIDS, 78 (26%) needed opioid and NSAIDs and 51 (17%) needed opioid only. Complications in our studied patients on follow up revealed 29 (9.7%) had PTSD, 22 (7.3%) had post burn contracture, 16 (5.3%) had post burn pain, 15 (5.0%) were having anxiety.Conclusions: Pain in burn victims is present throughout the rehabilitation and so should be dealt with multimodal specialties.

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.

Role of Autologous Platelet Rich Plasms (Aprp) In the Take of Full Thickness Skin Graft in Post Burn Contracture

All deeper burns especially second degree deep dermal and full thickness heals by scarring that causes restrictions in the movements and aesthetics issues for patients. Burn reconstructive surgery requires that the defects after release should be replaced with donor tissues which have matching texture and colour like autologous skin grafting or flap surgeries. Autologous platelet rich plasma contains concentrated platelets after graded centrifugation, which has various applications like alopecia, acne, reproductive techniques etc. Here we are using this method to test for role in take of Full Thickness Skin Graft post burn contracture. Full-thickness skin grafts include full thickness of the epidermis and dermis whereas split-thickness skin grafts include the entire epidermis and only partial dermis. The main complication of this procedure is risk of graft failure. Autologous platelet-rich plasma (APRP) as the name suggests is concentration of the patient’s own platelets in a small amount of plasma. It is enriched by growth factors, and it acts as a fibrin sealant and has various properties. Its important application is in skin grafting where it aids as a fibrin sealant and aids in the take of the graft by enriching it with growth factors and promoting angiogenesis The purpose of this case report is using autologous platelet rich plasma as a therapeutic method for accelerating take of Full Thickness Skin Graft in post burn contracture with better prognosis.

IMPACT OF NURSING REHABILITATION PROGRAM ON MINIMIZING POST- BURN JOINT CONTRACTURE

Globally, burns are a serious public health problem. Rehabilitation isanessential and basic part of burn treatmentto limit contracture. It isnt something whichhappens following healing of skin grafts or discharge from hospital all things considered a process that beginnings from day one of admission and proceeds for a long time and sometimes years after the initial event. Aim of the current study:The aim of this study was to evaluate the impact of nursing rehabilitation program on minimizing post-burn joint contracture. Research Design: Quasi-experimental pretest, posttest research design was utilized. Setting:The study was conducted in Burn Unit at General Kafrelsheikh Hospital- Kafrelsheikh City- Kafrelsheikh Governorate). Subjects:A purposive sample of 60 adults male and female inpatients diagnosed with major burn injury at shoulder, elbow, hip or knee joint where they included in the study, Patients assigned into two groups (control and study). Tools of data collection: tool 1:Demographic and medical data sheet, tool II: Joint motion measurement scale. Results:most of the study group were suffering contractures with active range of motion compared with more than three quarter of control group. While, about one third of the study have contractures with passive range of motion compared with more than two third of control group.A Statistically significant difference put into evidence between the two groups regarding severity, and frequency of range of motion limitation for affected joints. Conclusion: contractures are common problems after a major burn injury. Number of contractures occurred in spite of receiving a rehabilitation program. Despite the frequency of contractures at time of hospital discharge, very few contractures were severe. Recommendations.Early application of rehabilitation program as an important intervention for minimizing contracture in sever burn patients.

A Technique of Immobilization of Digits by Spinal or Intracath Needle Following Soft Tissue Surgery.

After release of post burn flexion contracture and repair of soft tissue injury of digits, it is desirable to maintain the digits in full extension. This is conventionally done by insertion of Kirschner wires across the interphalangeal or metacarpophalangeal joints. We have been inserting a spinal or intracath needle in a dorsal supra-periosteal plane for immobilizing digits after release of post burn contractures or repair of soft tissue injury. The needle is maintained for 2-3 weeks, and all patients achieved stable immobilization of digits. There were no major complications. This procedure is minimally invasive, simple to perform, and provides stable immobilization. Level of Evidence: Level V (Therapeutic).

Improvement in functional and aesthetic outcome in postburn contracture of neck following split skin grafting using goniometer

Introduction: Although the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. Objective: The main objective of this study was to compare the improvement in cervico-mental angle after surgery, using a goniometer; and to assess the postoperative complications, cosmetic outcome and patient satisfaction after contracture release and split-thickness skin grafting. Methods: In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer. Results: In this study, we observed that the mean cervicomental angle before the surgery was 85.5° ± 12.8° and after the surgery was 106.4° ± 7.8°. The percentage improvement was 24.3% which was found to be statistically significant (P < 0.001). Patients were also classified based on age, gender, mechanism and classification of burns, time elapsed since burn injury. Postoperative complications, cosmetic outcome and patient satisfaction were also studied. Conclusion: PBCs can affect a patient's life functionally, aesthetically, and psychologically. Split-thickness skin grafting is a safe and reliable option for PBC neck. This causes improvement in cervicomental angle and thus range of movements of the neck in different axes (as measured by a goniometer). lthough the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer, and a significant improvement was noted. Overall patient satisfaction was also very good. Hence, split thickness skin grafting is a safe and reliable option for PBC neck.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОСЛЕОЖОГОВЫХ РУБЦОВЫХ РАЗГИБАТЕЛЬНЫХ КОНТРАКТУР ПАЛЬЦЕВ СТОПЫ

Objective: To study surgical management of post-burn scar extension contractures of the toes. Methods: The treatment outcomes of 72 children with post-burn scar extension contractures of the toes between the ages of 3-15 were analysed. There were 38 boys (52.8%), girls – 34 (47.2%). In 14 (19.4%) children, both feet were affected, with a total of 86 feet with extension contracture. In most cases (n=53, 73.6%) of children (62 feet), retracting scars extending proximally also caused extension contracture of the ankle joint. Results: In all cases, a modified Z-plasty (butterfly flap) technique, according to Hirshowitz, was used to correct scar contracture of the anterior ankle. In 89.5% of patients (77 feet) after reconstruction using a local flap, soft tissue defects (range, 6-30 cm2) remained. The defects were covered with full-thickness autologous skin grafts. In this case, in 32.6% (28 feet), the exposed tendons and cutaneous nerves were preliminarily covered by the surrounding subcutaneous tissue and fascia used as a blood-supplying source. Local flap surgery helped reconstruct mild scar contracture in 16 (18.6%) feet. In 21 (24.4%) cases, tendon-articular structures were reconstructed. Complications in the early postoperative period were observed in 7 out of 86 operated feet, which amounted to 8.1%. In all cases, complications included marginal necrosis of local flaps and transplanted full-thickness skin grafts observed in 4 feet (4.6%) and 3 (3.5%) feet, respectively. In all cases, engrafting of a full-thickness skin graft was noted; and there was no complete recurrence of contracture. Due to the somatic growth of children in 8 cases (9.3%) in the late postoperative period (after 6-10 years), repeated corrective surgical procedures were required. Conclusion: In children, burn contractures of the toes require surgical intervention on the skin and soft tissue. Unfortunately, the pathological process is almost always accompanied by a lack of skin and soft tissue, requiring skin grafts. In the long term, there is a need for repeated corrective surgical interventions. Keywords: Post-burn contracture, skin autografts, foot contracture, local flap surgery.

Novel use of Pedicled Medial Sural Artery Perforator flap for Post Burn Knee Contractures

<br><b>Background:</b> Postburn flexion contractures of the knee may arise even with adequate treatment of the burn injury. Pedicled medial sural artery perforator (MSAP) flap has been described for the reconstruction of defects of the knee and proximal third of the leg. Its use in the management of postburn contracture release is sparse. We are presenting the use of a medial sural artery pedicled flap for the reconstruction following postburn knee contracture release. <b>Materials and Methods:</b> This study included six patients with postburn unstable scars and a mild degree of knee contractures who underwent release of the contracture and coverage using MSAP pedicled flap. The results in terms of flap size, recurrence, complications, functional outcome, and cosmesis were assessed. <b>Results:</b> The flap size ranged from 7 cm × 6 cm to 13 cm × 7 cm with a mean pedicle length of 9.41 cm. All six flaps survived without any complications with a satisfactory outcome. The patients were followed up for 6–18 months. There was no recurrence of contracture without any restriction of knee joint mobility. <b>Conclusion:</b> MSAP flap is a reliable flap and should be considered for the management of postburn knee contracture of grade 2 and grade 3 contractures, as it provides optimum and ideal coverage with fewer chances of recurrence.<br>

Study of management of postburn flexion contracture of finger by glabrous versus nonglabrous split skin graft

Aims and Objectives: This prospective study was designed to determine the outcome of split-thickness glabellar and nonglabellar skin graft for the coverage of defects on palmar aspect of hand after release of postburn contracture in terms of graft take, complications, recurrence, and patient satisfaction for color and texture match. Materials and Methods: This prospective comparative study was carried out on patients from December 2018 to December 2020. Fifty patients were randomly divided into two groups by simple randomization method. Group A was offered treatment with split-thickness graft from glabellar region and other Group B was offered treatment with split-thickness graft from nonglabellar skin. Frequencies and percentages of both recipient and donor sites complications such as infection, hypertrophic scarring on the Vancouver scar assessment scale, recurrence, and difficulty in walking were noted. Patient satisfaction for colour and texture match to neighboring skin at recipient site were assessed 3 months after the operation using five points Likert scale. Results: At follow-up of the Group A, the donor areas were completely healed in all the cases 100%. The grafted area showed excellent color and texture match with the adjacent palmer skin. The graft was mobile, stable and without any pigmentation. There was also no hypertrophic scarring, hyperpigmentation or pain at the donor site as compared to ordinary skin graft. Walking and weight bearing were smooth and the instep curvature appeared normal. In Group B, 100% of patients had hyperpigmentation, 20% had marginal scarring and scar hypertrophy at hand. While 40% had scar hypertrophy at 80% had hyperpigmentation over the donor site. Recurrence was noted in 32% of patients in Group B as compared to 8% in Group A. Conclusions: Glabellar skin of the instep is the best replacement for the palmar skin of the digits and hand because of the similarities in their characteristics. Results are excellent in terms of color and texture match, no hyperpigmentation, less marginal scarring, scar hypertrophy, and less recurrence of contracture in patients with area grafted with glabellar skin. Donor site morbidity is very low and hardly any donor site scar is visible. So in conclusion for the management of postburn flexion contracture of the finger. An ideal skin substitute is glabellar skin grafts from the instep region of foot.