Post Burn Contractures Of Hand Research Articles

Z-plasty in post-burn contracture of hand among pediatric patients.

Objective: To find out the frequency of hand burn and the effectiveness of Z-plasty in post-burn hand contractures. Study Design: Descriptive Cross-sectional study. Setting: Department of Pediatric Surgery, Khawaja Muhammad Safdar Medical College, Sialkot. Period: January to December 2021. Material & Methods: A preformed proforma was used, consisting of 4 parts, the first part including demographic data like age and gender, second part consist of patient’s history, consisting of presenting complaint, its duration, past history of any medical or surgical illness or comorbidity. Third part consisted of physical clinical examination of the hand (fingers and palm) while fourth part was for post-operative complications of reconstructive procedure, Z-plasty. The data was analyzed by using Statistical Package for Social Sciences (SPSS) version-20. Results: The most commonly affected age group was less than 6 years of majority of them, 53.3%, were male. The most common cause was thermal burns as compared to electrical burns. Among 91.1% of the participants, the right hand was affected more. Majority of the cases (48.9%) reported single finger burn, followed by multiple fingers (31.1%) and very few (20%) were having palm burns. Segregating the single figure, results showed that little finger was affected in 20% of cases No post-operative complications, like skin necrosis, wound dehiscence, hematoma or infection, were noted. Conclusion: It can be concluded that post-burn hand contractures and hand deformity was common among children. Z-plasty with/without skin grafting is an ideal surgical management to subside the contracture of hand.

A Prospective Study of Reconstructive Procedures For Post Burn Hand Contractures

Objective: The hand is among the most frequent sites of burns contracture deformity. It represents a common problem and a difficult challenge for many reconstructive surgeons. It is important to restore length, function, and provide good quality skin cover. Our aim is to evaluate the different surgical procedures for resurfacing after release of post burn hand contractures in terms of functional recovery and aesthetic outcome. Methods: Totally 30 cases of post burn hand contractures were reconstructed between May 2018 and November 2019 according to site and type of contracture with individualization for each case. All cases were followed up with physiotherapy and splinting devices, functional and aesthetic outcome for each procedure. Results were analyzed as per successful reconstruction, type of procedure, complications, functional and aesthetic outcome. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z- plasties with proper planning gives maximum length gain with no donor morbidity as other procedures and acceptable appearance. Conclusion: Postoperative physiotherapy and splinting are must for better outcome in all cases.

Surgical Management of Post Burn Hand Deformities.

Objective:To evaluate the efficacy of different surgical procedures on post burn contracture of hand.Methods:A quasi-experimental study design was conducted at the Department of Plastics and Reconstructive Surgery, Dow University of Health Science, DR. Ruth KM Pfau, Civil Hospital, Karachi, Pakistan from 1st June 2019 to 30th November 2019. Ninety-three participants of burned hand contracture of either gender, aged between 6- 60 years were included in the study. Resurfacing surgery with skin graft and loco-regional flaps were done according to type of contracture with individualization for each patient. All patients were kept under follow up for ninety days to assess efficacy of contracture release for each surgical procedure was noted. SPSS version 23 was used to analyse data.Results:Full thickness skin graft (FTSG) was performed in 60.2% cases, 17.2% with split thickness skin graft (STSG) and 12.9% with cross finger flaps. About 25% of recurrence was observed in cross finger flaps, whereas no recurrence was seen in Z-plasties and posterior interosseous flap. The significant association was between recurrence and surgical procedures (p<0.05).Conclusion:Z-plasty followed by FTSG was effective in the management of post burn contractures of hand.

Functional Reconstruction of Post-Burn Hand Contractures

Most patients who have survived severe burn injury may not have truly escaped the aftermath of severe scars which is post burn contractures. Hands are one of the most prevalent site of burn injury leading to contractures, which are important in terms of function and cosmesis. There is great deal of functional limitation, whereof contractures in both hands can make a burn survivor a total cripple. Moreover poor cosmetic result must also be considered as it gives impact towards patient’s self-esteem and quality of life. Treatment algorithm must be based on clinical presentation and severity of range of motion. Release of contracture, wound resurfacing and choice of reconstructive procedures must be based on timing of scar maturity as well as through a case-by case approach.

Advances in the research of prevention and treatment of postburn contractures of hand

Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

Study on Surgical Management of Post Burn Hand Deformities.

Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. It's a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.

Correction of Severe Postburn Claw Hand

Burn scar contractures are perhaps the most frequent and most frustrating sequelae of thermal injuries to the hand. Unfortunately, stiffness occurs in the burned hand quickly. A week of neglect in the burned hand can lead to digital malpositioning and distortion that may be difficult to correct. The dorsal contracture is the most common of all the complications of the burned hand. It is the result of damage to the thin dorsal skin and scant subcutaneous tissue, which offers little protection to the deeper structures. Consequently, these injuries are deep resulting in a spectrum of deformities that has remained the bane of reconstructive surgery. Flap coverage will be required in the event of exposure of joints and tendons with absent paratenons. Multiple different flap types are available to treat complex severe postburn hand contractures. In our center, which is the largest regional burn center in northwest Iran, we have considerable experience in the treatment of thermal hand injuries. Between 2005 and 2010, we treated 53 consecutive patients with 65 severe postburn hand deformities. There were 35 men and 18 women with a mean age of 35±3 years. Flame injury was the inciting traumatic event in each patient. The severity of original injury and inadequate early treatment resulted in all of the fingers developing a severe extension contracture with scarred and adherent extensor tendons and subluxed metacarpophalangeal joints. In 36 cases, the injury was in the patients' dominant hand. We first incised the dorsal aspect of the contracted hands where there was maximum tension, then tenolysed the extensor tendons and released the volar capsules, collateral ligaments, and volar plate in all cases. In 30 cases, we also tenolysed the flexor tendons. We reduced the subluxed metacarpophalangeal joints and fixed them with Kirschner wires in 70 to 90 degrees flexion. Then, we planned and performed axial groin flaps to reconstruct the defects in all of them. In all of these patients, there was availability of intact skin in the territory of groin flap. However, in case of burn scars in this region, we had other options such as posterior interosseous flap in mind. Six patients experienced superficial necrosis at the distal margin of the flap, which was successfully treated with local wound care and dressing changes. There were no other complications. Physical therapy was initiated after Kirschner wire removal.

Electrophysiological and histological changes in extrinsic muscles proximal to post burn contractures of hand

Burn scar hand contractures of variable degree are frequently encountered. Although the forearm is apparently spared, it was clinically observed that there was disuse atrophy in the unburnt extrinsic forearm muscles. Usually the clinicians do not give much importance to this fact. The girth at the midforearm was significantly reduced as compared to normal side. The flexion of the hand joints are governed by two components (a) intrinsic and (b) extrinsic muscles. The intrinsic muscles are directly involved in the contracted tissue. Therefore it was thought essential to evaluate the extrinsic group of muscles for their contribution in the final functional recovery following corrective surgery. Thirty patients having unilateral post thermal burn contracture sparing forearm were studied. A detailed clinical evaluation was made including grade of contracture and reduction in the forearm girth. The forearm unburnt muscles were evaluated by preoperative electrophysiological studies. Intraoperative biopsies were taken from these muscles for histopathological examination. On histopathological examination, there were significant abnormal changes in the form of muscle fiber atrophy, fibrolipomatous tissue replacement of atrophic muscle fibers and sarcolemmal changes. These changes were directly proportional to the severity of contractures. The electrophysiological studies showed proportionate changes in the form of reduction in amplitude, duration and interference. This study suggests that if these changes are mild and in reversible stage, they will favourably affect the functional recovery following surgery. However if these changes are of severe grade and irreversible, in spite of adequate surgery, splinting and physiotherapy, the functional recovery may not be complete.

Socioeconomic factors affecting presentation of patients with post burn contractures of the hand in an Indian population– a review of 196 cases

Background: As the etiological factors of burn injuries vary considerably in different communities, careful analysis of the epidemiological features in every community is needed to formulate a sound prevention programme. The present study attempts to analyze the demographic factors affecting the presentation of post burn contractures of hand in a developing country.Material and Methods: The study was conducted prospectively and retrospectively between 2004 and 2009. The patients were analyzed for their demographic profile. The patients and their family were asked to state the reason for seeking treatment and the patient’s narrative was recorded in his or her own language.Result: The age of presentation ranged from three to 65 years. Agricultural workers were the most common affected group of population (32%) followed by students (16%). Sixty four percent of all cases had injury due to flame burns. Electric burns were the second most common group (12%). Job related disability was the most common reason for seeking treatment amongst males (59%). Females most commonly sought treatment because of the inability of the family to find a suitable matrimonial alliance (57%). Forty four of the 102 males had a delay of less than six months in seeking treatment. Overall, 75 of 102 males sought treatment in the first year while only 13 of the 94 females reported for treatment within the first six months.Conclusion: We suggest that preventive community programmes for burn contractures of the hand should be based on sound epidemiological studies and should take into account the socioeconomic requirements of the given society.Key words: Burn contractures, Socio-economic factors, Felt need.

Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

ObjectiveTo assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures.MethodWe enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks.ResultsThe 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05).ConclusionThe modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.

Flap Choices to Treat Complex Severe Postburn Hand Contracture

Many regions of the hand are affected seriously in the patients with complex severe postburn hand contractures. Multiple flap choices should be in count to treat complex severe postburn hand contractures affectively. We preferred dorsal ulnar flap for palmar region, cross-finger flap, side finger flap, and combined use of both for flexion contracture of the fingers, and rhomboid flap for web contractures. Eight patients having complex severe postburn hand contractures were treated between November 2001 and February 2005. The maximum improvements of the joint extensions were 75 degrees for median of digits metacarpophalangeal joint and 105 degrees for proximal interphalangeal joint. Grasp function of the hand dramatically improved, and the bulk of the flap did not interfere grasping. Complex severe postburn hand contracture can be treated sufficiently with dorsal ulnar flap, combined use of cross-finger and side finger transposition flap, and rhomboid flap.

Specifically designed external fixators in treatment of complex postburn hand contractures

External fixators designed specifically for severe, late postburn contractures of hand and wrist have been used in five patients between 1993 and 1997 with follow up for an average of 30.2 months. The mean age of patients at operation was 16.6 years ranging from 14 to 20 years. They had a number of failed operations. There were fixed joint contractures beside severe soft tissue contractures. There was total loss of hand functions in four patients. After reconstructive operations, at least one hand function was attained. We have found the external fixator method to be helpful in treating severe, fixed and complex postburn contractures of hand where previous surgery had failed. This study indicates the uses and benefits of external fixators as a soft tissue lengthener when correcting progressively complex burn contractures of hand.