Tag: Post-Burn

When Burns Steal the Hand’s Function

The hand is one of the most functionally vital — and most vulnerable — parts of the body after a burn injury. Deep burns to the hand often heal with dense scar tissue that pulls the fingers into fixed positions, most commonly a flexion contracture, where the fingers curl inward and can no longer straighten. Left untreated, this doesn’t just limit grip and dexterity; it can affect a patient’s ability to work, perform daily tasks, and maintain independence. Well-planned, well-executed contracture release doesn’t just restore movement — it can be life-changing, and in severe cases, life-saving by preventing complications of a permanently disabled limb.

The Case: All Digits Involved

In this case, the patient presented with flexion contractures affecting all fingers of the hand following a burn injury. This is a more complex presentation than an isolated finger contracture, since every digit needed release, coverage, and a coordinated plan to avoid creating new problems — such as webbing between fingers — while solving the old one.

A Staged Surgical Approach

Severe multi-digit contractures are rarely fixed in a single operation. This case followed a carefully staged reconstructive plan: Stage 1 — Release and Provisional Fixation The contracted bands were completely released to bring the fingers back to a corrected, extended position. Temporary Kirschner wires (K-wires) were used to hold the joints in this corrected alignment while healing progressed, preventing the contracture from recurring during the early recovery period.
Stage 1 — Soft Tissue Cover Releasing a contracture always leaves a raw area that needs healthy, well-vascularised tissue for cover — skin grafts alone are often insufficient for a mobile, functional hand. In this case, a syndactylised groin and hypogastric flap was used, joining the fingers together temporarily within a single flap of tissue transferred from the groin/lower abdominal region. This approach provides robust, reliable coverage for multiple digits simultaneously.
Stage 2 — Syndactyly Release and Flap Thinning Once the flap has taken and matured, the fingers — temporarily joined together under the flap — are surgically separated (syndactyly release) to restore individual finger mobility. The flap tissue is also thinned at this stage, since flap tissue transferred from the groin tends to be bulky and needs refinement to allow better finger movement and a more natural hand contour.