Home Tag: "Reconstruction"

Tag: Reconstruction

post-burn hand contracture treatment
10Jul

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.

post-burn hand contracture treatment

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.

Why This Staged Strategy Works

• Complete release first ensures the deforming force of the contracture is fully addressed, not just partially corrected.
• K-wire fixation protects the correction during early healing, when the tissues are most prone to re-contracting.
• Flap cover (rather than skin grafting alone) provides durable, supple tissue that can withstand the mechanical demands of hand use.
• Staged separation and thinning allows the reconstruction to mature before fine-tuning, ultimately yielding a hand that is not only released but genuinely functional — with fingers that move independently and a contour that supports grip, pinch, and daily activity.

Post-burn hand contractures are a reminder that burn care doesn’t end when the wound closes. Reconstructive surgery, done in the right stages with the right techniques, can return meaningful function to a hand that might otherwise remain permanently disabled. This case illustrates how a systematic, staged plan — release, provisional fixation, flap cover, then refinement — can achieve excellent outcomes even in severe, multi-digit involvement.

post-burn hand contracture treatment

Frequently Asked Questions (FAQ)

What is a post-burn flexion contracture?

It’s a condition where scar tissue formed after a deep burn tightens and pulls a joint — in this case, the finger joints — into a bent position, restricting the ability to straighten the fingers.

Why can't the contracture be released and closed in one surgery?

Releasing a contracture leaves a raw area that needs stable, well-vascularized tissue for cover. In multi-digit cases, achieving reliable correction, adequate coverage, and eventual individual finger mobility usually requires a staged plan rather than a single procedure.

What is a K-wire, and why is it used here?

A Kirschner wire (K-wire) is a thin metal pin used to temporarily hold a joint in a corrected position while the surrounding soft tissue heals, reducing the risk of the contracture recurring.

What is a syndactylised groin and hypogastric flap?

It’s a flap of skin and tissue taken from the groin/lower abdominal region and used to cover multiple released fingers at once, with the fingers temporarily joined together under the flap for reliable healing.

 

Why are the fingers joined together temporarily?

Joining the fingers under a single flap (syndactylisation) allows robust blood supply and coverage for all digits simultaneously, which is more reliable than trying to cover each finger separately at this stage.

What happens in the second stage of surgery?

Once the flap has matured, the fingers are surgically separated (syndactyly release) and the flap tissue is thinned, restoring individual finger movement and improving the hand’s contour and function.

How long does the full treatment take?

Staged hand reconstruction typically spans several weeks to a few months between stages, allowing the flap to mature and heal properly before the next step, though exact timelines vary by case.

What results can patients expect?

With proper staged management, patients can regain meaningful finger movement, grip, and pinch function — outcomes that significantly improve independence and quality of life compared to an untreated contracture.

Can this approach be used when all fingers are affected, not just one?

Yes — this case specifically demonstrates the technique in a patient with all fingers affected, showing that even complex, multi-digit contractures can be systematically addressed with a staged flap-based approach.

Is this type of surgery only cosmetic?

No. While the hand’s appearance does improve, the primary goal is restoring function — the ability to grip, hold, and use the hand for daily activities and work, which can be essential to a patient’s independence and livelihood.

How can i book appointment

A consultation with Dr. Jyoshid is completely confidential. You will receive a clinical assessment, grade classification, a recommended treatment plan, and a transparent quote — with no pressure and no obligation.
Sushrutha Institute of Plastic Surgery Elite Mission Hospital, Thrissur, Kerala
📞 +91 8113005557 ✉️ drjosh4u@gmail.com 🌐 www.drjosh.in

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