DOI: 10.1097/01.prs.0000256522.22911.ed
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PMID: 17415276
Issn Print: 0032-1052
Publication Date: 2007/04/15
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Excerpt
Severe postburn hand deformities have been classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Severe postburn hand deformities can be corrected with extensor tenotomy, joint capsulotomy, and release of the volar plate and collateral ligament. Aggressive contracture release of the bone, joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.1 The conventional lifestyle and enclosed daily activities in the southeastern part of Turkey have resulted in a different kind of causative agent of burn: the tandir. Most victims of tandir accidents sustain severe burns to the head, neck, and hands. These burn victims do not have adequate burn care facilities, and most of their burn care is administered at home, resulting in terribly scarred and distorted heads and faces and severely deformed hands.2 We present a patient whose hand was burned in a tandir in childhood (Fig. 1).
A patient presented with severe burn extension contracture in her hand, especially in the index finger and to a minimal degree in the little finger. We operated on the hand in one session. First, we performed dorsal release and then carried out the fixation using Kirschner wire. Later, we restored the soft-tissue defect with a reverse forearm fasciocutaneous flap and full-thickness skin graft. The patient was then included in an exercise program (Fig. 2).
Many treatment choices have been mentioned in literature. We believe that hand contractures, especially severe burn hand contractures, should be very painstakingly treated. This treatment method can give the patient a chance for a nearly normal hand position compared with other treatments.
