Surgical Management of Post Burn Hand Deformities (original) (raw)
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Study on Surgical Management of Post Burn Hand Deformities
Journal of clinical and diagnostic research : JCDR, 2015
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...
The Professional Medical Journal, 2021
Objective: To determine the frequency of success of acellular dermal matrix and split thickness skin graft in release of post burn contractures in hand using Vancouver scar scale. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st March, 2019 to 30th October, 2019. Material & Method: A descriptive case series conducted at Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Center, Lahore. A sample size of 75 patients, who full filled the inclusion criteria, was selected through non probability consecutive sampling Informed consent was obtained from all the patients. Pre-operative photography was done to compare the post-operative results. After the release of contractures, coverage with acellular dermis and split thickness skin graft was performed. All the patients were followed up to 2 months and the outcome was assessed by Vancouver Scar Scale. The collected data was enter...
Indications and Predictors for Reconstructive Surgery After Hand Burns
The Journal of Hand Surgery, 2017
k{# and the Dutch Burn Repository R3 Group Purpose The objective of this study was to analyze the prevalence, indications, and type of reconstructive surgery and predictors of the outcomes of reconstructive surgery after hand burns. Methods A retrospective cohort study was conducted that included all patients admitted with acute hand burns in the Dutch burn centers from January 1998 through December 2002. The details of reconstruction including frequency, timing, indication, and techniques were collected over a 10-year follow-up period. Results Hand burns were seen in 42% (n ¼ 562 of 1,334) of all patients admitted with acute burns. Reconstructive surgery during the 10-year follow-up period was required in 15%. Contractures, especially of the first web space and little finger, were the most frequent indications for reconstructive surgery. Web spaces 1 to 3 and the little finger were the location most frequently operated on. The most frequently performed surgical technique was release of the contractures and the use of a random flap. Eighty percent of the reconstructive surgery patients required more than 1 reconstructive procedure, most often within 2 years of the initial injury. Secondary operations at the same location were required in 12%. In 40% of the patients, the first reconstructive surgery was performed within the first postburn year. Significant independent factors related to the need for reconstructive hand surgery were a larger area of full-thickness burns and surgical treatment of the hand during the acute phase. Conclusions Reconstructive surgery was required in 15% of patients who sustained hand burns. The majority of the patients requiring reconstructive surgery of the hand needed 2 or more operations to correct the contractures of the hand. Contractures of the little finger and first web space were the locations most frequently operated on. Patients with more extensive burns and who required hand surgery during the acute phase were more likely to need reconstructive surgery.
Management of Post Burn Mutilated Hand
This study included 40 cases suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital from June 2004 to May 2006. Their ages ranged between 4 and 45 years with a mean age 24.5 years. (Twenty-two females and eighteen males). They presented by a variety of post-burn hand deformities as the following: A-Dorsal hand contracture (14 cases). B-Volar contracture (10 cases). C-First web space contracture (3 cases). D-Post burn syndactly (2 cases). E-Wrist deformity (3 cases). F-Skin and tendon affection (2 cases). G-Complex deformity (6 cases). All patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post operative splintage of the hand for 10 days in cases covered by skin graft to prevent recontracture again. Also postoperative physiotherapy program started at the second week to gain good functional results. The follow-up period ranged from 6-20 months. The results were satisfactory in most of cases as regard: • Quality of coverage which was achieved in most of cases except one case which show partial loss of skin graft which healed by secondary intention. • Full range of motion was achieved in most of cases except that have joint affection. Conclusion: Based on our results, management of post burn hand deformity depend upon several factors: Initial treatment of burnd hand, it is of great importance for prevention of secondary deformities. • On secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. • The second step is the proper selection of methods of coverage for resultant defects using either skin grafts or flaps depending on the presence of exposed tendons, nerves or joints.
Trapeze Flap for Correction of Post Burn Finger Flexion Contractures
2020
Background and Objective: Scar flexion contractures of the fingers are a significant complication of burns of the hand, and they are a common cause of hand disability. Many reconstructive techniques are currently used however: the results are unsatisfactory in many of them. The objective is to evaluate the Trapeze flap for correction of post burn finger flexion contractures. Materials and Methods: This is a Prospective study conducted at Rizgary teaching hospital and CMC private hospital in Erbil-Iraq from May 2013 to June 2018. The data of 48 patients [103 fingers] with post burn contractures treated with Trapeze flap were included. Follow-up results were observed from 6 months to 1 year after surgery. Full finger active flexion and active extension was regarded as a good result. Results: Our study showed very high patient satisfaction rate about 96% (46 Patient out of 48]. Partial flap loss was a rare complication [ in one patient 2%] and infection in one patient 2%. In both the wounds healed with conservative management. post-operative scars were nearly invisible with no hypertrophic scar and no keloid formation, and the flaps' surface texture was close to the texture of undamaged fingers. There was no recurrence of the contractures. Conclusions: Trapeze flap is a reliable and effective local flap for reconstruction of fingers post burn flexion contracture with very high patient satisfaction and success rate.
Management and outcome in patients with post burn contracture
International Surgery Journal, 2018
Background: Post burn contractures are distressingly common and severe in developing nations and considered as a significant problem in developed countries as well. Despite advances in the overall management of burn injuries, severe post-burn contractures continue to be a formidable foe for reconstructive surgeons in developing countries.Methods: The study was carried out in Department of Surgery, Himalayan Institute of Medical Sciences, SRH University, Swami Ram Nagar, Dehradun over a period of 12months. Cases of the post burn contractures attended in the O.P.D were included in the study.Results: Contracture release with split thickness skin grafting STSG in 25 (55.5%) cases. Contracture release with STSG with flap cover was performed in 7 cases (15.5%), contracture release with K wire insertion with coverage was performed in 8 cases (17.7%) and Z plasty was performed in 5 cases (11%).Conclusions: There have been major advances in burn care in the last three decades and the mortali...
2019
Background: Square flap theoretically offers 2.82 times increase in the length of contracted surface as compared to maximum of 2.23 times of z-plasties. Aim: To assess the effectiveness of this technique for the most critical first web-space contracture, this study is done to find its efficacy. Methods: Case series was done in department of plastic surgery, JHL. 30 patients with first web-space contractures were included. Pre and post angle and length, and efficacy, as determined by post op angle of ≥ 90o, were recorded. Mean and standard deviation of numerical variables while frequency and percentages of qualitative variables were calculated. Data stratification and post stratification chi-square test was applied to check effect modifier. Results: Mean age was 17.90± 9.271 years. Male patients were 19, while female were 11. Mean duration of contracture was 1.523±0.424 years. Mean pre-operative length was 2.330 ± 0.4921 cm, while post-operative length was 4.470 ± 0.8579 cm. Mean pos...
Physiotherapy Approach to a Flexor Contracture in a Burned Hand After 30 Years
Materia Socio Medica, 2010
Introduction and Purpose: This case study describes the importance of postoperative rehabilitation program in case of contracture in the burned hand, several years ago. The purpose of this study is to report the results of kinesitherapy in restoring the functionality of burned hand, which is treated with various therapies and sessions such as: management of cicatrix, the amplitude of relocation in passive and active movements of affected joints, treatment for muscle atrophy, and coordination. Case Description: Our case study involves a 31-years old female, who after the release of flexor contracture by the plastic surgeon, was hospitalized with edematous hand, muscle hypotrophy, and limited amplitude of movement. Results: Improvements were noted in the amplitude of passive and active movements, and muscle strength. The assessment was performed according to Modified Strickland's classification, where the total active motion (TAM) was 17.6% during the first month of treatment, however after five months of treatment, TAM reached up to 52.8%, which is assessed as positive result. Discussion: The aim of this case study is to demonstrate the importance of burned hand treatment and the necessity of an adequate treatment program in order to reach the most effective results in the relocation of hand its functionality.
Management of severe burned-hand deformities at Huê Central Hospital
European Journal of Plastic Surgery, 2005
During the years 1998-2002 there was collaboration between surgeons at HueˆCentral Hospital and Belgian plastic surgeons coming each year to teach at the HueˆMedical School and to work at the Hospital. Of 150 hands deformed after burns admitted to HueˆCentral Hospital from 1998 to 2003, 52 patients presented with severe hand deformities. The classification of deformities was as follows: dorsal hand contractures-21 hands, palmar hand contractures-9 hands, and wrist contractures-22 hands. The management of these deformities is a combination of surgical treatment, postoperative splinting and physical exercise in order to regain the function of the hand as much as possible. The strategy of surgical procedures is based on the lesions of the individual patient. After releasing the contractures, the raw area is covered by skin grafts and local flaps. There were also 50 osteoarticular procedures. Long-term results: 'Good' 33% (17 hands), 'Mild' 13% (7 hands), 'Moderate' 50% (26 hands) and 'Poor': 4% (2 hands).
Medicina (Kaunas, Lithuania), 2009
Hands actively participate in daily activities of a human; therefore, hands are the most vulnerable parts of the human body. People injure hands so often because namely hands are in the closest position to the dangerous equipment. According to the data of various authors, the injuries of hands and fingers make even 30-75% of all industrial traumas, and burns of hands account for about 6% of all traumas of hands. The aim of the study was to compare the effectiveness of active surgical treatment method with conservative treatment method, applied for the treatment of deep dermal partial skin thickness burns of the hands, wrists, and forearms of distal third. A total of 49 patients with burned hands participated in the perspective study of random sample (totally 79 hands). All these patients were treated in the Department of Plastic and Reconstructive Surgery, Hospital of Kaunas University of Medicine, during the period of 2001-2005. The patients were assessed after 3, 6, and 12 months....