TITLE:
Postburn dorsal and palmar interdigital commissural contractures: Anatomy and treatment—A new approach
AUTHORS:
Viktor M. Grishkevich
KEYWORDS:
Postburn Syndactyly; Syndactyly Treatment; Hand Burn Complications; Trapezoid Flap; Trapeze-Flap Plasty
JOURNAL NAME:
Advances in Bioscience and Biotechnology,
Vol.4 No.4,
April
18,
2013
ABSTRACT: Background: Postburn dorsal and palmar interdigital commissural contracture is
one of the most common complications of hand burns which restricts finger
motion and presents a serious cosmetic defect. Many techniques and flaps have
been suggested, and research continues for more effective techniques as the
problem has not been solved. Methods:
Anatomy of scar interdigital commissural contractures was studied in 760
operated patients aiming to develop a new, more
effective surgical technique. Results:
There are two anatomic types of scar
commissural contractures: edge and total. Dorsal and palmar commissural
contractures are identified as the edge type and are caused by the fold located along interdigital fossa’s edge. In
the fold, the lateral sheet is scars, and the medial sheet and adjacent
interdigital fossa are healthy skin. Total commissural contracture is characterized
by interdigital fossa obliteration and phalanges’ fusion. Scar sheets have a trapeze-shaped surface
deficiency (contracture cause), which spreads from the fold’s crest to metacarpophalangeal joints.
The surgical technique consists of scar surface deficiency compensation and
commissural groove and slant restoration which can be optimally achieved with
the trapezoid adipose-cutaneous flap. The best donor site is interdigital fossa.
The small skin grafts on the lateral surface of proximal phalanges did not present
a cosmetic defect. Conclusion:
Dorsal and palmar interdigital commissural
contractures are of an edge type and
can be successfully reconstructed with trapeze-flap plasty.