Postburn dorsal and palmar interdigital commissural contractures: Anatomy and treatment—A new approach

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.


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Grishkevich, V. (2013) Postburn dorsal and palmar interdigital commissural contractures: Anatomy and treatment—A new approach. Advances in Bioscience and Biotechnology, 4, 518-530. doi: 10.4236/abb.2013.44068.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Kalliainen, L.K. and Schubert, W. (2005) The management of web space contractures. Clinical Plastical Surgery, 32, 503-514. doi:10.1016/j.cps.2005.06.002
[2] Gulgonen, A. and Ozer, K. (2007) The correction of postburn contractures of the second through fourth web space. Journal of Hand Surgery, 32A, 556-564. doi:10.1016/j.jhsa.2007.01.017
[3] Grishkevich, V.M. (2010) Trapezeflap plasty: An effective technique for postburn edge elbow contracture elimination. Shoulder and Elbow, 2, 273-280. doi:10.1111/j.1758-5740.2010.00077.x
[4] Grishkevich, V.M. (2011) Post-burn microstomia: Anatomy and elimination with trapeze-flap plasty. Burns, 37, 484-489. doi:10.1016/j.burns.2010.09.003
[5] Smith, M.A., Munster, A.M. and Spence, R.J. (1998) Burns of the hand and upper limb—A review. Burns, 24, 493505. doi:10.1016/S0305-4179(98)00063-1
[6] Asuku, M.E., MacCauley, R.L. and Piazza, R.C. (2005) Reconstruction of the burned hand. In: MacCauley, R.L., Ed., Functional and Aesthetic Reconstruction of Burned Patients, Taylor and Francis, Boca Raton, 437-462.
[7] Sood, R., Brenner, K., Bruce, M. and Achauer, B.M. (2006) Reconstruction of the burned hand. In: Sood, R., Ed., Achauer and Sood’s Burn Surgery. Reconstruction and Rehabilitation, Saunders, Elsevier, 307-323.
[8] Parry, S.W. (1989) Reconstruction of the burned hand. Clinical Plastical Surgery, 16, 577-586.
[9] Germann, G. and Phillip, K. (2005) The burned hand. In: Green, D.P., Hotchkiss, R.N., Pederson, W.C., Wolfe, S.W., Eds., Green’s Operative Hand Surgery, Elsevier Churchill Livingstone, Philadelphia, 2159-2190.
[10] Mlakar, J.M. and Dougherty, W.R. (2002) Reconstruction of the burned hand. In: Herndon, Ed., Total Burn Care, W.B. Saunders, Philadelphia, 628-655.
[11] Kurtzman, L.C. and Stern, P.J. (1990) Upper extremity burn contractures. Hand Clinics, 6, 261-279.
[12] El-Din, S.A.S., El-Din, A.B., El-Shafeey, E.-S. and Shouman, O.M. (2000) Reconstruction of post burn palmar web contractures: A surgical approach. Egypt Journal of Plastic and Reconstructive Surgery, 23, 29-33.
[13] Savaci, N., Hosnuter, M. and Tosun, Z. (1999) Use of reverse triangular V-Y flaps to create a web space in syndactyly. Annals of Plastic Surgery, 42, 540-544. doi:10.1097/00000637-199905000-00013
[14] Rousso, M. and Wexler, R.M. (1978) Secondary reconstruction of the burned hand. Progressive Surgery, 16, 182-206.
[15] Rouge, D., Bondar, R., Grolleau, J.L., Braye, F., Micheau, P., Chavoins, J.P. and Costagliola, M. (1996) Spearhead procedure for repair of web space burn sequelae. European Journal of Plastic Surgery, 19, 77-80. doi:10.1007/BF00207919
[16] Alexander, J.W., MacMillan, B.G. and Martel, L. (1982) Correction of postburn syndactyly: An analysis of children with introduction of the WM plasty and postoperative pressure insert. Plastic and Reconstructive Surgery, 70, 345-354. doi:10.1097/00006534-198209000-00009
[17] Davami, B. (2009) V-M plasty and double Z-plasty: Two versatile flaps for treatment of postburn syndactyly. Techniques in Hand & Upper Extremity Surgery, 13, 124-129. doi:10.1097/BTH.0b013e3181a6b5e1
[18] Tan, O., Atik, B. and Ergen, D. (2005) Versatile use of the VM-plasty for reconstruction of the web space. Annals of Plastic Surgery, 55, 623-628. doi:10.1097/01.sap.0000181651.66907.8f
[19] El Kollali, R., Ghoneim, I. and Al-Azemi, M. (2006) V-N plasty for release of severe postburn contractures. Journal of Plastic, Reconstructive & Aesthetic, 59, 1424-1428. doi:10.1016/j.bjps.2006.01.043
[20] Lapid, O. and Sagi, A. (2005) Three-square-flip flap reconstruction for post burn syndactyly. British Journal of Plastic Surgery, 58, 826-829. doi:10.1016/j.bjps.2005.04.001
[21] Browne Jr., E.Z. Teague, M.A. and Snyder, C.C. (1972) Burn syndactyly. Plastic and Reconstructive Surgery, 62, 92-95. doi:10.1097/00006534-197807000-00014
[22] Rampazzo, A., Gharb, B.B. and Bassetto, F. (2008) “Four flap’s technique” for the reconstruction of grade 4 postburn dorsal neosyndactyly. Burns, 34, 144-147. doi:10.1016/j.burns.2007.04.015
[23] Hultman, C.S., Teotia, S., Calvert, C., Thorntton, S. and Schram, J. (2005) STAR plasty for reconstruction of the burned web space: Introduction of an alternative technique for the correction of dorsal neosyndactyly. Annals of Plastic Surgery, 54, 281-287.
[24] Smith, P.J. and Harrison, S.H. (1982) The “seagull” flap for syndactyly. British Journal of Plastic Surgery, 35, 390393.
[25] Emsen, I.M. (2008) The cross incision plasty for reconstruction of the burned web space: Introduction of an alternative technique for the correction of dorsal and volar neosyndactyly. Journal of Burn Care and Research, 29, 378-385. doi:10.1097/BCR.0b013e31816673cd
[26] Murakami, M., Hyakusoku, H. and Ogawa, R. (2005) Band rotation flap. Burns, 31, 220-222. doi:10.1016/j.burns.2004.09.012
[27] MacDougal, B., Wray, R.C. and Weeks, P.M. (1976) Lateral-volar finger flap for the treatment of burn syndictyly. Plastic and Reconstructive Surgery, 57, 167-712. doi:10.1097/00006534-197602000-00006
[28] Klein, M.B. (2011) Burn reconstruction. Physical Medicine and Rehabilitation Clinics of North America, 22, 311-326. doi:10.1016/j.pmr.2011.01.002
[29] Grishkevich, V.M. (1991) The basic types of scar contractures after burns and methods of elimination them with trapeze plasty flaps. Plastic and Reconstructive Surgery, 88, 1044-1054. doi:10.1097/00006534-199112000-00015

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