Burns-Postburn Contractures of the Hand

Postburn Contractures of the Hand

Pdf Summary

Postburn contractures of the hand are a common sequelae of deep thermal injury to the hand. Despite appropriate initial management, contractures can occur and limit hand function. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly can be managed with scar excision and local tissue rearrangement or skin grafting. The burn claw hand, which presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints, is treated with complete surgical excision of scar tissue and resurfacing of the soft tissue defect, usually with full-thickness skin grafts. Early motion and rehabilitative modalities are crucial to prevent initial contracture formation and recontracture after surgical release. Nonsurgical management includes splinting, early range of motion, compressive therapies, orthosis fabrication, and scar massage. Indications for surgical release include functionally limiting contractures and lack of improvement with nonsurgical methods. Surgical management of webspace contractures involves local soft tissue rearrangement, and severe cases may require additional releases and the use of grafts or tissue transfer. The surgical management of burn claw hand includes scar excision and release of the deeper structures, followed by resurfacing with full-thickness skin grafts. Postoperative rehabilitation includes splinting, motion exercises, scar massage, and the use of compression garments to prevent recurrence. Overall, the surgical correction of burn contractures results in significant functional improvement.

Keywords

postburn contractures

hand

thermal injury

webspace contractures

postburn syndactyly

scar excision

local tissue rearrangement

skin grafting

burn claw hand

surgical excision