Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Novel Technique of Stellate/Short liner finger flexion contracture release – Free style Triangular/Quadrangular flaps (1691)

Samitha Prasad Iddagoda Hewage Don 1
  1. Plastic and Reconstructive Surgery Department, Waikato DHB, Hamilton, Waikato, New Zealand

Background -
Finger skin contracture bands show various morphologies depending on the nature of initial traumatic insult. Small areas of deep burns over flexor aspects or focal trauma, mainly industrial accidents over joints can cause stellate or short linier contractures which are often debilitating and reduce hand functions.

Methodology/Surgical Technique -
We selected five patients who had stellate or short liner cars with flexor contracture significant enough to cause loss of important hand functions.

Pathoanatomy of the scar itself & contracture bands were delineated first which usually extend radially from the center of the scar. These are observed along the direction of tension and tissue expansion is seen between them.
Free style triangular and quadrangular flap incisions were marked along those scar bands. This was possible as these scar bands spread in triangular fashion. Then we mark opposing triangular flaps to complete z plasties or V-Y type advancement flaps. Flaps extended down to the flexor sheath and to mid axial lines.
Once adequate extension achieved triangular flaps were rearranged and sutured together in either Z or V-Y fashion +/- skin grafting.

Results
Three out of five patients were children between 10-18 years and two were adults. Four were males. In all cases we could achieve enough extension of the finger to keep it flat on the table.
We did not observe any flap losses. 2 patients complained of transient altered sensation at the tip of the finger in the first 24 hours. Occupational therapy started subsequently & at the end of the 3 months all demonstrated complete functional recovery with well settled scars.

Discussion
In this technique we use pathoanatomy of the scar itself to achieve the contracture release and subsequent reconstruction.

Conclusion
We have demonstrated full functional contracture release, excellent cosmesis with less morbidity & less chance for recurrence.

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  2. Kurtzman LC, Stern PJ. Upper extremity burn contractures. Clin Plast Surg. 1990;6:261–79.
  3. Hajashida K, Akita S. Surgical treatment algorithms for postburn contractures. Burn Trauma. 2017;5:1–9