1. Burn contractures
Sarah Tucker
November 2016

5. Why flaps? Contracture recurrence rates SSG 50% FTSG 20%
Pensler et al.
Cutaneous flaps 0%
Waterstone and Quabba

6. Location of Contracture
Neck 10
Axilla 5
Elbow
Upper back 1

7. Perforators mapped pre-operatively with a handheld doppler probe
Known perforator flap used when appropriate
Adhoc flap used in remainder of cases
Full soft tissue release of the contracture
Perforator flap raised and inset

22. Results
3 partial flap necrosis requiring split skin graft of the superficial layer only

23. Hand contractures

24. Distal to the distal palmar crease
Thin scar with supple tissue around no
Mid-axial to midaxial H shaped incision and ‘fall back’ flaps
yes
Z plasty attempted +/- FTSG

25. flag flap based on perforator at 2nd web space
Is the wound bed suitable for a graft? Is the PIPJ flexor surface perfect for a graft? NO
Index and middle;
flag flap based on perforator at 2nd web space
Ring and little;
Cross finger flap
yes
FTSG

27. Radial forearm fascial flap and thick SSG
Palm
More than 2/3 involved? No
FTSG
Yes
Radial forearm fascial flap and thick SSG

29. Extensor surface contracture with hyperextension of the MCPJ’s
Defect all proximal to MCPJs?
Yes; Posterior interosseus artery flap
No; radial forearm flap