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Published byWilfred McKinney Modified over 5 years ago
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Burn contractures Sarah Tucker November 2016
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Why flaps? Contracture recurrence rates SSG 50% FTSG 20%
Pensler et al. Cutaneous flaps 0% Waterstone and Quabba
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Location of Contracture
Neck 10 Axilla 5 Elbow Upper back 1
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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
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Results 3 partial flap necrosis requiring split skin graft of the superficial layer only
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Hand contractures
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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
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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
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Radial forearm fascial flap and thick SSG
Palm More than 2/3 involved? No FTSG Yes Radial forearm fascial flap and thick SSG
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Extensor surface contracture with hyperextension of the MCPJ’s
Defect all proximal to MCPJs? Yes; Posterior interosseus artery flap No; radial forearm flap
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