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KMID : 0853020170200010031
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Journal of Korean Burn Society
2017 Volume.20 No. 1 p.31 ~ p.40
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Optimizing Outcomes in the Reconstruction of Postburn Scar Hand Deformities
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Kim Dong-Chul
Shin Chi-Ho
Han Yae-Sik
Chung Sang-Hun
Kim Ji-Hyun
Lee Ryun
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Abstract
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Purpose: Reconstruction of severe postburn hand deformities with flexion or extension contractures with finger webbing deformities, large hypertrophic scars of dorsal hand are frequently encountered problems in burn hand surgery. To obtain the good results after correction of various type of postburn scar hand deformities, we have used the sophisticated reconstructive procedures such as scar contracture release, skin graft, and use of acellular dermal matrix (ADM). We report reliability and usefulness of these novel updated procedures according the type of postburn hand deformities, and reviewed the literatures.
Methods: We had 82 postburn hand deformities. Among them we selected 7 patients of severe postburn hand deformities, which had different affected sites involving over 1/3 of hand. To reconstruct the finger flexion contractures, the scar contracture release and full thickness skin graft was most frequently performed. For correction of finger webbing deformities, the 5 flap Z-plasty for 1st web, dorsal and volar interposition flap for 2, 3 and 4 web, FTSG were used. The diffuse hypertrophic scar of dorsum of hand was reconstructed with total excision of scars, skin coverage with one piece of medium thickness STSG, and postoperative clenched hand position. The postburn palmar contractures was reconstructed with extensive contracturerelease followed by resurfacing with ADM (AlloDermTM) and thin STSG. The severe postburn abduction contractures of wrist was treated by total excision of scars, ADM (CGDermTM), and thin STSG.
Results: After 1 month to 1.6 years follow up, relatively satisfactory results were obtained in all patients. As complications, 1 case of recurrent palmar contractures, which was reconstructed with ADM (AlloDermTM) with thin STSG, were noticed.
Conclusion: The postburn finger flexion contractures could be managed by the scar contractures release and FTSG. This method is very safe and reliable. For reconstruction of postburn finger webbing deformities, it is mandatory to use 5-flap Z-plasty for 1st webbing deformities, and dorsal and volar interposition flap for 2, 3 and 4th webbing deformities concomitantly with resurfacing with FTSG. The diffuse hypertrophic scars of dorsum of hand was managed by total excision of scars, resurfacing with one large piece of over medium thickness STSG, and postoperative clenched hand position. After release ofscar contractures of hand, acellular dermal matrix (ADM) with thin STSG can be used in case of deficient FTSG donor site.
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KEYWORD
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Burn hand deformities, Webbing deformities, Clenched hand position, Finger contracture, Hypertrophic scars of dorsum of hand
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