title: Postburn hand border contractures and eliminating them with trapeze-flap plasty.
abstract: The hand burns can be complicated with the scar contracture of the ulnar or radial hand border. The contracture restricts the mobility of adjacent joints (fifth interphalangeal, wrist joints), causing deviation of the small finger and the whole hand. The contracture and deviation are caused by semilunar fold sheets of which are scars (medial contracture). The fold sheets have the trapeze-shaped surface deficiency in length and surface surplus in width. Thus, the local tissue flaps should have the corresponding form (trapeze-shaped flaps) for surface deficiency compensation. The sheets are transformed into trapezoid flaps along the total length of the semilunar fold with radial incisions until the full tension release is achieved. The incision's ends are split to complete the scar tension release. The distance between radial incisions at the fold's top is approximately 2 to 3 cm, which matches the width of the flap's end. The flaps are mobilized with the full fatty layer and transposed toward each other until the end of one flap reaches the base of the opposite flap. As a result, the skin surface lengthens by two to three times, which allows complete contracture elimination. The contractures were liquidated in all 16 patients without complications. The trapeze-flap plasty is recommended for a wide use in treatment of hand boarder contractures.
authors.affiliation: Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Sciences. Moscow, Russia.
authors.forename: Viktor M
authors.initials: VM
authors.lastname: Grishkevich
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000601:surgery*; D002648:Child; D002921:Cicatrix / Q000517:prevention & control*; D003286:Contracture / Q000517:prevention & control*; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D016896:Treatment Outcome