title: Postburn contractures of the hand.
abstract: Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release.
authors.affiliation: Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: fufad@hss.edu.
authors.forename: Duretti T
authors.initials: DT
authors.lastname: Fufa
authors.affiliation: Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shiow-Shuh
authors.initials: SS
authors.lastname: Chuang
authors.affiliation: Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY; Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Jui-Yung
authors.initials: JY
authors.lastname: Yang
mesh_terms: D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003286:Contracture / Q000209:etiology* / Q000601:surgery*; D006227:Hand Deformities, Acquired / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D016038:Skin Transplantation; D013524:Surgical Flaps; D013576:Syndactyly / Q000209:etiology / Q000601:surgery
keywords: Burn; contractures; hand; reconstruction