RESUMEN
INTRODUCTION: Persistent postburn flexion contractions of the digits present challenging deformities. The surgical goal is to lengthen the linear scar band on the flexion surface of a finger through local tissue rearrangement using different z-plasty techniques. This study aimed to analyse the length gain and compare outcomes between 5-flap z-plasty and double serial z-plasty techniques for correcting digital flexion contracture. PATIENTS & METHOD: This retrospective study was conducted from November 2022 to January 2024 on patients who presented with digital flexion contractures caused by volar linear scar contracture and who needed surgical intervention. All patients who underwent correction via the 5-flap z-plasty or double z-plasty technique were categorized into two groups. RESULTS: A total of 12 patients were included in this study. All patients successfully achieved complete release of their digital contracture in both groups. While there was a significant increase in the length of the contracture band and extensor lag angle postoperatively in both groups, the mean increase in band length for patients treated with five-flap Z-plasty was significantly greater than that for patients treated with double z-plasty (63.667±13.125% vs. 41.333±12.1764%, respectively). CONCLUSION: The 5-flap Z-plasty technique could be a more favourable alternative to the frequently used double z-plasty method due to its ability to achieve a superior rate of elongation in the contracture band and restore finger function when treating linear digital flexion contractures.
RESUMEN
Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.