Reconstruction of severe hand contractures: An illustrative series

AIM: An overview of a series of severe burn contractures in 44 hands reconstructed over a 20 month period with an easy to follow algorithm. SETTINGS AND DESIGN: The series was carried out by a single surgeon at Green Pastures Rehabilitation Centre in Pokhara, Nepal. All patients attending with severe burn contractures to the hand were included in the series. MATERIALS AND METHODS: This is a retrospective review of burn contractures in a total of 44 hands. All the contractures involved limitation of movement by 60 degrees in two or more joints or by 80 degrees in one joint. The decision making process is presented as a flow chart indicating when and which flaps were used. RESULTS: Illustrations demonstrate what was achieved, with all hands obtaining an improvement in function. CONCLUSIONS: Although many of these contractures can be dealt with by skin grafting the series clearly illustrates the indications for flap coverage.