Management of postburn digital flexion contractures.

Objective: To determine the outcome of plantar/palmer skin graft for the management of postburn digital flexion contracture in terms of functional and cosmetic improvements.

Design: Interventional quasi-experimental study.

Place And Duration Of Study: Department of Plastic and Reconstructive Surgery, PGMI, Hayatabad Medical Complex, Peshawar. The duration of the study was 1-1/2 years (from January 2001 to June 2002).

Patients And Methods: Fifty patients with postburn digital flexion contracture were recruited in the study. Patients with posttraumatic and postinfective contractures were excluded from the study population. The contracture was released and the deficit produced was replaced by plantar/palmer split skin graft. Active range of motion (ROM) was measured before and after surgery. Postoperative follow-up was done for one year. The outcome measurements were color and texture match of graft with the adjacent palmer skin, sensibility, recurrence rate of contracture and donor site morbidity. The data collected was labeled with the help of statistical package for social sciences (SPSS) and descriptive statistics were calculated accordingly.

Results: The graft take was complete (100%) in 48 patients, 50% in one patient (2%) and nil in one (2%) patient. Recurrence of contracture occurred in 5 patients (10%). Pre-operative median active range of motion (ROM) at proximal interphalangeal (PIP) joint was 60 degree to 90 degree (extension/flexion). Postoperatively median active range of motion (ROM) at PIP joint was 0 degree to 90 degree at one year follow-up examination. The healed graft showed good colour and texture match with the surrounding palmer skin. The sensory function return was satisfactory and there was no significant donor site morbidity.

Conclusion: The excellent colour, texture match and the functional advantages in terms of active range of motion and sensibility offered by the split thickness palmer/plantar skin grafts exceeded the expected outcome of conventional techniques (thigh, groin and buttock skin grafts).