Pre-operative scrutiny of late burned hand presentations: Crucial step for the improvement of results

Abstract

Post burn contractures are a common occurrence after severe burn injuries. In more than 80% of all burns, the hand is involved (Fufa et al., 2014). This article aims to emphasize on the need of detailed pre-operative scrutiny of hand deformities and guide a burn surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The study is a prospective, non-randomized, observational study of patients presenting with post burn deformities of hand(s) requiring surgical intervention. McCauley’s classification of burn scar contracture in hand was used to classify the post burn deformities. A total of 1021 patients with 23 cases of both hands (total, 1044 hands) were included over a period of 60 months (5 years) from Jan 2015 to Dec 2019. A total of 449 cases (43%) were reconstructed with STSG, FTSG in 261 (25%) cases, Z-plasty in 86 (8.2%) cases, FTSG & Z-plasty in 136 (13%) cases, local, loco-regional and distant flaps in 98 (9.3%) and 14 (1.3%) cases required amputations for uncorrectable deformities. Overall functional improvement in the study was satisfactory, with good recovery in 689 (66%) resurfacing procedures, average recovery in 282 (27%) procedures and poor recovery in only 73 (7%) procedures. Preoperative assessment, surgical planning and meticulous execution, extensive physiotherapy, proper splintage and regular follow-up at least for 3 to 5 years after operation are the secrets of better functional recovery.

Keywords

• Hand
• Post burn
• Deformities
• Skin grafting
• Z-plasty
• Preoperative