Management of Post-Burn Hand Contractures in Yemen

Abstract

Background: Burn contractures of the hand cause significant physical and mental impairment, compromising a patient's quality of life. Reconstructive surgery aims to restore both function and aesthetics by releasing contractures, creating adequate web spaces, and separating fused digits.
Methods: This prospective descriptive study evaluated the functional outcomes of various reconstructive techniques in 60 patients with post-burn hand contractures. The primary objective was to identify the most effective surgical interventions for restoring hand function for daily activities.
Results: The patient cohort consisted primarily of females (63.26%), with most patients aged between 19 and 50 years (median age: 19 years), and a majority (85.17%) were right-handed. The surgical procedures employed included split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), Z-plasty, and cross-finger flaps. Early postoperative complications included infection (3.3%), graft loss requiring reoperation (3.3%), and flap tip necrosis (1.7%), which was managed conservatively. Late complications involved contracture recurrence in 8.4% of cases and the development of hypertrophic scars in 5%.
Conclusions: Post-burn hand contractures can be effectively managed using Z-plasty, its modifications, and skin grafts. Achieving optimal outcomes is multifactorial and depends critically on a robust postoperative regimen of physiotherapy and splinting. Furthermore, the appropriate selection of the reconstructive technique based on the contracture's characteristics and donor tissue availability, combined with the surgeon's experience, are crucial for successful functional and aesthetic restoration.