Clinical outcomes of lateral digital flap–based local flap combinations in the reconstruction of post-burn metacarpophalangeal joint contractures: Management of MP joint post-burn contractures

Cenk Melikoglu

doi:10.28982/josam.8505

Authors

Cenk Melikoglu Department of Plastic Surgery, Ekol Hospitals, Izmir, Turkey https://orcid.org/0000-0002-6944-721X

DOI:

https://doi.org/10.28982/josam.8505

Keywords:

burn sequelae, MCP joint contracture, lateral digital flap, local flap reconstruction, Z-plasty

Abstract

Background/Aim: Post-burn metacarpophalangeal (MCP) joint contractures may severely impair hand function due to scar formation involving the palmar surface and volar digital skin. This study aimed to evaluate the clinical and functional outcomes of local flap combinations based on the lateral digital flap for the reconstruction of post-burn MCP joint contractures.

Methods: This retrospective case series included nine male patients who underwent surgical treatment for post-burn MCP joint contractures between May 2010 and April 2011. A total of 48 local flaps were applied in various combinations according to contracture localization and defect characteristics. The lateral digital flap was used as the primary reconstructive method, rhomboid flaps were used for web space reconstruction, and five-flap Z-plasty was applied selectively for deformities involving the palmar surface and/or first web space. All flaps were designed before contracture release, and dissections were performed under tourniquet control with magnification. Clinical outcomes were assessed using postoperative extension deficit and follow-up duration (months).

Results: All patients had contractures at the MCP joint level, with concomitant web space involvement in some cases. Complete restoration of MCP joint extension was achieved in eight patients. One patient had a 10° extension deficit localized to the proximal interphalangeal joint rather than the MCP joint. Follow-up ranged from 1 to 10 months. No flap loss or major postoperative complications were observed during follow-up.

Conclusion: Local flap combinations based on the lateral digital flap constitute a biomechanically compatible, reliable, and functionally effective reconstructive option for post-burn MCP joint contractures in the early to mid-term period. In patients with multiple MCP joint contractures accompanied by web space deformities, combining the lateral digital flap with rhomboid flaps and/or five-flap Z-plasty allows comprehensive correction within a single surgical session.

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References

Liu HY, Alessandri-Bonetti M, Kasmirski JA, Stofman GM, Egro FM. Free flap failure and contracture recurrence in delayed burn reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2024;12(8):e6026. doi: 10.1097/GOX.0000000000006026.

Dilek ÖF, Sevim KZ, Dilek ON. Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons. World J Clin Cases. 2024;12(35):6791-807. doi: 10.12998/wjcc.v12.i35.6791.

Hayashida K, Akita S. Surgical treatment algorithms for post-burn contractures. Burns Trauma. 2017;5:9. doi: 10.1186/s41038-017-0074-z.

Köse R. El parmaklarının yanığa bağlı fleksiyon kontraktürlerinin lateral parmak flebi ile onarımı. Fırat Tıp Dergisi. 2008;13(1):15-7.

Chang LS, Kim YH, Kim SW. Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps. ANZ J Surg. 2021;91(9):E578-83. doi: 10.1111/ans.16640.

Bali ZU, Özkan B, Keçeci Y, Ertaş N, Yoleri L. Reconstruction of burn contractures with free anterolateral thigh flap in various anatomic sites. Ulus Travma Acil Cerrahi Derg. 2021;27(4):337-43.

Chen HC, Wu KP, Yen CI, Chang CH, Chen HC, Tang YB, et al. Anterolateral thigh flap for reconstruction in postburn axillary contractures. Ann Plast Surg. 2017;79(2):139-44. doi: 10.1097/SAP.0000000000001097.

Ma Z, Mo R, Chen C, Meng X, Tan Q. Surgical treatment of joint burn scar contracture: a 10-year single-center experience with long-term outcome evaluation. Ann Transl Med. 2021;9(4):303. doi: 10.21037/atm-20-4947.

Schneider JC, Holavanahalli R, Helm P, Goldstein R, Kowalske K. Contractures in burn injury: defining the problem. J Burn Care Res. 2006;27(4):508-14. doi: 10.1097/01.BCR.0000225994.75744.9D.

Oosterwijk AM, Mouton LJ, Schouten H, Disseldorp LM, van der Schans CP, Nieuwenhuis MK. Prevalence of scar contractures after burn: a systematic review. Burns. 2017;43(1):41-9. doi: 10.1016/j.burns.2016.08.002.

Stekelenburg CM, Marck RE, Tuinebreijer WE, de Vet HCW, Ogawa R, van Zuijlen PPM. A systematic review on burn scar contracture treatment: searching for evidence. J Burn Care Res. 2015;36(3):e153-61. doi: 10.1097/BCR.0000000000000106.

Woo SH, Seul JH. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers. Plast Reconstr Surg. 2001;107(1):1-8. doi: 10.1097/00006534-200101000-00001.