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Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The release of postburn contractures in the hand is one of the most commonly performed procedures in burn injuries. Various local flaps have been described for release of severe postburn contractures. As the largest burn center covering north and northwest of Iran, we always needed acceptable reliable methods to reconstruct postburn syndactyly and make it as a standard treatment. We used double Z-plasties for the first web in severe contractures (23 patients) and V-M plasties for the second, third, and fourth webs and minor first web contractures (V for the dorsal aspect and M for the volar aspect of the webs). A total of 50 patients from September 2005 to June 2007 with 130 web contractures were operated. Their age ranged from 1 to 75 years. In a 1-year follow-up, all of the patients had good mobility of the fingers with no recurrence. Three cases of necrosis of tip of Z-plasties and 2 cases of necrosis of tip of V-M plasties occurred which were under 3 mm and resolved gradually. Double Z-plasty in first web and V-M plasty in second to fourth webs are considered good choices for release and reconstruction of postburn syndactyly. They are straightforward in technique and can be carried out with little complications.

Significant hand burns frequently result in dorsal and/or palmar neosyndactyly despite appropriate wound care, excision/grafting, and occupational therapy. Patients often develop limited abduction, tethered flexion/extension, intrinsic tightness, and inversion of the web space. We present a new technique for neosyndactyly release "The Cross Incision Plasty." We performed a retrospective review of 15 patients who underwent 35 web space reconstructions by a single surgeon from January 2004 to February 2007. The cross incision plasty was developed before the study period with the following goals: to use local tissue, negate the need for a skin graft, and permit early range of motion. Combined with longitudinal and transverse releases, the cross incision plasty uses the four finger flaps, harvested from each sidewall of both proximal phalanges with 90-degree angle. The cross incision plasty simultaneously deepens and widens the web space while correcting the angle of inclination. Fifteen patients (mean age: 13.3 years; range: 3-24 years) underwent 35 cross incision plasties after burn injury. No complications such as infection, flap loss, dehiscence, nerve injury, or recurrent contracture were seen in the cross incision plasty group. All patients improved function (mean follow-up: 15.2 months; range: 9-22 months). The cross incision plasty is a new, safe, and efficacious technique to correct dorsal and palmar neosyndactyly and reconstruct the web space after burn injury.

Introduction: Burns of the hands may result in the formation of web space contractures-post burn syndactyly. We present our experience using the three-square technique originally described by Bandoh for minor syndactyly., Method: Tissues of the contracted web are regard as forming three facets of a cube. If elevated and transposed 90 degrees on their base the facets will fall into place and line the interior of the cube creating a deepened web-space. The first flap is based on the web itself either dorsally or volarly. The second flap is based distally on one of the fingers. The third flap is based laterally on the other finger. Surgery is followed by a splinting regimen., Results: The design of the flaps is simple and the operation is easy to perform. This technique has achieved good functional and cosmetic results; there have been no flap losses or significant complications., Conclusion: The three-square-flip-flap is a simple reliable and safe method for the treatment of post burn syndactyly.

Upper extremity burn contractures are a major challenge to the reconstructive surgeon. Despite increasing sophistication in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in the hand. Reconstructive options for axillary, antecubital, wrist, metacarpophalangeal joint, and interdigital web contractures are discussed, with special emphasis on the techniques and advantages of local flap reconstruction.

To completely open the web space in burn syndactyly and provide tissue that is pliable and elastic, we describe a flap from the lateral and volar surfaces of an adjacent finger which will completely cover the opened defect. The results of this procedure in 24 web spaces are reported.

A technique is described for the treatment of post-burn syndactyly using a seagull shaped flap to produce a realistic commissure that does not subsequently advance distally. It can release volar digital contractures at the metacarpo-phalangeal level and import skin with tactile "adherence" into the distal palmar area.

When the entire digital web space has been destroyed by burn scarring and there is a contracture of the volar aspect of the web as well as the dorsum, Z-plasties and skin grafts alone seldom produce a satisfactory web space. During the past 3 years, for the release of 46 contracted web spaces in 20 burned patients, we have turned a rectangular flap from the dorsal surface of the web through into an inverted-T incision in the palm. The adjacent sides of the defects have been skin grafted. In all these patients, we obtained satisfactory release of the contracture and restoration of the web space.