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Severe postburn hand deformities were classified into three major patterns hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The softtissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap n4, dorsalis pedis flap n3, posterior interosseous flap n3, first web space free flap n3, and radial forearm flap n1. Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, keypinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone, joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand. Plast. Reconstr. Surg.107 1, 2001.

Until recently, osteotomies and surgeries to reposition prominent zygoma have been performed by means of a coronal incision or intraoral and preauricular incisions. Such incisions have penalties such as scars, the possibility of facial nerve injury, and long operative times. After reflecting on their past experiences with facial bone surgery, the authors developed an alternative approach. In this method, the cheekbone protrusion is corrected by performing an osteotomy and repositioning through an intraoral incision only.

Owing to its unique anatomic arterial supply and dual nerve innervation, the first web space of the foot can be used to harvest various sizes and shapes of flaps, which the authors have classified into four types according to their usage in hand reconstruction. This in turn depends on the site, shape, and size of the softtissue defect in the hand. Web skin flaps n8 were used in prevention of contracture in the first web space and for proximal finger reconstruction. Twoisland skin flaps n4 were used to resurface the pulp defect in two adjacent fingers. In severe adduction contracture of the first web space, fillup web flaps n10 were used to replace the volume defect after a release procedure in the hand. Adjuvant web flaps n9 were used in wraparound procedures, in dorsalis pedis flap transfer, and in vascularized joint transfer to supplement the main flaps and to restore sensation in the reconstructed area.

The great toe partialnail preserving transfer technique is another modification for distal thumb reconstruction in composite defects at or below the interphalangeal joint of the thumb. Noting the size difference of the nail width between the great toe and thumb, the authors dissected only a thumb nail width and skin flap from the great toe, leaving the remainder of the medial skin flap and nail of the great toe at the donor site. A total of 25 cases between 1993 and 1996 were performed using this technique, and the mean followup period was more than 12 months. The reconstructed thumb had a better cosmesis with a more natural appearance. At longterm followup, the thumb nail width decreased an average of 1.8 mm, but the pulp volume was almost the same as that of the normal contralateral side. The average static 2point discrimination was less than 9.0 mm. In cases with preserved interphalangeal joint, an average of 48 degrees of range of motion with keypinch of 80 percent of that of the normal contralateral thumb was achieved. The final appearance of the donor site with partial nail looks like a brachymetatarsia. Plast. Reconstr. Surg.101 114, 1998.