Management of established Volkmann's contracture of the forearm in children.

As with many diagnoses in medicine, the best treatment for Volkmann's ischemic contracture is prevention. Early recognition and prompt treatment of impending Volkmann's ischemia should decrease the presentation and severity of late contracture and hand dysfunction. The authors have found the flexor muscle slide the best treatment option for mild and moderate deformity. This procedure can be combined with additional reconstructive procedures to maximize functional outcome. The authors believe this procedure results in the best preservation of the muscle resting length and limits the scarring around the adjacent muscles. For severe cases,early wide excision with functional free-muscle transfer may limit the injury to the nerves, decreasing the distal problems associated with mo-tor and sensory impairment in the hand.