Morad Askari1, Myles J Cohen, Peter H Grossman, David A Kulber. 1. Los Angeles and Sherman Oaks, Calif. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California; Cedars-Sinai Hospital; and the Grossman Burn Center.
Abstract
BACKGROUND: Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery--at times--as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored. METHODS: Nine patients with burn contracture scars involving different locations in the hand and the wrist underwent two-stage reconstruction consisting of contracture release and use of acellular dermal matrix followed by definitive coverage with skin graft at the second stage. Patients were followed up for a period of at least 10 months (range, 10 to 25 months), during which time the passive range of motion of the hand was used as a quantitative measure of surgical outcome. RESULTS: All nine patients retained at least 83 percent of the corrected range of motion involving the affected joints by 1 year and at least 89 percent of correction at each webspace. No patient required a revision procedure. CONCLUSION: Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.
BACKGROUND:Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery--at times--as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored. METHODS: Nine patients with burn contracture scars involving different locations in the hand and the wrist underwent two-stage reconstruction consisting of contracture release and use of acellular dermal matrix followed by definitive coverage with skin graft at the second stage. Patients were followed up for a period of at least 10 months (range, 10 to 25 months), during which time the passive range of motion of the hand was used as a quantitative measure of surgical outcome. RESULTS: All nine patients retained at least 83 percent of the corrected range of motion involving the affected joints by 1 year and at least 89 percent of correction at each webspace. No patient required a revision procedure. CONCLUSION: Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.
Authors: Ahmed M S Ibrahim; Pieter G L Koolen; Azra A Ashraf; Kuylhee Kim; Marc A M Mureau; Bernard T Lee; Samuel J Lin Journal: Plast Reconstr Surg Glob Open Date: 2015-05-07