Burn contractures Sarah Tucker November 2016

Why flaps? Contracture recurrence rates SSG 50% FTSG 20% Pensler et al. Cutaneous flaps 0% Waterstone and Quabba

Location of Contracture Neck 10 Axilla 5 Elbow Upper back 1

Perforators mapped pre-operatively with a handheld doppler probe Known perforator flap used when appropriate Adhoc flap used in remainder of cases Full soft tissue release of the contracture Perforator flap raised and inset

Results 3 partial flap necrosis requiring split skin graft of the superficial layer only

Hand contractures

Distal to the distal palmar crease Thin scar with supple tissue around no Mid-axial to midaxial H shaped incision and ‘fall back’ flaps yes Z plasty attempted +/- FTSG

flag flap based on perforator at 2nd web space Is the wound bed suitable for a graft? Is the PIPJ flexor surface perfect for a graft? NO Index and middle; flag flap based on perforator at 2nd web space Ring and little; Cross finger flap yes FTSG

Radial forearm fascial flap and thick SSG Palm More than 2/3 involved? No FTSG Yes Radial forearm fascial flap and thick SSG

Extensor surface contracture with hyperextension of the MCPJ’s Defect all proximal to MCPJs? Yes; Posterior interosseus artery flap No; radial forearm flap