Repair of hand burn scar contracture deformity

Most of the hand burns occur on the back of the hand, so the contracture deformity of this part is also more common in the back of the hand. The hand is an important functional part, and the treatment of scar contracture should be done sooner rather than later, without waiting for the scar tissue to be completely stable, that is, surgery. Hand scar contracture can also be divided into two types: light contracture and heavy contracture deformity. Treatment of diseases: burns in children Indication Hand burns contracture deformity. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Excision of the scar: a large serrated incision along the edge of the contracted scar, and the scar tissue is completely excised by sharp and blunt separation to reveal the subcutaneous tissue. When cutting and separating, care should be taken not to damage the tendon and important blood vessels. After correcting the deformity, release the tourniquet and press with hot saline gauze to completely stop the bleeding. 2. Repair the wound: If the scar is on the palm of the hand, the area is small, and it can be repaired with full thickness skin. If the area is large or the wound is on the finger, it can be repaired with medium-thickness skin. The size of the skin cut should be the same as the size of the wound. Interrupted or continuous suture along the wound edge, followed by rinsing under the skin, pressure bandaging, fixation in the functional or antagonistic position. Claw-shaped hand repair The claw-shaped hand is a deformity caused by heavy scar contracture on the back of the hand. The main manifestations are: 1 thumb adduction, due to the contraction of the i-interbody and the adductor muscle. 2 metacarpophalangeal joint excessive extension, the dorsal side of the joint capsule contracted, and even caused joint dislocation, adhesion and joint capsule rupture. 3 proximal interphalangeal joint flexion or rigidity. 4 distal interphalangeal joint extension, flexion or rigidity, nail root exposure, nail thickening. 5 palm bow disappeared. 6 wrist joints are mostly buckling deformities. All of the above deformities need to be corrected during surgery. The wound after the scar resection should be repaired with a flap. The distal flap can be taken in the abdomen to prepare the skin tube. The free flap and the anterior forearm pedicle flap can also be taken. The distal flap or free flap and the ipsilateral forearm pedicle flap can be designed according to the size of the wound after scar removal. The method of repairing with a leather tube is now described. 1. Preparation of the skin tube: According to the size of the hand, and the size of the wound after the claw-shaped hand contracture scar is removed, it is estimated that the length and width of the skin tube (generally 18 × 6 cm) are required, and the skin tube is prepared in the abdomen. 2. Skin tube transfer: 3 weeks after the formation of the skin tube, one end of the skin tube can be cut and transferred to the back side of the hand. After another 3 weeks, the other end of the abdomen was transferred to the ulnar side of the hand. 3. Scar resection: 3 weeks after the completion of the transfer of the skin tube, the incision was performed along the scar margin, and the scar tissue was completely removed. In the case of scars and deep tissue adhesions, care should be taken not to damage the remaining tendons, blood vessels, nerves and deep tissues, and then completely stop bleeding. 4. Metacarpophalangeal joint reduction: After the scar is removed, most of the metacarpophalangeal joints are still stretched and cannot be reset, and further treatment is needed. (1) Cutting the collateral ligament: cut longitudinally along the sides of the extensor tendon at the joint to find the collateral ligament, cut or partially cut, and sometimes the joint can be repositioned. (2) release the dorsal joint capsule contracture, and separate the intra-articular adhesion: after the collateral ligament is cut, the joint can not be reset, indicating that the dorsal joint capsule has contracted, and the extensor tendon can be pulled to one side to expose the joint capsule and metacarpal head. neck. At this site, the periosteum and the joint capsule were made into a v-shaped incision, separated into petals, and tried to be reset. If it still cannot be reset, it means that there is adhesion in the joint, the joint surface should be exposed, and the joint is separated by a small stripper, which may reset the joint. Then, the periosteal flap is advanced to perform a vy forming procedure to repair the defect of the joint capsule. (3) metacarpophalangeal joint formation: If the metacarpophalangeal joint is still unable to flex and completely reset after the above treatment, the metacarpal head should be removed. The amount of resection should be based on the flexion of the metacarpophalangeal joint, and should not be removed too much. The end of the bone after the removal of the metacarpal head is rounded with the callus. 5. Correction of thumb adduction deformity: The fascia is cut along the ulnar side of the long thumb of the thumb, revealing the ulnar side of the first phalanx, cutting off the part of the adductor muscle and the first interosseous muscle fiber, so that the thumb returns to the outreach position. For cases with metacarpophalangeal dislocation, the metacarpal head can be partially removed to reset the metacarpophalangeal joint. 6. Treatment of extensor tendon: If the above treatment, the metacarpophalangeal joint still can not flex, should consider the tendon shortening, can be corrected by tendon transplantation or tendon extension. If there is tendon injury, it should be repaired to restore the function of the fingers. 7. Flap repair: cut the skin tube, select the appropriate part according to the size of the wound to cut the flap (cut off the subcutaneous fat, pay attention not to damage the blood vessels of the skin tube), after hemostasis, repair the "Tiger mouth" with the lateral section of the skin tube And the thumb wound surface, the ulnar side section repairs the back of the hand and the metacarpophalangeal joint. 8. Kirschner wire fixation: In order to prevent postoperative deformity recurrence, the Kirschner wire should be used to fix the metacarpophalangeal joint in the flexion position, and the thumb should be fixed in the abduction to the palm position (the Kirschner wire should not be fixed for more than 3 weeks, otherwise it will easily cause joint rigidity. ). Finally, it is rinsed with saline under the flap, and the skin is disinfected and then pressure-wrapped. 9. Interphalangeal joint treatment: general interphalangeal joint flexion or overextension, need to be rectified in the second phase. Interphalangeal joints are often required for arthrodesis, and the angle of fusion is determined by the recovery of the flexion function of the metacarpophalangeal joint. The interphalangeal joints are mostly fixed between 90° and 120°. During the treatment, a transverse incision can be made on the dorsal side of the interphalangeal joint, the switch capsule is cut, the joint surface is exposed, and the wedge-shaped bone is designed according to the design requirement, and then the skin is sutured by the Kirschner wire in the functional position. If the passive function of the interphalangeal joint becomes better, but it cannot be actively stretched, it means that the central iliac crest has been damaged, and the side scorpion on both sides can be sutured to the center to replace the function of the central iliac crest. complication Wound infection.