Chronic postburn palmar contractures reconstruction using the medial pedis perforator flap

Chronic flexion contractures of the palm of the hand impair hand function considerably and cause a poor esthetic appearance. Various reconstructive methods have been used for the treatment. However, satisfactory esthetic and functional results are difficult to achieve due to the unique anatomic characteristics of the palmar region, such as thick, cornified, stratified squamous epithelium. In the present study, free medialis pedis flap was used in a number of patients who suffered from severe palmar flexion contractures due to burn injuries. Here, the experience, technique, and follow-up results are presented. Eleven patients admitting to our department with palmar flexion contracture were reconstructed with free medialis pedis flap from 2004 to 2007. All were men and ranged in age from 19 to 22 years old (average, 21 years). In all cases, different parts of palmar region were covered. In all cases except 2, arterial anastomosis was done to proper digital arteries. Although the concomitant vein and superficial vein were prepared in all cases, only superficial vein of flap was used for anastomosis. In one case, the donor site was closed primarily, the others were closed with skin graft. The transplanted flaps survived with satisfactory recovery in function and appearance. In 2 cases, transient venous insufficiency was observed and resulted in possible increase in flap thickness. Grasp function of the hand was dramatically improved. The follow-up period ranged from 10 to 22 months. In one case, the flap required debulking. Postoperative follow-up revealed no marked donor site morbidity. We determined that the medialis pedis flap was a remarkable alternative for palmar reconstruction of the hand and digits due to burn because of its glabrous skin, which was very similar to palmar skin, and low donor site morbidity.