Planning and technical details when treating a post-burn hand contracture

Hand contractures are still a problem in everyday plastic surgery practice. We decided to review the hand contractures we had treated over a 5-yr period (2000-2004) and to present some guidelines for their prevention. In the 5-yr period we operated on 206 patients with hand contractures. The number of patients demonstrates that not infrequently our plastic surgeons still have to treat this condition. The age group most liable to this form of burns sequelae is that of children up to five years old, because of the deeper burns they suffer in the hands. The surgical approach to post-burn contractures of the hand is discussed from three aspects: the skin aspect, the osteotendinous aspect, and the wound closure procedure. The discussion puts special stress on the risk of impairing blood supply to the distal phalanges, which is related not only to the involvement of the arteries in the scar tissue but also to spasms or accidental damage in the digital arteries. Special attention must be paid when the fifth finger is interested.