Jsmc-10289

COMBINED RHOMBOID FLAP AND DOUBLE Z-PLASTY TECHNIQUE FOR RECONSTRUCTION OF POSTBURN WEB SPACE CONTRACTURES

Sabir Osman Mustafa a and Zhwan Sabah Hassan b

a Plastic Surgery, Hawler Medical University, Kurdistan Region, Iraq.

b Sulaimani Burn, Plastic and Reconstructive Surgery Hospital, Kurdistan Region, Iraq.

Submitted: 22/2/2020; Accepted: 9/6/2020; Published: 21/3/2021

DOI Link: https://doi.org/10.17656/jsmc.10289

ABSTRACT

Background

One of the most common deformities after the occurrence of hand burn is web space contracture which has both aesthetic and functional drawbacks. In this prospective study combined rhomboid and double Z-plasty technique is used to reconstruct web space contracture.

Objectives

Is to assess a combination of the rhomboid flap with a double Z-plasty technique for reconstruction of palmar and dorsal web space contractures to decrease shortcoming and achieve better functional and aesthetic results.

Patients and methods

18 webs of 9 patients with postburn web space contracture of palmar and dorsal type were submitted to reconstruction using combined rhomboid and double Z-plasty technique.

Results

The average age of the 9 patients included in our study was 24 years and most of them developed web space contracture as a result of a flame burn. The duration of their contracture ranged between (2-20) years. Our patients were satisfied with the results both regarding the functional and aesthetic appearance of the webspace. After using this technique for reconstruction of 18 webs which were included in our study, we didn’t notice any significant complications in terms of flap necrosis, digital ischemia, wound dehiscence or infection, and recurrence of contracture.

Conclusion

The combined rhomboid flap and double Z-plasty technique is a simple and effective method for reconstruction of postburn web space contracture of the hands.

KEYWORDS

Webspace; Postburn contracture; Rhomboid flap; Z-plasty.

References

1. Puri V, Khare N, Venkateshwaran N, Bharadwaj S, Choudhary S, Deshpande O, et al. Serial splintage: Preoperative treatment of upper limb contracture. Burns [Internet]. 2013;39(6):1096–100. Available from: http://dx.doi.org/10.1016/j.burns.2013.01.010.

2. Kamolz LP, Kitzinger HB, Karle B, Frey M. The treatment of hand burns. Burns. 2009;35(3):327–37.

3. Kalliainen LK, Schubert W. The management of web space contractures. Clin Plast Surg. 2005;32(4):503–14.

4. Lapid O, Sagi A. Three-square-flip-flap reconstruction for post burn syndactyly. Br J Plast Surg. 2005;58(6):826–9.

5. Sari E, Tellioglu AT, Altuntas N, Seven E, Ozakpinar HR. Combination of rhomboid flap and double Z-plasty technique for reconstruction of palmar and dorsal web space burn contractures. Burns. 2015;41(2):408–12.

6. Tuncel U, Turan A, Uyanik D, Kostakoglu N. The use of an alternative Kirschner fixation design to facilitate the treatment of postburn web space deformities. J Plast Reconstr Aesthetic Surg [Internet]. 2013;66(9):e267–8. Available from: http://dx.doi.org/10.1016/j.bjps.2013.02.030.

7. Markal Ertaş N, Küçükçelebi A, Bozdoǧan N, Çelebioǧlu S. The use of subcutaneous pedicle multiple rhomboid flaps in the treatment of long postburn scar contractures. Burns. 2004;30(6):594–9.

8. Knight A, Wasiak J, Salway J, O’Brien L. Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge. Burns [Internet]. 2017;43(1):100–6. Available from: http://dx.doi.org/10.1016/j.burns.2016.07.025.

9. Carmudie C. Management of the burned hand. Aust J Physiother [Internet]. 1980;26(4):123–31. Available from: http://dx.doi.org/10.1016/S0004-9514(14)60806-0.

10. Li L, Dai J xi, Xu L, Huang Z xia, Pan Q, Zhang X, et al. The effect of a rehabilitation nursing intervention model on improving the comprehensive health status of patients with hand burns. Burns. 2017;43(4):877–85.

11. Hirche C, Senghaas A, Fischer S, Hollenbeck ST, Kremer T, Kneser U. Novel use of a flowable collagen-glycosaminoglycan matrix (IntegraTM Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand - A preliminary 6 month follow-up. Burns [Internet]. 2016;42(1):e1–8. Available from: http://dx.doi.org/10.1016/j.burns.2015.10.013.

12. Rea SM, Goodwin-Walters A, Wood FM. Surgeons and scars: Differences between patients and surgeons in the perceived requirement for reconstructive surgery following burn injury. Burns. 2006;32(3):276–83.

13. Byrne M, O’Donnell M, Fitzgerald L, Shelley OP. Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes. Burns [Internet]. 2016;42(2):356–65. Available from: http://dx.doi.org/10.1016/j.burns.2015.06.017.

14. Gulgonen A, Ozer K. The Correction of Postburn Contractures of the Second Through Fourth Web Spaces. J Hand Surg Am. 2007;32(4):556–64.

15. Alexander JW, MacMillan BG, Martel L. Correction of postburn syndactyly: an analysis of children with introduction of the VM-plasty and postoperative pressure inserts. Plast Reconstr Surg [Internet]. 1982 Sep;70(3):345—354. Available from: http://europepmc.org/abstract/MED/7111486.

16. Ülkür E, Çeliköz B, Karagöz H, Açikel C. Comparison of the rates of elongation provided by multiple smaller rhomboid flaps and larger single rhomboid flap - An experimental study. Burns. 2006;32(2):218–21.

Full Text

This work is licensed under a Creative Commons Attribution 4.0 International License.