"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach?
10.1016/j.cjtee.2022.10.003
- VernacularTitle:"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach?
- Author:
A PRIYADHARSHINI
1
;
Geley ETE
1
;
Paul M KINGSLY
1
;
Shwetha AGARWAL
2
Author Information
1. Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
2. Department of Plastic Surgery, Christian Medical College, Vellore, Tamil Nadu, India. Electronic address: dr.shwetha.agarwal@gmail.com.
- Publication Type:Case Reports
- Keywords:
Burns;
Post-burn contractures;
Release sequence;
Upper limb
- MeSH:
Humans;
Child, Preschool;
Surgical Flaps/surgery*;
Upper Extremity;
Plastic Surgery Procedures;
Skin Transplantation;
Contracture/surgery*
- From:
Chinese Journal of Traumatology
2023;26(1):60-62
- CountryChina
- Language:English
-
Abstract:
Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
