Successful treatment of postburn

flexion contracture in fingers of early

childhood with dynamic splint therapy
after operation: long-term follow-up
ABSTRACT
Background Infants or early childhood
individuals are proneto be burned on the palm
and fingers, since they tend to extend their hands
to the heat source
Wounds with more than 3-week-prolonged ulcers
frequently result in flexion contracture. Despite
successful surgery, the outcome might be
unsatisfactory because of postoperative
contracture
INTRODUCTION
Infants or early childhood individuals are prone
to be burned on the palm and fingers, since they
tend to extend their hands to the heat source
Wounds with more than 3-week-prolonged,
intractable ulcers frequently result in flexion
contracture depending on the sites
For palmar contracture of the fingers, division or
excision of the constricting scar and skin grafting
are usually performed
Splints can produce beneficial effects on scar
tissue length and subsequent range of motion
(ROM)
PATIENTS AND METHODS
Ten patients with postburn flexion contractures
of the fingers (9 men and 1 woman; age range at
burn injury, 11 23 months; on average, 15.4
months) were enrolled in the study (Table 1). All
were due to contact burn. The causes of burns
were as follows: stove (4 cases); rice cooker (4
cases); steam iron (1 case); and pot (1 case). The
most affected finger was the middle finger (n =
8), followed by the index finger (n = 7), the ring
finger (n = 4), and the thumb (n = 3). The mean
period between the injury and surgery was 5.6
months (310 months)
TREATMENT PROTOCOL
After epithelialization of wounds had been
completed,surgery was performed. In the
surgery, a fishtail dart was placed at the end of
the releasing incisions, and contracture was
released by scar incision rather than scar
excision
To maintain the corrected position, Capener-type
dynamic splints were worn for 2 years (Figs. 1, 2,
and 3). Because of an infants small size, the
splint was prone to be distally dislocated without
intention.
EVALUATION OF FUNCTIONAL AND
AESTHETIC OUTCOME

Three observers (two plastic surgeons and one

outpatient nurse) independently evaluated scar
and graft appearance, using the Vancouver scar
scale (VSS) before and 2 years after operation.
The VSS, which was designed by Sullivan et al.
[21] in 1990, rated the scars according to four
parameters: pigmentation, vascularity, pliability,
and height
RESULTS
In the preoperative VAS, all 30 evaluation results
(100%) were contracture (score 5) in pliability. In
the postoperative VAS, 24 evaluation results
(80%) were restored to normal (score 0) and 6
evaluation results (20%) were repaired to supple
(score 1) in pliability. In the postoperative VAS,
all 18 evaluation results (100%) of the cases
receiving skin graft from the lower abdomen were
hyperpigmentation (score 2), while all 12
evaluation results (100%) of the cases receiving
skin graft from plantar region were normally
pigmented (score 0). Both in the preoperative and
postoperative VAS, all 30 results (100%) were
normal (score 0) in vascularity
DISCUSSION
The length of time that a joint can tolerate
immobility is longer when the age is younger.
The risk of postoperative infection may be
lowered, when operation is performed after
healing of acute burn. Considering these
observations, surgery was planned in this study,
after epithelialization of wounds had been
completed
Skin grafts tend to yield better results than local
flaps, especially in the treatment of moderate and
severe contractures
CONCLUSION
At the mean postoperative follow-up period of
49.6 months (range 3181 months), no recurrence
of contracture was observed. Our protocol
provided the excellent functional result and
improved the aesthetic appearance. This study
demonstrated that the present protocol, which
promotes mature of grafted skin and elongates
the remaining scar tissue by using a dynamic
splint for 2 years, may be a valid. Until the
adolescent growth spurt is over, the contracture
might recur. Until then, follow-up should be
continued.