Arch Hand Microsurg.  2019 Sep;24(3):260-266. 10.12790/ahm.2019.24.3.260.

Sensate Medial Plantar Free Flap Transfer and Adductor Pollicis Myotomy for Treatment of Palmar Burn Scar Contracture

• Ku I
• Jeong E

• KMID: 2456251
• DOI: http://doi.org/10.12790/ahm.2019.24.3.260

Abstract

A postburn contracture involving the palmar skin and subcutaneous tissues results in a severe loss of functionality of the affected hand. The corrective surgical procedures aim for an improvement of the range of motion of the metacarpophalangeal (MCP) joints and target the reconstruction of a durable and sensitive palmar-specific anatomical structure. We successfully treated a 53-year-old male patient with a long-standing postburn contracture of all the right MCP joints and underlying palmar tissue. We performed contracture release and adductor pollicis myotomy and reconstructed the resultant palmar defect with a sensate medial plantar free flap to restore acute skin sensitivity and resurface the glabrous skin of the palm. The Kirschner-wire fixation utilized for stabilizing the extended MCP joints was maintained for 3 weeks after contracture release. The restored palmar skin and soft tissue improved the MCP joint movements, enabling grasping and pinching motions and thus restoring functionality of the operated hand.

Keyword

Surgical flaps; Hand; Burns; Contracture

MeSH Terms

Burns*
Cicatrix*
Contracture*
Free Tissue Flaps*
Hand
Hand Strength
Humans
Joints
Male
Middle Aged
Range of Motion, Articular
Skin
Subcutaneous Tissue
Surgical Flaps

Figure

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  Fig. 1 Preoperative (A) clinical photograph and (B) radiograph of the postburn palmar contracture.

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  Fig. 2 Illustrations of the operative procedures. (A) Adductor pollicis myotomy of the transverse head for release of the 1st webspace contracture. (B) Elevation of sensate medial plantar free flap with the medial plantar pedicle and nerve. (C) Micro-anastomosis of the medial plantar vascular pedicle with the right radial artery and cephalic vein (using an interpositional vein graft) and of the medial plantar nerve with a split portion of the superficial branch of the radial nerve.

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  Fig. 3 Intraoperative clinical photos are shown. (A) The preoperative palmar burn contracture of the right hand with the indicated incision line, designed for contracture release. (B) The elevated sensate medial plantar free flap with the pedicle and the medial plantar nerve. (C) Micro-anastomosis of medial plantar pedicle and nerve. (D) Flap inset and wound closure.

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  Fig. 4 Clinical photos taken at 6 months postoperatively. (A) Release of postburn palmar contracture and successful coverage with free medial plantar sensate flap. (B) Finer hand function restored as demonstrated by the patient grasping a pen and writing.

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