Assessment of Clinical Results of Flap Surgery and Grafting in the Treatment of Metatarsophalangeal Joint Hyperextension Following Burn Scar Contractures

Burn is one of the morbidity factors in developing countries and majority of burns in the foot fingers and dorsum of foot is due to hot liquids and falling in traditional baking ovens in the north-west of Iran. Children are specifically high–degree- burn victims resulting in severe contracture and deformity. On the other hand, excavation of chronic scar and skin graft brings about recurrence of contracture and failure in the treatment of deformity. Such dilemmas gave rise to this research in order to find out the efficiency of flapping and grafting as a new method of skin repair.
In order to treat patients (n=17), we utilized flap. Due to the lack of enough tissues, we applied split thickness graft technique. In the meantime, dissection of articular capsule and pinning were fulfilled to prevent deformity and the patients were regularly visited and followed up for 6 consequent months.
17 patients (14 females and 5 males), with a mean age of 13.76 and the average burn time of 10 years after burn with deformity and difficulty in wearing shoes underwent this procedure. The first to third week after surgery, 4 patients (23.5%) developed a mild flap tip ischemia that was treated and no recurrence of deformity was reported. In the meantime, 11.7% of the patients were moderately satisfied, and 88.3% were totally satisfied with the outcome. A 6- month- follow- up period demonstrated a general satisfaction.
It is concluded that Z plasty accompanied by skin grafting, articular capsule release and long time pinning prevents contracture recurrence and flap necrosis.