Annals of Burns and Fire Disasters - vol. XIII - n. 2 - June 2000 INTERDIGITAL BRIDGING FOR TREATMENT OF THE BURNED HANDUllmann Y.,Lerner A.,Shtein H.,Peled I.J. - Israel Departments of Plastic Surgery and Orthopaedics W, Rambarn Medical Centre and the Faculty of Medicine, Technion, Haifa, Israel RESUME. A simple method is presented for bridging between burned fingers in order to keep the webs open during and after surgery. This "trick" can be tried when Kirschner wires are used during surgery for stabilization of the interphalangeal and metacarpophalangeal joints. Horizontal wires are connected to the free ends of the intradigital wires by means of bone cement. Stabilization of the skin grafts is easier, fewer bandages are needed, and good preservation of the webs can be achieved. Our experience is based on the patient described and on four others, in whom the method was used to treat burned hands. Introduction Dealing with the deeply burned hand is a great challenge for the reconstructive surgeon. Deformation of the fingers due to scar contracture is a common consequence. Contracture of the fingers sometimes occurs in spite of early skin grafting, good splinfing, and vigorous exercises, and early treatment of the problem may prevent long-term disability. We suggest the use of internal splinting for a limited period, after release of the contracted scar and skin grafting.The use of internal fixation stabilizes the interphalangeal and the metacarpophalangeal joints, and this allows good positioning of the fingers and immobilization until the grafts take.In this paper we describe a "trick" to maintain good separation of the fingers while internal splints are being used, with a view to reducing the common phenomenon of web space contracture. Case history A 20-yr-old soldier was
admitted to our burn unit with a 50% TBSA deep burn caused during a military operation.
The patient underwent early excision of the eschar on the third day post-burn. About 20%
of the bare areas, including the neck, hands, and elbows, were covered by splitthickness
autografts. Cryopreserved homografts were used to cover the remaining excised areas.
During the third week post-burn the patient was taken back to the operating room, where
the homografts were exchanged for autografts. Owing to the deep hand burns, which were
complicated by the delay in healing, and in spite of early surgery, meticulous splinting,
and vigorous exercises, the patient developed scar contracture. This affected the
metacarpophalangeal and interdigital joints of both hands.
Discussion It is well known that in
some patients with deep hand burns, the scars - despite excellent splinting and
physiotherapy - begin to contract and form secondary deformities. These cases should be
treated early, in order to prevent badly positioned autofusion.The use of Kirschner wires
for the positioning of joints is well described. It helps to overcome the malpositioning
of the joints, facilitates stabilization of the skin graft, and eliminates the need for
bolster dressing.
RESUME. Les Auteurs présentent une méthode simple pour créer un pont entre les doigts brûlés afin de maintenir ouvertes les toiles pendant et après l'intervention chirurgicale. Ce "truc" peut être employé quand le chirurgien emploie les broches de Kirschner pour stabiliser les jointures interphalangiennes et métacarpophalangiennes. Moyennant des fils horizontaux il faut attaquer lesextrémités libres des broches interdigitales avec du ciment osseux. La stabilisation des greffes cutanées devient plus facile, on emploie une quantité mineure de pansements, et on obtient une bonne conservation des toiles. L'expérience des Auteurs se base sur les résultats obtenus dans le cas qu'ils présentent et sur quatre autre cas oû la méthode a été employée pour des mains brûlées. BIBLIOGRAPHY
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