Fist position for skin grafting on the dorsal hand: I. Analysis of length of the dorsal hand surgery in hand positions

Longitudinal extensibility of the dorsal skin of the hand

We aimed to assess the longitudinal extensibility of the dorsal skin of the hand. Measurements were done in five hand positions on the dominant hands of 64 volunteers. The positions were full flexion of the wrist and fingers, drop hand, flat hand, hand with opposed thumb and full extension. Dorsal marks were made on the skin in full flexion. The marks were transferred to transparent parchment paper strips with the hand in the different positions. Skin extensibility was assessed by the change in the distance between two skin marks from the full extension position to the other positions. Opposition required the highest degree of skin extensibility in the dorsal radial region, followed orderly by ulnar and central regions. Generally, the extensibility increased from distal to proximal and from ulnar to radial. These findings may be useful in the management of dorsal hand soft tissue defects.

Evaluation of Patients' Satisfaction and Functional Outcome of Dorsal Hand Unit Reconstruction in Burn Patients in Shiraz, Southern Iran

The aim of this study was to assess patients' satisfaction and functional outcome of dorsal hand unit reconstruction in burn patients in Shiraz, southern Iran.From September 2013 to February 2017, 11 patients (15 hands) with hand aesthetic complaint who were unhappy with their hand appearance were included for dorsal hand unit reconstruction. Under general anesthesia and tourniquet control, the burned tissue on dorsal surface of the hands was excised and a thick partial thickness skin graft was used for coverage, whereas the fingers were fixed by sutures to the palm. After 1 year, the five-points scale was used for evaluation of patients' satisfaction regarding the five major activities considered for hand function before and after operation. The mean age of the patients was 25.8 ± 5.17 years. The skin grafts were well taken. Six (40%) and eight patients (53%) reported the result of operation as completely satisfied and satisfied, respectively. Dorsal hand unit reconstruction in patients with dorsal hand contracture and significant dorsal scar was shown to simultaneously improve the function and aesthetic outcome of the surgery.

Effects of early versus delayed excision and grafting on the return of the burned hand function

Background:

Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome.

Materials and Methods:

This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients’ conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting.

Results:

The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P < 0.0001 and P = 0.019).

Conclusion:

The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

The abdominal flap using scarred skin in the treatment of postburn hand deformities of severe burn patients

PURPOSE

To present a random-pattern flap technique using scarred skin from the abdominal wall to cover the defect after burn scar was released from the hand and the scarred skin raised from the hand was transferred to the abdominal wall to cover the flap-donor area in patients who suffered from severe burns involving the entire body and had no available healthy skin to be used for coverage.

METHODS

Ten hands of 7 patients (5 males, 2 females) were treated in our department between April 1994 and February 2001. The total body surface area involved with second-or third-degree burns was 85% to 96% and there was no available healthy skin to be used for reconstruction. All hands had severe scar contracture on the dorsum and lost most of their function and the patients lost the ability to take care of themselves. The scarred skin on the dorsum of the hand was elevated integrally as a flap based on the ulnar border of the hand. The tendons were released, the stiff metacarpophalangeal joints were mobilized by closed capsulotomies, and the contracture of the thumb web space was released. A random-pattern abdominal flap using scarred skin was designed and elevated to cover the defect of the scar-released hand and the scarred skin raised from the dorsum of the hand was transferred to cover the defect of the abdominal flap donor site.

RESULTS

The flaps that were transferred to the dorsum of the hands survived entirely and the defects of the flap donor area were covered perfectly without further skin graft. All patients were evaluated for 0.5 to 4 years after surgery. The range of motion of the metacarpophalangeal joints and the space capacity of the thumb web were improved greatly. All patients regained the ability to take care of themselves.

CONCLUSIONS

This method is simple and has satisfactory results. It appears from our experience that the mature postburn scarred skin on the abdomen can be used for a flap procedure for reconstructing the burned hand and that the scarred skin raised from the dorsum of the hand can be transferred to cover the flap donor sites on the abdomen. Under circumstances in which there is no normal skin for reconstruction the function of the burned hand could be improved greatly by this method.

Fist position for skin grafting on the dorsal hand: II. Clinical use in deep burns and burn scar contractures

The fundamental problem in all types of hand burns is a loss of skin and subsequent deformities. The goal of skin grafting on the dorsal hand is to graft a sufficient amount of skin, as much as the original amount, and to restore normal hand function without secondary deformities. The safe, or Michigan, position commonly has been used for immobilizing the hand. However, this position is to protect hand function rather than to provide for adequate skin grafting. This institution has developed a new hand position (the fist position) for grafting the greatest amount of skin on the dorsal side of the hand. In the fist position, the hand is positioned flexing all joints of the wrist and the fingers and maximally stretching the dorsal surface of the hand before skin grafting. Ten hands with deep second- or third-degree burn (n = 6) and burn scar contracture (n = 4) of the dorsal hand in eight patients were treated with split-thickness skin grafting after immobilizing in the fist position. The burns and contractures involved nearly the total area of the dorsal hand. The hand was kept in the fist position for 7 to 9 days after skin grafting. Excellent functional and cosmetic results were observed in all cases during the follow-up period of 6 months to 2 years. Complications resulting from hand immobilization for a short period did not occur. The fist position may be a proper hand position for skin grafting to reconstruct the dorsal hand.