Post burn flexion contracture of hand: a prospective study


  • Subbu Pilla Lakshmi Bai Department of Plastic Surgery, Government Rajaji Hospital and Madurai Medical College Hospital, Tamilnadu
  • Raman Gunasekaran Plastic Reconstructive and Cosmetic Surgeon, Vallalar Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu



Burns, Contracture, Flexion, PIP, Z-plasty, Split skin graft, Full thickness graft


Background: Burn contracture of the hand can cause severe functional and psychological deprivement in patients. This study mainly concentrates on different types of hand deformity cases presenting to our department and the various options used to correct them. The postoperative functional outcome is also compared so that standardization of procedures can be done. This study assesses the severity of the deformity, the success of various reconstruction options and the functional outcomes of cosmetic procedures.

Methods: This work includes the study of 60 patients who underwent reconstruction for post-burn flexion contracture of the hand including fingers, in the department of plastic surgery, Government Rajaji Hospital, Madurai. The patients were treated between September 2009 to February 2012.

Results: Males were twice commonly affected by burn injuries and thermal burns were more common than electrical burns. The little finger was more frequently involved and contracture release followed by grafting was the commonly done reconstructive procedure. Complications like recurrence, residual contracture, partial graft loss and infection were noted.

Conclusions: Contracture release by multiple Z–plasty with or without skin grafting was sufficient in most cases of contracture due to thermal burns. Flaps were required for reconstructing electrical burns. Complication rates are higher in children than in adults and postoperative physiotherapy and splinting is mandatory to achieve a better functional outcome.


Hariharan NC, Sridhar R, Sankari B, Valarmathy VS, Asirvatham E, Geetha K. Reconstruction of postburn crippled hands: A study of functional outcome. Indian J Burns. 2018;26:9-14.

Sheridan RL, Hurley J, Smith MA, Ryan CM, Bondoc CC, Quinby WC, et al. The acutely burned hand: management and outcome based on a ten-year experience with 1047 acute hand burns. J Trauma. 1995;38(3):406–11.

Gupta RK, Jindal N, Kamboj K. Neglected post burns contracture of hand in children: analysis of contributory socio-cultural factors and the impact of neglect on outcome. J Clin Orthop Trauma. 2014;5(4):215–20.

McCauley RL. Reconstruction of the pediatric burned hand. Hand Clin. 2009;25(4):543–50.

McCauley RL. Reconstruction of the pediatric burned hand. Hand Clin. 2000;16(2):249–59.

Bhattacharya V, Purwar S, Joshi D, Kumar M, Mandal S, Chaudhuri GR, et al. Electro-physiological and histological changes in extrinsic muscles proximal to post burn contractures of hand. Burns. 2011;37(4):692–7.

Saraiya H. Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless? Correction of a 20-year old post-burn palmar contracture: a case report. Burns. 2001;27(2):192–5.

Kola N, Isaraj S, Belba GJ. Planning and technical details when treating a post-burn hand contracture. Ann Burns Fire Disasters. 2006;19(4):208–11.

Tubiana R, McCullough CJ, Masquelet AG. An atlas of surgical exposures of the upper extremity. Philadelphia, USA: Lippincott; 1990: 279–281.

Peker F, Celebiler O. Y-V advancement with Z-plasty: an effective combined model for the release of post-burn flexion contractures of the fingers. Burns. 2003;29(5):479-82.

Baryza MJ, Hinson M, Conway J, Ryan CM. Five Year Experience With Burns From Glass Fireplace Doors in the Pediatric Population. J Burn Care Res. 2013;34(6):607-611.

Scott JR, Costa BA, Gibran NS, Engrav LH, Heimbach DH, Klein MB. Pediatric palm contact burns: a ten-year review. J Burn Care Res. 2008;29(4):614–8.

Buchan NG. Experience with thermoplastic splints in the post-burn hand. Br J Plast Surg. 1975;28(3):8193–7.

Saleh Y, El-Shazly M, Adly S, El-Oteify M. Different surgical reconstruction modalities of the post-burn mutilated hand based on a prospective review of a cohort of patients. Ann Burns Fire Disasters. 2008;21(3):141–9.

Woo SH, Seul JH. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers. Plast Reconstr Surg. 2001;107(1):1–8.

Fufa DT, Chuang SS, Yang JY. Prevention and surgical management of postburn contractures of the hand. Curr Rev Musculoskelet Med. 2014;7(1):53–9.

Brown M, Coffee T, Adenuga P, Yowler CJ. Outcomes of outpatient management of pediatric burns. J Burn Care Res. 2014;35(5):388–94.

Buchan NG. Experience with thermoplastic splints in the post-burn hand. Br J Plast Surg. 1975;28(3):8193–7.

Stern PJ, Neale HW, Graham TJ, Warden GD. Classification and treatment of postburn proximal interphalangeal joint flexion contractures in children. J Hand Surg Am. 1987;12(3):450-7.

Stern PJ, Neale HW, Carter W, MacMillan BG. Classification and management of burned thumb contractures in children. Burns Incl Therm Inj. 1985;11(3):168–74.






Original Research Articles