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Combined Iliazarov and Free Flap for Severe Recurrent Flexion–Contracture Release

Bar-Meir, Eran MD*; Yaffe, Batia MD; Winkler, Eyal MD*†; Sher, Nir; Berenstein, Michael§; Schindler, Amos MD

doi: 10.1097/01.BCR.0000226033.45478.2D
Original Articles

This article discusses the treatment of recurrent flexion-contracture of the knee after circumferential burns involving the entire limb. A two-team approach to surgery is used: the orthopedic team widely excises the scar tissue and releases tendons, muscles, and adjacent soft tissue that limit joint movement. The microsurgery team covers the exposed popliteal neurovascular elements with a latissimus dorsi free flap. However, full range of the knee is still limited by the short neurovascular bundle. Therefore, the orthopedic team applies a circular hinged Iliazarov external-fixator-frame to achieve gradual correction, until full range of the knee is achieved. Intensive physiotherapy and continuing use of extension splints for additional 6 months until the scars are deemed stable compliment the treatment regimen and prevent the recurrence of contractures. Between the years 2002 and 2003, we treated four patients (totaling five knee joints) with recurrent severe flexion-contractures after circumferential burns of the entire lower extremity. A significant limitation was caused by the abnormal scarring, which left the patients confined to a wheelchair. In all our patients, previous attempts to release the flexion-contracture failed. With the aforementioned technique, within 3 months after the procedure, all patients were able to walk. We encountered one major complication (ie, drop foot). At follow-up, all patients enjoyed a full range of motion and were able to walk. The strength of our approach comes from combining a free muscle flap with an Iliazarov external fixation and a detailed postoperative rehabilitation plan.

From the *Department of Plastic and Reconstructive Surgery, †Microsurgery Unit, ‡Pediatric Unit, Department of Orthopedic Surgery, and §Department of Orthopedic Surgery, Chaim Sheba Medical Center, Israel.

Address correspondence to Eran Bar-Meir, MD, Kfar Maas, P.O.B. 5345, 49925, Israel.

© 2006 The American Burn Association