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Surgical Management of Burn Flexion and Extension Contractures of the Toes

Chang, Jessica B. BS*; Kung, Theodore A. MD; Levi, Benjamin MD; Irwin, Todd MD§; Kadakia, Anish MD; Cederna, Paul S. MD

doi: 10.1097/BCR.0b013e3182a368fc
Original Articles: 2013 ABA Papers

Burn contracture of the toes is a devastating sequela of thermal injury to the foot. Without proper treatment of toe burn contractures, patients suffer from significant functional and social limitations, including difficulties with activities of daily living. The authors classify the severity of toe burn scar contractures (TBSCs) by considering important characteristics of the deformity and tailor definitive surgical treatment based on the individual needs of the patient’s condition. A retrospective review was performed on 20 patients who underwent a total of 32 reconstructive operations involving 275 TBSC procedures from 2000 to 2010. Multiple clinical, functional, and anatomic criteria were used to describe each patient’s contracture as mild, moderate, or severe. Mild TBSC involved scarring of the superficial tissues only with no functional impairment; these were treated with scar release or local tissue rearrangement. Moderate TBSC involved soft tissue shortages requiring skin grafts and occasional closed joint capsulotomy. Severe TBSC caused the greatest impairment in function and involved burn injury to deeper structures. For these difficult contractures, a patient-specific technique was paramount to optimal reconstruction. There were six, three, and 11 patients with mild, moderate, and severe TBSC, respectively. The mean number of primary procedures per toe increased with increasing burn complexity from 1.1 procedures for mild, 1.5 for moderate, and 1.8 for severe groups, with severe TBSC undergoing more primary procedures overall (13.7 in severe vs 2.8 in mild TBSC). Complication rates per toe were highest for severe TBSC (59.0%). Only severe TBSC received secondary operations, and overall contracture recurrence was 35%. An individualized surgical approach based on TBSC severity is recommended for addressing burn contracture of the toes. Careful analysis of the clinical, functional, and anatomic characteristics of the burned foot determines the severity of each toe contracture and dictates the interventions necessary for reconstruction.

From the *University of Toledo College of Medicine, Ohio; Section of Plastic Surgery and Division of Acute Care Surgery, Department of Surgery and §Department of Orthopaedic Surgery, University of Michigan, Ann Arbor; International Center for Automotive Medicine, Ann Arbor, Michigan; and Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Glenview.

J.B.B. and T.A.K. are cofirst authors.

Address correspondence to Paul S. Cederna, MD, FACS, Section of Plastic Surgery, Departments of Surgery and Biomedical Engineering, 1500 East Medical Center Drive, Ann Arbor, MI 48109.

© 2014 The American Burn Association