Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery—at times—as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored.
Nine patients with burn contracture scars involving different locations in the hand and the wrist underwent two-stage reconstruction consisting of contracture release and use of acellular dermal matrix followed by definitive coverage with skin graft at the second stage. Patients were followed up for a period of at least 10 months (range, 10 to 25 months), during which time the passive range of motion of the hand was used as a quantitative measure of surgical outcome.
All nine patients retained at least 83 percent of the corrected range of motion involving the affected joints by 1 year and at least 89 percent of correction at each webspace. No patient required a revision procedure.
Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.
Los Angeles and Sherman Oaks, Calif.
From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California; Cedars-Sinai Hospital; and the Grossman Burn Center.
Received for publication July 28, 2010; accepted October 19, 2010.
Presented at the 2010 Plastic Surgery Senior Residents Conference, in Anaheim, California, January 20 through 23, 2010.
Disclosure:None of the authors has a financial interest in any of the products or devices mentioned in this article.
David A. Kulber, M.D., Cedars-Sinai Hospital, 8635 West 3rd Street, Suite 990-W, Los Angeles, Calif. 90048, firstname.lastname@example.org