Management of First Web Space Contracture in a Severely Burned Patient

Dr William A. Ziaziaris1, Dr Heather Greig1, Dr David A. Stewart1

1Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia


Introduction:Burns of the hand are common, most often affecting young males. Hands are involved in approximately 30-60% of all burn injuries and seen in up to 80% of severe burns.

We present an interesting case of a severely burned patient with complex vascular anatomy who required free tissue transfer to correct a first web space contracture of the right hand.

Case Report: A 42 year-old male was admitted to the Severe Burns Unit of Royal North Shore Hospital with 82% total body surface area flame burns in January 2017. Along with other affected regions, both upper limbs sustained full thickness, circumferential burns.

The patient developed a flexion deformity of the right little finger along with a contracture of the first web space and was referred for reconstructive management in 2018.

Fusions of the distal interphalangeal joint of the little finger and the first carpometacarpal joint were performed, with thumb fixation in a pronated position. The web space was released and a groin free flap based on the superficial circumflex iliac artery pedicle was inset. The patient had an uncomplicated post-operative course and was discharged after 10 days.

Discussion: Due to the paucity of healthy, non-burnt tissue, options for reconstruction in this case were limited. Web space deformity is common post thermal injury to the hand and occurs secondary to scar contracture and banding. The major goal of contracture correction is to deepen the web space using local advancement flaps, Z plasty, V-to-M plasty or free tissue transfer.


Resident medical officer, Royal North Shore Hospital, Hand and Peripheral Nerve Surgery

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