Effectiveness of Distraction Principle by External Circular Frame in Correction of Postburn Wrist Contracture | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 7, Volume 49, Issue 2, April 2025, Page 123-133 PDF (302.05 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2025.425145 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| SHERIEN Metwally SALAMA* ; AMR MAHMOUD FAYED* ; AHMED Gadallah* | ||||
| The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University | ||||
| Abstract | ||||
| Background: Although it is preferable to prevent post-burn contractures of the upper extremities rather than to cure them, Many patients, nonetheless, experience this handicap, particularly following serious burns or inadequate primary care. Plastic surgeons find Post-burn Fixed Flexion Deformity (FFD) of the wrist to be difficult to treat because of its intricacy and severe impact on patient impairment. Even though Post-burn flexion contracture deformity has been treated with surgical release and reconstruction extensively, the surgery is not without major difficulties, and the degree of rectification is not always sufficient. Objective: This case series study was conducted to evaluate the effectiveness and safety of Ilizarov’s principles of distraction neo histiogenesis and differential distraction as a minimally invasive technique for correction of post burn soft tissue contracture deformity of the wrist joint without any concurrent bony procedures to prevent the risks associated with release and reconstructive surgery and to achieve long-term improvement With no complication or recurrence. Results: A total of 15 consecutive patients with a mean age of 32 years (11 to 40) had distraction for a Mean period of 25 days (21 to 30). The fixator was removed after a mean of 38 days (35 to 42) when the wrist was in neutral position, followed by physiotherapy. Final Assessment after a 12-month period showed improvement in functional position that allowed more active movement of the hand, and appearance had markedly improved. Without any serious consequences, every patient had their deformity completely corrected. Conclusion: Although surgical release and reconstruction have been used extensively to treat severe post burn wrist flexion contractures, the degree of correction is sometimes unsatisfactory, and the procedure is not exempt from significant complications. Based on the principle of slow, gradual differential distraction, we mounted a circular frame distractor to deal with joint contractures. This is a percutaneous surgery, with very mild aggression to the patient and very low iatrogenic risks. The technique is easy, the degree of correction may be almost complete, and the hospital stay is limited. | ||||
| Keywords | ||||
| Burn; Wrist; Ilizarov; Contracture; Fixator | ||||
| References | ||||
|
1- Stern P.J., Law E.J., Benedict F.E., and MacMillan B.G.: Surgical treatment of elbow contractures in postburn children. Plast. Reconstr. Surg.., 76: 441, 1985. 2- Klifto K.M., Asif M., and Hultman C.S.: Laser management of hypertrophic burn scars: A comprehensive review. Burns Trauma, 8: 002, 2020. 3- Ogawa R.: Surgery for scar revision and reduction: From primary closure to flap surgery. Burns Trauma, 7: 7, 2019. 4- Ilizarov G.A. and Soibel’man L.M.: Some clinical and experimental data concerning lengthening of ower extremities. Eksp. Khiz. Anesi., 14: 27, 1969. 5- Wang X.J., Chang F., Su Y., et al.: Ilizarov technique and limited surgical methods for the correction of post-traumatic talipes equinovarus in children. ANZ J. Surg., 87: 815–819, 2017. 6- Steinwender G., Saraph V., Zwick E.B., et al.: Complex foot deformities associated with soft-tissue scarring in children. J Foot Ankle Surg., 40: 42–49, 2001. 7- Shen Y.M., Huang L., Hu X.H., et al.: Treatment of burn cicatricial foot drop with Ilizarov fixator. Zhonghua Shao Shang Za Zhi., 24: 287–289, 2008. 8- Ullmann Y., Lerner A., Ramon Y., et al.: A new approach to Deal with post-burn knee contracture. Burns, 29: 284–286, 2003. 9- Zhang Z., Dou X., and Wei Z.: Treatment of knee flexion contracture with Ilizarov technology after burns. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi., 32: 1271–1274, elbow, 2018. 10- Chen Y., Niu Z., Yin X., et al.: Treatment of Severe Postburn Contracture of the Elbow via Distraction with External Circular Frame in Pediatric Patient. Ann. Plast. Surg., 87 (3): 253-259, 2021. doi: 10.1097/SAP.0000000000002960. 11- Tomak Y., Piskin A. and Gulman B.: Treatment of U-shaped bone ankylosis of the knee with the Ilizarov method: A case report. J. Bone Joint Surg. Am., 87A: 1104, 2005. 12- A New Approach to the Management of Fixed Flexion- Deformity of the Knee Using Ilizarov’s Principle of Distraction Histogenesis: A Preliminary Communication Kulshrestha Gaurav, DNB1 and Jog Vilas, MS2. The International Journal of Lower Extremity Wounds, 9 (2): 70–73 2010. 13- Atar D. and Lehman W. Posner Metal: Ilizarov technique in treatment of congenital hand anomalies: Two case reports. Clinical Orthopaedics and Related Research, 273: 268-274, 1991. 14- Madhuri V. and Dhanraj P.: Correction of post burns contracture of wrist with Ilizarov method. Burns, 24 (6): 576- 578, 1998. doi: 10.1016/s0305-4179(98)00055-2. 15- Stern P.J., Law, E.J., Benedict F.E. and MacMillan B.G.: Surgical treatment of elbow contractures in postburn children. Plast. Reconstr. Surg.., 76: 441, 1985. 16- Huang S.C.: Soft tissue contractures of the knee or ankle treated by the Ilizarov technique. High recurrence rate in Egypt, J. Plast. Reconstr. Surg.., April 2025 133 26 patients followed for 3-6 years. Acta. Orthop. Scand, 67 (5): 443-449, 1996. doi: 10.3109/17453679608996665. 17- Damsin J.P. and Ghanem I.: Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J. Bone Joint Surg. Br., 78 (1): 140-144, 1996. 18- Ullmann Y., Fodor L., Soudry M. and Lerner A.: The Ilizarov technique in joint contractures and dislocations. Acta. Orthop. Belg., Feb. 73 (1): 77-82, 2007. 19- Ullmann Y., Fodor L., Soudry M. and Lerner A.: The Ilizarov technique in joint contractures and dislocations. Acta. Orthop. Belg., Feb. 73 (1): 77-82, 2007. 20- Sud A.D., Kaul R., Prasad M., et al.: Gradual distraction for the treatment of severe knee flexion contractures using the Ilizarov’s apparatus. Int. J. Res. Orthop., 5: 929-935, 2019. doi: 10.18203/issn.2455-4510. 21- Kocaoğlu M., Eralp L., Atalar A.C., et al.: Correction of complex foot deformities using the Ilizarov external fixator. J. Foot Ankle Surg., 41: 30–39, 2002 | ||||
|
Statistics Article View: 31 PDF Download: 34 |
||||
