Z-Plasty with Skin Grafting for Post-Burn Contracture - Study of 30 Cases

Introduction: Postburn contracture is a very common problem in case of undertreated and neglected cases of burns involving the flexor surface of joints of limbs. Satisfactory treatment of postburn contracture needs surgical excision of scar followed by Z-plasty. In case of a severe contracture of joints, Z-plasty is combined with skin grafting for the tension-free treatment of post-burn contracture. Methods: The study was conducted in Sadar Hospital, Sunamgonj and several private clinics in selected districts during the period from 2008 to 2020. Thirty (30) patients with contractures involving flexor surface of Elbow, Knee, and Metacarpophalangeal joints of hands of mild to severe degrees and various durations were treated with Z-plasty plus Split thickness Skin grafts. The operated limbs were immobilized with POP casts. Perioperative Parenteral Antibiotics were prescribed along with adequate Analgesics, Autiulcerants and vitamins, and proper nutrition. Both the operative sites (Recipient and donor areas) were examined by check dressing after the 7th to 14th postoperative days. Result: 5 and 12 patients had complications like infection, flap tip necrosis, and recurrent contractures respectively. But overall results were satisfactory in terms of joint extension, mobility, cosmetic appearance, and patient satisfaction. Very naturally in case of severe contractures, full correction was not possible by single-stage operation. Conclusion: Tension-free flap must be used in patients with mild to severe contractures. Combining skin Grafting with Z-plasty is easy and has better results than Z-plasty alone. It is recommended in patients of Z-plasty with intraoperative flap tension.