Aggressive remodelling with pedicled skin flaps of the volar surface for the release of contractures of the fingers

Abstract

We treated contractures of fingers with one or several pedicled skin flaps on one or both sides of the scar, depending on the site and spread of the scar. The length of the flap was equivalent to half the circumference of the unaffected finger, or the distance between bilateral midlateral lines. The width of the flap was the same as the distance between the scar and the midlateral line. A subcutaneous pedicle including one or several vessels is left at the proximal or distal end of each flap. After the scar has been excised the flaps are rotated about 90° and both ends of the flaps are sutured on the bilateral midlateral line. The skin defect that remains between the flaps is covered with a full-thickness skin graft from the non-weight-bearing area of the sole. In all cases, the flaps and skin grafts survived perfectly. Because of the flexibility of the subcutaneous flaps, the skin defects are effectively divided to avoid recontraction without disadvantages such as excess trimming of normal skin, extensive dog ears, or formation of scars on the dorsal surface. The method seems to be less invasive than the procedures used currently, and to yield a satisfactory aesthetic appearance.

Key Words::

• Finger contracture
• subcutaneous flap
• skin graft