Abstract:
Objective: To determine the outcome of split thickness planter skin graft for the management of post burn flexion contractures of hand in comparison with ordinary skin grafts. In terms of functional and cosmetic improvement and patient satisfaction and development of late complication i.e. graft contracture Study Design: Randomized Control Study. Place and Duration of Study: Department of plastic and reconstructive surgery, Bahawal Victoria Hospital Bahawalpur and Burn Care Center PIMS Islamabad. Duration of Study: Three years from June 2007 to May 2010. Materials and Methods: Sixty patients with post burn contractures of digits and palm were recruited in the study. Patients with posttraumatic and post infective contractures were excluded from the study population. They were randomly divided in two groups each having 30 patients. The contractures were released and the deficit portion was replaced by planter split thickness skin graft in group A and replaced by ordinary skin graft in group B. Active range of motion was measured before and after the surgery. The patients were followed up for one year postoperatively. The outcome measurements were color and texture match of graft with the adjacent palmer skin, recurrence of contracture, donor site morbidity and patient satisfaction. The data collected was labeled with the help of SPSS version 12 and descriptive statistics were calculated accordingly. Results: At follow up of the group A, the donor areas were completely healed in all the cases 100 %. The grafted area showed excellent color and texture match with the adjacent palmer skin. The graft was mobile, stable and without any pigmentation. There was also no hypertrophic scarring, hyper pigmentation or pain at the donor site as compared to ordinary skin graft .Walking and weight bearing was smooth and the instep curvature appeared normal 100 % Post operative median active range of motion (ROM) at PIP joint was 0 to 90 (extension / flexion) after one year follow up examination. And in group B, only 10 patients (33%) have satisfactory functional outcome that is (ROM) was 0 to 90 degree in all others it was less than 60 degree. In this group only 8 (26%) patient showed good color match. Patient satisfaction rate was 53%in group B that was 76% in group A. in long term follow up there was not a single case of recurrence in group A while 8 patients in group B showed recurrence of contracture. Conclusion: The excellent color, texture match and the functional advantage in terms of active range of motion offered by the split thickness planter grafts were more than the conventional techniques like thigh grafts with higher rates of patient satisfaction. Key Words: Post burn hand contractures, split thickness planter skin grafts.
Page(s):
83-86
DOI:
DOI not available
Published:
Journal: Annals of the Pakistan Institute of Medical Sciences, Volume: 8, Issue: 1, Year: 2012