Biomedical subjects
Publications and source records attributed to L C Kurtzman.
The thumb accounts for 40 to 50% of hand function. Reconstruction of soft-tissue contractures include release and coverage with skin grafts or various local, regional, distant, or free flaps. Thumb length, so important for prehension and opposition, can be restored by phalangealization, pollicization, or toe-to-thumb transfer. Secondary techniques such as metacarpal distraction-lengthening or osteoplastic reconstruction are rarely indicated.
Acute management of upper extremity thermal and electrical injuries requires an aggressive treatment protocol which combines meticulous wound care, intensive hand therapy, and early stable wound coverage to salvage upper extremity function. Electrical injuries inflict severe deep-tissue destruction that frequently results in major limb amputation.
Upper extremity burn contractures are a major challenge to the reconstructive surgeon. Despite increasing sophistication in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in the hand. Reconstructive options for axillary, antecubital, wrist, metacarpophalangeal joint, and interdigital web contractures are discussed, with special emphasis on the techniques and advantages of local flap reconstruction.