Paediatric upper limb contracture release following burn injury

Purpose: The aim of this study was to assess the functional outcome in children who had undergone release of upper limb burn contractures at the axilla, elbow and wrist. Methods: We studied a series of 10 patients reconstructed with local flaps (n = 5), Integra™ artificial skin (n = 10) and micro-vascular free tissue transfer (n = 5) to release contracted axillae (n = 8), elbows (n = 5) and wrists (n = 7). Follow-up ranged from 6 months to 6 years and outcome was assessed by functional improvement. Results: Full functional release was achieved in all cases at the time of the surgery. Local flaps resulted in good or excellent outcomes in all five cases. Six patients reconstructed with Integra™ were assessed as having an excellent outcome whereas four had a poor outcome. Free tissue transfer with excellent result was achieved in five children. Conclusions: This series assessed the three treatment options that we have used for the release of upper limb post-burn contractures. We have shown that local flaps fashioned from burnt skin survive, Integra™ requires extended post-operative care to prevent recontraction and free tissue transfer is safe in young children. Each method when used appropriately has produced excellent results which have been maintained over the follow-up period.