A study of resurfacing of elbow defects following release of post burn contracture with different loco-regional flaps

The present study prospectively analyzed 38 patients with post-burn contractures of the elbow who were treated in the Department of Plastic Surgery, Medical College Kolkata in the period between January 2016 and September 2017. The patient age ranged from 4 years to 60 years and maximum number of patients belonged to the age group of 12-60 years (74% of all patients). There were 13 males (34%) and 25 females (66%) in the study. 32% of the contractures were of the longitudinal band type and the remaining 68% were of total (diffuse) type contracture. According to the severity of contracture, there were 14 elbows with mild contracture (36.8%), 15 elbows with moderate contracture (39.5%), and 9 elbows with severe contracture (23.7% cases) as per the standard classification system based on the degree of loss of elbow extension. The operative procedure was chosen according to the type and severity of elbow contracture, size of the defect after contracture release, and condition of the surrounding skin. The various reconstructive procedures used for resurfacing elbow contractures in the study were Reverse Lateral Arm Flap (RLAF) in 13 cases (34%), Multiple Z-plasty in 5 cases (13%), Reverse Medial arm fasciocutaneous flap in 7 cases (18%), the Square flap in 7 cases (18%) and the Proximal Radial Artery Perforator flap (PRAPF) in 6 cases (16%). In this study, multiple Z-plasty, Square flaps were used only in cases of band contractures of elbow. The other fasciocutaneous flaps were used for diffuse type of contractures. Patients were followed up for at least 6 months after surgery. Functional recovery of elbow joint mobility was assessed by measuring the gain in the angle of maximum elbow extension possible at 6 months after surgery. Achievement of full elbow extension was possible in 78% cases of mild contracture, 86% cases of moderate contracture, and 55% cases of severe contracture. Overall functional improvement in the study was satisfactory, with achievement of full elbow extension in 76% cases (29 out of the total 38 cases) in the study. However, the functional results varied slightly across the different surgical procedures. There was no recurrence of contracture in the procedures. Overall, the complications were minimal, and there was no flap loss. There was minimum donor area and recipient site morbidity. The aesthetic results were acceptable to majority of patients.