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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1806745
Original Article

Manual External Skeletal Distraction of Restricting Soft Tissue after Release of Long-Standing Burn Contractures

Bharatendu Swain 
1   Aakar Asha Hospital, Kukatpally, Hyderabad, Telangana India
,
C. Shravya
1   Aakar Asha Hospital, Kukatpally, Hyderabad, Telangana India
,
Shalini Sampreethi 
1   Aakar Asha Hospital, Kukatpally, Hyderabad, Telangana India
› Author Affiliations Funding None.
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Abstract

Background

Long-standing burn contractures of limb joints are resistant to complete surgical release and have been addressed earlier by serial casting, and more recently, distraction with a distractor, mostly limited to small joints of the hand. This retrospective study of patients with long-standing burn contracture was done to evaluate the efficacy of external skeletal distractors in securing complete release of various affected joints.

Materials and Methods

In our series, complete release was achieved through gradual manual distraction using skeletal uni- and multiplanar frameworks across the affected limbs after incisional release. The resultant wound after complete release was skin grafted or covered with flaps.

Results

Thirty-one limbs in 27 young patients (average age: 19 years) with long-standing contractures (18.5 years) due to burns underwent manual soft tissue distraction in order to achieve complete release (50–95 degrees across various joints). All patients achieved complete release of contractures with minimal complications.

Conclusion

Gradual manual soft tissue distraction through external skeletal distractors of restricting soft tissue (“stretch as you go”) after incisional release in long-standing burn contracture of limb joints achieves complete release without exposure of vital structures.

Keywords

postburn contracture - external fixators - soft tissue distraction - manual distraction - joint forces.


Publication History

Article published online:
21 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Tredget EE. Management of the acutely burned upper extremity. Hand Clin 2000; 16 (02) 187-203
    CrossrefPubMedSearch in Google Scholar
  • 2 Bennett GB, Helm P, Purdue GF, Hunt JL. Serial casting: a method for treating burn contractures. J Burn Care Rehabil 1989; 10 (06) 543-545
    CrossrefPubMedSearch in Google Scholar
  • 3 Goverman J, Mathews K, Goldstein R. et al. Pediatric contractures in burn injury: a burn model system national database study. J Burn Care Res 2017; 38 (01) e192-e199
    CrossrefPubMedSearch in Google Scholar
  • 4 Gushue DL, Houck J, Lerner AL. Rabbit knee joint biomechanics: motion analysis and modeling of forces during hopping. J Orthop Res 2005; 23 (04) 735-742
    CrossrefPubMedSearch in Google Scholar
  • 5 Sun JS, Hou SM, Hang YS, Liu TK, Lu KS. Ultrastructural studies on myofibrillogenesis and neogenesis of skeletal muscles after prolonged traction in rabbits. Histol Histopathol 1996; 11 (02) 285-292
    PubMedSearch in Google Scholar
  • 6 Fink B, Singer J, Braunstein S, Schwinger G, Schmielau G, Rüther W. Behavior of blood vessels during lower-leg lengthening using the Ilizarov method. J Pediatr Orthop 1999; 19 (06) 748-753
    CrossrefPubMedSearch in Google Scholar
  • 7 Madhuri V, Dhanraj P. Correction of post burns contracture of wrist with Ilizarov method. Burns 1998; 24 (06) 576-578
    CrossrefPubMedSearch in Google Scholar
  • 8 Gulati S, Joshi BB, Milner SM. Use of Joshi external stabilizing system in postburn contractures of the hand and wrist: a 20-year experience. J Burn Care Rehabil 2004; 25 (05) 416-420
    CrossrefPubMedSearch in Google Scholar
  • 9 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989; (239) 263-285
    PubMedSearch in Google Scholar
  • 10 Ilizarov GA. Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue. Berlin: Springer Science & Business Media; 2012
    Search in Google Scholar
  • 11 Yun AG, Severino R, Reinker K. Attempted limb lengthenings beyond twenty percent of the initial bone length: results and complications. J Pediatr Orthop 2000; 20 (02) 151-159
    CrossrefPubMedSearch in Google Scholar
  • 12 Shakirov BM. Evaluation of different surgical techniques used for correction of post-burn contracture of foot and ankle. Ann Burns Fire Disasters 2010; 23 (03) 137-143
    PubMedSearch in Google Scholar
  • 13 Grishkevich VM. Ankle dorsiflexion postburn scar contractures: anatomy and reconstructive techniques. Burns 2012; 38 (06) 882-888
    CrossrefPubMedSearch in Google Scholar
  • 14 Smith AA, Greene TL. Preliminary soft tissue distraction in congenital forearm deficiency. J Hand Surg Am 1995; 20 (03) 420-424
    CrossrefPubMedSearch in Google Scholar
  • 15 Chen Y, Niu Z, Yin X. et al. Treatment of severe postburn contracture of the elbow via distraction with external circular frame in pediatric patient. Ann Plast Surg 2021; 87 (03) 253-259
    CrossrefPubMedSearch in Google Scholar
  • 16 Bansal RK. Engineering Mechanics: Fundamentals of engineering mechanics, Resolution of force. New Delhi: Laxmi Publication; 2005: 1-23
    Search in Google Scholar