Management of severe post burns deformities of the hand.

A burn contracture of the hand is deemed to be severe if it leads to loss of prehension. When the contractures prevent the thumb from opposing the fingers, the patient loses the ability to pinch and grasp. First web contracture, extension contracture of the metacarpophalangeal joints, and flexion contracture of the fingers are the common components of a severe contracture. Concentrating on correction of the deformities that limit the thumb opposing the fingers rather than on range of movement in individual joints, attending to the deformity that will provide a perceivable difference in the first operation, attempting to achieve maximum correction on the table, choosing the appropriate soft tissue cover, performing the procedure early enough to prevent severe joint changes particularly in children, and following up with therapy and splintage to prevent recurrence are the important principles to restore prehension in a severe burn deformity. Some may need staged reconstruction. Patients use the reconstructed extremity very well when the esthetic aspect of reconstruction is also taken care of. With the available reconstructive techniques, it is possible to rehabilitate even the most severe post burn deformities of the hand.