Staged Reconstruction for Old Electrical Burns Around the Wrist

Kim, Hyoung Min; Choi, Moon Gu; Lee, Kee Haeng; Jung, Chang Hoon; Song, Hyun Jun

Abstract

In our series with old electrical burn around the the wrist, there are several characteristics: for example, bad scarring in palm and volar aspect of wrist and distal forearm, large multiple defects of the flexor tendons, low median and ulnar nerve palsy, and occasionally insufficient blood supply. Between 1992 and 1995, we treated 8 cases of 7 patients with staged reconstruction. 4 patients with bilateral involvements had below-elbow amputee of contralateral upper extremity. The common approachs in each were soft tissue coverage, staged tendon reconstructiuon, and opponensplasty. The length of time between the injury and tendon reconstruction was 9 months on an average. Soft tissue coverage consisted of: 1. free tissue transfer (n=3), 2. abdominal (n=3) or groin (n=2). Total numbers of flexor tendon reconstruction were 26. Among them, staged reconstruction using silicone prosthesis were done in 18 tendons and primary tendon graft following tenolysis were done in 8 tendons. The time between first and second stage tendon reconstruction was 4.13 months. In all cases, opponen-splasty using extensor indicis proprius (n=4), extensor pollicis longus (n=2), and extensor digiti mini- mi (n=l), were performed. Good functional improvement of the hand were obtained in all cases. Patient s satisfaction were much better than the degree of functional improvement of the hand.