Surgical Treatment of Postburn Boutonniere Deformity

Abstract

Deep burns of the dorsal hand can injure tendon extension apparatus over the proximal interphalangeal (PIP) joint. The defect of the central slip and retinaculum cause displacement of the lateral bands below the joint rotation axis. As a result, the finger (PIP joint) is flexed up to 90° and the extremity becomes disabled. The literature is limited regarding contracture anatomy and evaluation of the efficiency of the existing treatment methods. The problem becomes great if the PIP joint loses its passive extension; if there was intra-articular damage; if the dorsal hand lost soft tissue; and if thin scars were connected with osseous phalanges. The existing publications did not have answers for these problems. In our Institute there were numerous possibilities to explore the anatomy of the contracture, to test methods of tendon plasty, to develop techniques of passive PIP movement restoration and tendon plasty, and techniques for adipose-cutaneous layer restoration. Good results have been achieved. All these aspects are presented in this chapter.