Free Transfer of Fascia of the Scalp by Microvascular Technique Plus Skin Graft for the Repair of Postburn Clawhand Deformity

Abstract

Postburn clawhand deformity has long been a challenge to both plastic and hand surgeons because it involves not only the skin and subcutaneous tissue but also deep structures such as tendons, ligaments, bones and joints. A combination of all these factors makes reconstruction of the hand a difficult problem. The conventional reconstruction of clawhand deformity usually begins with the replacement of the scar tissue with a flap or tube transplantation which always requires several stages before deep structures can be handled safely. With the help of microvascular anastomosis technique, a one-stage free flap transfer can be substituted but, as we all know, the flap thus transferred is often too bulky in appearance. Since October 1980 we have been adopting a new surgical technique including a free scalp fascia transfer and a free skin graft on top of it. This new technique has been used in repairing seven cases of clawhand deformity with good results. The technique was first advocated by Smith in 1980 for repair of chronic leg ulcer.