The use of acellular dermal matrix in release of burn contracture scars in the hand

Background: Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery-at times-as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored. Methods: Nine patients with burn contracture scars involving different locations in the hand and the wrist underwent two-stage reconstruction consisting of contracture release and use of acellular dermal matrix followed by definitive coverage with skin graft at the second stage. Patients were followed up for a period of at least 10 months (range, 10 to 25 months), during which time the passive range of motion of the hand was used as a quantitative measure of surgical outcome. Results: All nine patients retained at least 83 percent of the corrected range of motion involving the affected joints by 1 year and at least 89 percent of correction at each webspace. No patient required a revision procedure. Conclusion: Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.