'X-Plasty' for Post Burn Flexion Contractures of ... - ESPRS

Egypt, J. Plast. Reconstr. Surg., Vol. 32, No. 1, January: 67-69, 2008
‘X-Plasty’ for Post Burn Flexion Contractures of
Interphalangeal Joints of All Five Digits of Hand and
Adduction Contractures of Axilla
QUATAIBAH ABDULLAH AL-KANDARI, M.D.
Ministry of Health Kuwait.
ABSTRACT
X-Plasty is surgical technique or procedure to deal with
flexion contractures at Interphalangeal joints of hand, by this
procedure one can open a contracted IP joint and resurface
the raw area with STSG and by maintaining it in an anatomical
neutral position by splinting and thus one can restore the
function of these joints to a significant extent.
INTRODUCTION
Various plastics like Z-Plasty, W-Plasty, V-Y
Plasty, V-M Plasty etc. are well described techniques
for burn reconstruction and scar management.
Hand burn scar contractures are one of the most
common indications for Z-Plasty but Z-Plasty has
its limitation for flexion contractures of digits at
IP joints and large, dense adduction contractures
of axilla.
X-Plasty could serve the purpose of release of
contractures and restoration of function at axilla
and Interphalangeal areas.
MATERIAL AND METHOD
Tightly contracted axillary joint and especially
wide flexion contracture at IP joints are best dealt
with X-Plasty.
For IP joint flexion contracture the X-shape
incision should be taken in such a way that the
center of X come exactly on the centre of contracted
scar and two vertically slanted incision releases
the scar and form two horizontal triangular flap
with apex meeting together.
The finger is then manipulated to release the
contracture completely and the raw area is surfaced
with STSG.
K-wires or other splinting devices can be used
to keep finger in a anatomical neutral position.
67
For the axillary contracture X shape incision
should be taken in such a way that the joint of X
should be on the center of axilla to achieve complete
release of the contracture. After complete release,
the raw area is again resurfaced with STSG and
an abduction splint is given to prevent recontracture.
DISCUSSION
‘X-Plasty’ for post burn flexion contractures
of Interphalangeal joints of all five digits of hand
and adduction contractures of axilla. X-Plasty is
a good surgical procedure for complete functional
release of dense and wide axillary contractures [1]
and flexion contractures of IP joints.
Other surgical interventions like flap surgery
are technically complicated and they are not always
successful. This surgical technique was first described
by Vartak and Keswani [1].
It has been a common problem to find all five
fingers (Pic. 2) of hand going in to flexion contractures
simultaneously and in this case one can not
operate all the five fingers with cross finger flap
technique or free flap method but here one can
choose X-Plasty as a better option to deal with all
the five fingers at one stage.
Post-op splinting [2] is the major problem with
plaster of Paris splints but with availability of
remouldable (Orphit) fiber splints, good splintage
and early functional recovery is possible.
This paper pointed out the ‘X-Plasty’ as better
option for all the five finger flexion contractures.
As described in the pictures as far as the references
are concerned by Vartak and Keswani stressed on
Axilla and other joints but the situation of all the
fingers going into contraction was not described
in the papers. The case described in my paper is
a unique case study.

68 Vol. 32, No. 1 / ‘X-Plasty’ for Post Burn Flexion Contractures
X
(a) (b) (c)
X- Y shape incision.
Y- Two triangular horizontal flaps.
Z- STSG at the raw area.
y
Fig. (1): X-Plasty.
Pic. (1): X-Plasty incision.
Pic. (2): Multiple X-Plasty.
z
Pic. (3): STSG over raw areas.
Pic. (4): Axillary contracture.
Pic. (5): Plasty release.
Pic. (6): STSG over raw area.

Egypt, J. Plast. Reconstr. Surg., January 2008 69
REFERENCES
1- Vartak A. and Keswani M.H.: X-plasty for repair of burn
contractures Burns. Aug., 18 (4): 326-8, 1992.
2- Samy A.M., Shehab El-Din M.D. and Osama M. Shouman:
Reconstruction of post-burn axillary scar contractures a
surgical approach Egypt. J. Plast. Reconstr. Surg., Vol.
22, No. 2: 229-238, 1998.
3- Fox S.A.: The flat-X plasty. Ophthalmology Feb., 73:
204, 1965.
4- Yilmaz S., Yenidunya O., Ercocen A.R., Saydam M.,
Seven E., Sezer H. and McTurk P.: The seven flap Zplasty
revisited. Burns. Dec., 29 (8): 849-53, 2003.
5- Peker F. Celebiler: Y-V advancement with Z-plasty: An
effective combined model for the release of post-burn
flexion contractures of the fingers. Burns. Aug., 29 (5):
479-82, 2003.
6- Numangolu A.: Paired five-flap Z-plasty. Plastic and
Reconstructive Surgery. Sep., 92 (3): 543-6, 1993.
7- Cooper M.A.: The multiple Y-V plasty in linear burn scar
contracture release. Plastic Surgery. Mar., 43 (2): 145-9,
1990.
8- Tan O., Atik B. and Ergen D.: A new method in the
treatment of post burn scar contractures: Double opposing
V-Y-Z plasty. Burns. Jun., 32 (4): 499-503, 2006.
9- Lin T.M., Lee S.S., Lai C.S. and Lin S.D.: Treatment of
axillary burn scar contractures using opposite running Y-
V-plasty. Burns. Nov., 31 (7): 894-900, 2005.