Back to 2025 Abstracts
First Webspace Contracture Release in the Burn Population: A Single Center Experience
Cameron A Etebari, MD
1; Rachel Guest, MD
2; Maleika Ramirez, BA
3; Dhaval Bhavsar, MBBS
41University of Kansas Medical Center, Kansas City, KS; 2University of Cincinnati Medical Center, Cincinnatti, OH; 3Ponce Health Sciences University, Ponce, PR; 4Plastic Surgery, University of Kansas Medical Center, Kansas City, KS
Introduction: First webspace contracture is a debilitating condition that disproportionally affects the burn population. While there are numerous techniques for first webspace contracture release described in the literature, outcomes-based studies are lacking. This study investigates predictors of successful contracture release in burn patients who underwent first webspace reconstruction with local tissue rearrangement (LTR) and/or full thickness skin grafting (FTSG).
Methods: A retrospective review of all patients undergoing first webspace contracture release with LTR and/or FTSG following burn injury to the hand was performed. Surgeries were performed at a single institution over thirteen years. Data was collected regarding burn characteristics, surgical technique, peri-operative hand therapy, and post-operative outcomes. Analysis was performed with Fisher's exact test and two-sample t-tests with statistical significance at ?= .05.
Results: 29 primary first webspace contracture releases were performed for 24 patients. The mean follow-up time was 21 months (range: 1-54 months), with 3 patients lost to follow-up. The most common co-morbidities present were a mental health condition (29%) and peripheral neuropathy (25%), neither of which influenced re-contracture rates. All patients underwent pre-operative therapies with a combination of splinting, scar massage, or laser treatment prior to primary release. Multiple z-plasties with or without FTSG were performed as the primary surgical technique in 54% of patients, followed by the jumping man z-plasty in 34% of patients, FTSG alone in 8%, and four limb z-plasty in 4%. One patient had delayed wound healing. Re-contracture following primary release occurred in 38% of patients and was not significantly impacted by initial surgical technique (p=0.41). Time from burn injury to primary contracture release did not vary significantly in patients requiring secondary procedures compared to those who did not require reoperation (p=0.88). Patients requiring secondary release participated in post-operative therapy following primary surgical treatment less often (60% versus 94%, p=0.04). No additional procedures were required in any patient who underwent secondary release for re-contracture. Differences in contracture severity may have an additional impact on re-contracture rates.
Conclusions: First webspace contracture is a challenging condition to treat, with high rates of re-contracture following primary release. Patients should be counseled regarding the importance of compliance with intensive post-operative hand therapy to prevent recurrence.
Back to 2025 Abstracts
