Reconstruction of a Chronic Volkmann Contracture following Forearm Revascularization with Burkhalter's Procedure and Fractional Flexor Tendon Lengthening after a Failed Stiles-Bunnell Transfer.

Volkmann ischemic contracture is a cause of limb dysfunction that can lead to varying amounts of limb deformity, stiffness, and paralysis. Several procedures have been used to improve limb function in these patients. An 11-year-old male patient sustained a domestic accident with a glass door, resulting in a severe soft tissue trauma to his proximal third of the right forearm with damage to flexor muscles and tendons, complete section of median and ulnar nerves, and radial and ulnar arteries. He was submitted to immediate repair of the radial artery and median and ulnar nerves. Ulnar artery was not repairable due to extensive soft tissue loss. Despite surgical treatment and successful revascularization, postoperatively he developed a postreperfusion syndrome, and in consequence an ischemic contracture. To improve his condition, simultaneous Burkhalter's procedure and fractional flexor tendon lengthening were used after a previous failed Stiles-Bunnell transfer. After 6 months, a good result was obtained, with restoration of a more anatomical hand rest position, improved arc of motion, and significant improvement of hand function with DASH (Disabilities of the Arm, Shoulder and Hand) score improving from 59 to 43 despite a slight reduction in grip strength. Opposition to the ring or little finger tip with the interphalangeal joint (IPJ) of the thumb extended was observed. The combination of fractional flexor tendon lengthening and Burkhalter's procedure is a reliable and simple procedure in cases of Volkmann's ischemic contracture and combined median and ulnar nerve palsy, without significant complications.