Z-lengthening and gastrocnemius muscle flap in the management of severe postburn flexion contractures of the knee.

Five patients with seven severe flexion contractures after burn were treated. The problems confronted at the time of release of these contractures were bowstringing of contracted neurovascular bundles and hamstring tendons. These problems were overcome by Z-lengthening of tendons to achieve nearly normal extension. The medial head of the gastrocnemius muscle and local adipofascial flaps were used for coverage of exposed tendons and neurovascular bundles. Complete correction with full range of active motion of the knee joint was achieved in all of the patients after physiotherapy with no significant complication. We recommend this procedure routinely for patients with severe postburn flexion contractures of the knee with shortened tendons and neurovascular bundles.