Classification and management of burned thumb contractures in children.

Based on the position of the thumb metacarpal, 102 burned thumb contractures in children were classified into four categories: adduction, opposition, extension and flexion. The contractures were further classified as mild, moderate or severe, based on the amount of motion lost. All thumbs were surgically released. Coverage was obtained with local flaps or Z-plasties, skin grafts or a combination of local flaps and skin grafts. Factors influencing the results were as follows: Classification category: Extension contractures generally did poorly, whereas flexion contractures did well. Severity of contracture: The more severe the contracture, the worse the final results. Complexity of contracture: Contractures with a subluxated or dislocated joint did not do as well as those with undisturbed bony alignment. Type of surgical release: There was a trend towards better results when skin grafts (as opposed to local flaps) were used, especially in the treatment of moderate and severe contractures.