The burned small finger.

Postburn deformities are common in the small finger. A boutonniere-like deformity may develop when no injury has been noted in the central slip of the extensor tendon. Attention to the anatomic differences of the fifth digit and principles of graft contraction make this deformity preventable. In the long-standing burn hyperextension deformity of the metacarpophalangeal joint, recurrence of the deformity may occur after reconstruction. Evaluation of extrinsic extensor tightness may indicate an alteration in the soft tissue-to-skeleton relationship. Composite tissue expansion of the tendon and overlying skin graft provides an alternative reconstruction method.