Effectiveness of hand reconstruction techniques for the treatment of postburn contractures of the hand: A systematic review

Introduction

Despite the multitude of preventative methods, postburn hand contractures are poorly controlled and often require surgery. However, there is no consensus on which hand reconstruction technique is most efficacious. This systematic review aims to compare the efficacy of available postburn hand contracture reconstruction techniques over the long term and to evaluate the quality of current literature. Effectiveness is assessed with functional improvement, increase of skin surface area, and scar quality/enhanced cosmesis.

Material and methods

Four medical databases/registries were searched (PubMed/MEDLINE, Scopus, Cochrane, EMBASE) alongside grey literature sources from December 2012 to November 2022 for randomized controlled trials and observational studies with ≥ 15 participants and ≥ 3-month follow-up. Exclusion criteria were acute burn management, non-burn/non-hand contractures, non-surgical management, other burn sequelae, non-English studies, and outcomes reports, reviews, communications, editorials, letters, case reports, and non-human studies. Quality was assessed with the Joanna Briggs Institute checklist and GRADE.

Results

Seven observational studies (1310 patients) were eligible; three with a pre-/post-operative design and four comparative cohorts. Functional and aesthetic/scar quality outcomes for skin grafting and random or defined-vascularization flaps, complication rates and rehabilitation modalities were reported. No studies on dermal substitutes or utilising skin surface area measurements were identified. Significant risk of bias, indirectness and imprecision were noted in all studies, deriving from absence of randomization, blinding, or independent control groups; confounding; missing data; and subpar reporting. Owing to heterogeneity in outcome measures, meta-analysis was not possible.

Conclusions

No consensus remains on the superiority of a single reconstruction technique. Meticulous preoperative planning and intensive rehabilitation are vital. A stepwise approach, considering individual patient and contracture characteristics and the limitations of each technique, should be followed. Well-designed and conducted future studies, utilizing reliable and validated contracture description methods and outcome assessment, are now imperative.