Combined Local Flap and Split Thickness Skin Graft (STSG) as One of Reconstructive Surgery Technique for Diffuse Ankle Contracture Management (A Case Report)

Abstract

Aims: To describe combined local flap and skin graft as one of reconstructive surgery techniques for diffuse ankle contracture management. Case Presentation: A two years old girl with a history of exposure to hot water about one year ago. The patient was diagnosed with a diffuse right ankle contracture.Reconstruction was performed with two operation procedures. At first operation, release of contracture, excision of scar tissue and toe pinning were performed, continued with reconstruction with a local flap (advancement flap) of the inferior area of the medial trunk from the lateral side of ankle, attaching the fiber to the medial side. At second operation, we covered the defect with an intermediate split thikness skin graft. Discussion: Contracture is the loss or lack of full range of motion of the joint either passively or actively due to joint limitations, fibrosis of the supporting tissue, muscles and skin. The main concern for contracture therapy is restoration of function by encouraging the use of limbs for ambulation and other activities. Combination between flap and skin graft could be a solution for patient with contracture. Local flap with random pattern is the most commonly used flap type. Because the process is easier, if the defect area is not too large, this local flap can even be done with local anesthesia. STSG is often used over large areas. Grafts on STSG cover all parts of the epidermis and dermis with different thicknesses. Postoperative evaluation: viable flap, STSG Take 98%. Conclusion: Combined Local flap and skin graft is one of the therapeutic modalities for post burn contracture patients in the ankle joint area which also can prevent recontracture. Regular physiotherapy is still required after this procedure to get maximum range of movement and better walking function.