Functional Reconstruction of Severe Postburn Upper Extremity Contractures

Severe postburn hand contractures in both children and adults involve multiple tissue layers and represent a major cause of long-term functional impairment. This study aimed to evaluate surgical reconstruction strategies and outcomes using a comprehensive approach that prioritizes functional stability and coordinated restoration rather than isolated deformity correction. A retrospective analysis was conducted on pediatric and adult patients between January 2021 and September 2025. Preoperative and postoperative clinical photographs, video recordings, and radiologic images were reviewed. Outcomes were assessed using a 5-point Likert scale and functional evaluation. A total of 22 patients were included, with a wide age range from early childhood to adulthood. Across 28 operative sessions, more than one hundred procedures were performed, including contracture release, tendon transfer, joint fusion, graft and flap coverage, nerve procedures, and, when necessary, amputation or reconstruction of absent digits. In pediatric patients, repeated procedures were more common due to growth and recurrence. Satisfaction scores improved significantly in both groups, with marked gains in functional stability, hand use, and aesthetic appearance. Although functional recovery was limited in some long-standing deformities, overall hand utility and patient or caregiver satisfaction improved substantially. Reconstruction of postburn hand contractures requires a comprehensive, individualized strategy that addresses all tissue components as a functional unit. Emphasis on functional stability rather than isolated motion allows meaningful improvement even in severe cases. Both pediatric and adult patients can benefit from timely, carefully planned surgical intervention.