Combined Method for Treating Severe Recurrent Post Burn Flexion Contracture of the Knee Joint: Free Flap and Ilizarov Apparatus

Post-burn severe recurrent flexion contracture of the knee joint is an extremely difficult reconstructive problem. The dense popliteal scar includes contracted neurovascular bundles, hamstring tendons, and sometimes extra-articular heterotopic ossification. Surgical release and skin grafting are often inadequate and doomed to failure. The authors presented their approach to this difficult problem, which includes surgical release of the scar, limited by the length of the neurovascular bundle; free latissimus dorsi flap transfer; and application of the Ilizarov apparatus. The knee joint is straightened gradually over the following weeks.

From 2003 to 2004, 5 knee joints of 4 patients (2 children and 2 adults) were treated using this approach. In all the patients, several previous attempts to release the contractures had failed. All the joints were in full fixed flexion contracture of 90–110° before the new approach was used. Surgical release included resection of the popliteal scar and lengthening of the hamstring tendons, and was limited by the length of the neurovascular bundles. This was followed by free latissimus dorsi muscle flap transfer and application of the Ilizarov external fixator.

At the end of the procedure, about 30–45° of release were achieved. Over the following 4–9 weeks, gradual straightening of the joints was performed with the Ilizarov apparatus, until full extension of the joints was achieved. There were no flap failures and no recurrent contractures over a minimal period of 10 months follow-up.