Management of Scar Contracture of the Fingers with Percutaneous Needle Aponeurotomy and Fat Lipofilling

The hand is a crucial element for the proper functioning of an upper limb, both sensory and motor. Hand injury represents up to 10% of hospital emergency room visits [1,2]. Proper knowledge of hand anatomy and physiological function - including grips, opposition, and fine motor skills - combined with experience in physical examination of the hand is essential for appropriate management and for cutting down morbidity and disability rates [3,4]. Hand contracture constitutes a major form of disability and is defined as an inability to perform the full range of hand movement due to permanent shortening of the muscles and/or joints [5]. Scar contractures following burn injury (postburn contractures), in particular, represent a surgical dilemma that often necessitate multiple interventions and the supplementation with physical therapy [6]. Excessive scarring may involve the healing of deeper tissues after high-degree burns; this often begins as puckering but can advance to thick bands of hypertrophic scarring that may restrict or preclude joint movement and permanently impair its function [7]. Other causes of scar contractures of the hand include mechanical and chemical trauma [8].