Complete release of contracture should be done, avoiding damage to any important underlying structure, e.g., arteries, nerves, tendons, etc. Although contraction occurs in all directions, the incision begins across the point of maximum tension, i.e., where the contracture is most tight. This point is usually opposite the joint line. The incision is deepened all the way to the unscarred tissues. Multiple darts should be made at appropriate points along the periphery of the defect created to take into account the contracture along other directions. Fishtailing of the incision line at either end is inadequate and inferior to the multiple darts. No attempt should ever be made at undermining the surrounding healthy/scarred skin and advancing it to decrease the defect. Incision line can be infiltrated with 1:200,000 adrenaline solution to have a relatively bloodless field. The limb contractures can be released under tourniquet which should be deflated after complete release and haemostasis achieved using bipolar cautery.
Complete release of contracture should be done, avoiding damage to any important underlying structure, e.g., arteries, nerves, tendons, etc. Although contraction occurs in all directions, the incision begins across the point of maximum tension, i.e., where the contracture is most tight. This point is usually opposite the joint line. The incision is deepened all the way to the unscarred tissues. Multiple darts should be made at appropriate points along the periphery of the defect created to take into account the contracture along other directions. Fishtailing of the incision line at either end is inadequate and inferior to the multiple darts. No attempt should ever be made at undermining the surrounding healthy/scarred skin and advancing it to decrease the defect. Incision line can be infiltrated with 1:200,000 adrenaline solution to have a relatively bloodless field. The limb contractures can be released under tourniquet which should be deflated after complete release and haemostasis achieved using bipolar cautery.
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