Reconstruction of severe postburn contractures involving the neck, bilateral axillae, elbows, and right wrist in a pediatric patient: A multistage Z-plasty and split-thickness skin grafting approach

Postburn contractures (PBCs) often follow deep burns, especially in children, and limit growth, movement, and social confidence. We describe a 10-year-old boy with widespread PBCs of the neck (mentosternal adhesion), both axillae, elbows, and right wrist after flame burns involving 40% total body surface area. He was severely disabled (Disabilities of the Arm, Shoulder, and Hand [DASH] 95) and disfigured (Visual Analog Scale [VAS] 1/10). A staged plan was used. Stage 1: incisional release of the neck with Split thickness Skin Graft (STSG), plus Z-plasties for the right elbow and axilla. Stage 2: Z-plasties with STSG for the left axilla and elbow. Meticulous splintage, physiotherapy, pressure garments, and scar care followed. Stage 3: Additional neck scar release and partial release of a tight abdominal scar, which also improved scoliosis. At 8 months, neck motion, upper-limb function, and appearance improved markedly (DASH 30–40; VAS 9/10). This case underscores the value of staged releases using STSG and Z-plasty combined with disciplined, multidisciplinary rehabilitation.