Case Report on a Mitten Hand Contracture in Epidermolysis Bullosa

Authors

Keywords:

Epidermolysis bullosa, Hand deformities, Skin transplantation

Abstract

Epidermolysis Bullosa is a disorder characterized by skin fragility. Repetitive injury followed by healing can result in severe deformity due to scarring. The available evidence on whether surgery enhances hand function is somewhat inconclusive because there is a shortage of large, well-controlled studies. Nevertheless, the majority of the data suggest that surgery has the potential to enhance hand function. We present a case of Epidermolysis Bullosa in a 6-year-old patient who presented with bilateral mitten hand deformity. Right-hand contracture, pseudosyndactyly release, and defect resurfacing with a full-thickness skin graft (FTSG) were done. The patient had a smooth recovery and regained the ability to grasp objects.

References

Has C, Bauer JW, Bodemer C, et al. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol. 2020;183(4):614-27. doi: 10.1111/bjd.18921.

Has C, Fischer J. Inherited epidermolysis bullosa: New diagnostics and new clinical phenotypes. Exp Dermatol. 2019;28(10):1146-52. doi: 10.1111/exd.13668.

Has C, Liu L, Bolling MC, et al. Clinical practice guidelines for laboratory diagnosis of epidermolysis bullosa. Br J Dermatol. 2020;182(3):574-92. doi: 10.1111/bjd.18128.

Bernardis C, Box R. Surgery of the hand in recessive dystrophic epidermolysis bullosa. Dermatol Clin. 2010;28(2):335-41. doi: 10.1016/j.det.2010.01.013.

Terrill PJ, Mayou BJ, Pemberton J. Experience in the surgical management of the hand in dystrophic epidermolysis bullosa. Br J Plast Surg. 1992;45(6):435-42. doi: 10.1016/0007-1226(92)90207-e.

Bruckner AL, Losow M, Wisk J, et al. The challenges of living with and managing epidermolysis bullosa: insights from patients and caregivers. Orphanet J Rare Dis. 2020;15(1):1. doi: 10.1186/s13023-019-1279-y.

Fine JD. Epidemiology of Inherited Epidermolysis Bullosa Based on Incidence and Prevalence Estimates From the National Epidermolysis Bullosa Registry. JAMA Dermatol. 2016;152(11):1231-8. doi: 10.1001/jamadermatol.2016.2473.

DEBRA International. What is EB? DEBRA International; 2023 [cited 2023 December 3]. Available from: https://www.debra-international.org/what-is-eb.

Tuncer S, Sezgin B, Kaya B, et al. An algorithmic approach for the management of hand deformities in dystrophic epidermolysis bullosa. J Plast Surg Hand Surg. 2018;52(2):80-6. doi: 10.1080/2000656X.2017.1338183.

Anstadt EE, Turer DM, Spiess AM, et al. Surgical Management of Hand Deformity in Epidermolysis Bullosa: Initial Experience and Technique. Plast Reconstr Surg Glob Open. 2020;8(3):e2666. doi: 10.1097/GOX.0000000000002666.

Tian F, Li B, Tian LJ. Treatment of severe hand deformities caused by epidermolysis bullosa. Orthopedics. 2011;34(11):e780-3. doi: 10.3928/01477447-20110922-37.

Sibbald RG, Zuker R, Coutts P, et al. Using a dermal skin substitute in the treatment of chronic wounds secondary to recessive dystrophic epidermolysis bullosa: a case series. Ostomy Wound Manage. 2005;51(11):22-46.

Prasetyono TO, Sadikin PM, Saputra DK. The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review. Burns. 2015;41(5):890-906. doi: 10.1016/j.burns.2015.01.011.

Nakamura S, Saito S, Ishida Y, et al. Full-thickness Skin Grafts for Hand Contractures in an Adult Patient with Junctional Epidermolysis Bullosa: A Case Report. J Plast Recontr Surg. 2023;2(4):156-62. doi: 10.53045/jprs.2022-0049.

Formsma SA, Maathuis CB, Robinson PH, et al. Postoperative hand treatment in children with recessive dystrophic epidermolysis bullosa. J Hand Ther. 2008;21(1):80-4. doi: 10.1197/j.jht.2007.10.001.

TJS 45-2 04

Downloads

Published

2024-06-28

How to Cite

1.
Lim WY, Law TR. Case Report on a Mitten Hand Contracture in Epidermolysis Bullosa. Thai J Surg [Internet]. 2024 Jun. 28 [cited 2024 Dec. 23];45(2):53-6. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/266592

Issue

Section

Case Reports