A 49-year-old man was injured by a conveyor belt. His right arm, palm and thumb were severely scraped, resulting in his skin, flexor pollicis longus, thenar muscle and neurovascular bundle of his thumb becoming necrotic. After several rounds of debridement of the necrotic tissue, we performed skin reconstruction using a pedicled groin flap on the 18th day after injury. Adduction and flexion contracture of the thumb occurred despite aggressive rehabilitation. Five months after his injury, release of adduction contracture was performed by multiple Z-plasty and tenotomy, then an external fixator was placed on his right hand for two months. Seven months after his injury, the external fixator was removed and the thumb interphalangeal joint was fused. One year after the injury, his ability to pinch and grasp was improved, and he returned to his previous work.
A few reports have suggested that surgical debridement and replacement by skin graft or flap are the best methods for heat-press injuries. The groin flap is well established method and large flaps can be harvested. In our case, contracture of the thumb occurred after the operation. However, gradual release by external fixator improved the hand contracture because the injured hand was reconstructed using a thin and flexible flap.
