[Skin problems in severe retraction stiffness of the hand and fingers. Role of the so called "castle" flap].

Skin retraction is a commonly observed complication of severe joint stiffness in the hand. After freeing the joint, this raises the problem of closing the skin without tension to avoid necrosis, disunion or pain during early rehabilitation and splinting. We have used a simple rotation flap for PIP extension (and hyperextension) stiffness and a "castle" flap for PIP flexion retraction and for both extension and flexion stiffness of the MPJ. It consists in withdrawing the skin (dorsal or palmar) of the phalanx distal to the freed joint. We have used this flap in 13 clinical cases of severe stiffness and it allowed wide access to all structures involved and facilitated early post-operative mobilization.