Recurrence of Extremity Joint Contracture After Z-Plasty Versus Full-Thickness Skin Graft

NCT07885046 | Not Yet Recruiting DMC

• 2 other identifiers: 1.308/VII/HREC/2026308/VII/HREC/2026
• Study Type: observational
• Target: 300
• Locations: 0 countries
• Sites: N/A

Brief Summary

The purpose of this study is to compare how often joint contractures in the arms and legs come back after two common types of reconstructive surgery: Z-plasty and full-thickness skin graft (FTSG). A joint contracture is a tightening of scar tissue, most often after a deep burn, that limits how far a joint can move. Surgery can release the tight scar, but the contracture may return over time. Z-plasty rearranges nearby skin to lengthen the scar, while FTSG covers the released area with full-thickness skin taken from another part of the body. Previous studies have shown conflicting results about which technique has a lower risk of the contracture returning. This study will review the medical records of patients who had contracture release surgery of the shoulder, elbow, wrist/hand, hip, knee, or ankle at Dr. Moewardi General Hospital, Surakarta, Indonesia, between 2016 and 2026. No new treatment or procedure will be given to patients, and all patient information will be kept anonymous. The study hypothesis is that the rate of contracture recurrence differs between patients treated with Z-plasty and those treated with FTSG. The results may help surgeons choose the most suitable technique to reduce the risk of recurrence and improve patients' movement and quality of life.

Conditions

Joint Contracture; Contracture; Cicatrix; Burn Scar Contractures

Keywords

joint contracture; z-plasty; FTSG; Contracture Release; Contracture Recurrence

Outcome Measures

Primary Outcomes (1)

• Rate of Contracture Recurrence

  Proportion of participants with contracture recurrence in each group, defined as loss of the surgically corrected range of motion (ROM) or the development of a tethering scar band requiring revision surgery, as documented in medical records based on goniometric evaluation. Recurrence is recorded as a binary outcome (recurrence / no recurrence) and compared between the Z-plasty and FTSG groups.

  At least 6 months after surgery (assessed at last recorded follow-up)

Study Arms (2)

Z-Plasty

Patients with extremity joint contracture (shoulder, elbow, wrist/hand, hip, knee, or ankle) who underwent surgical excision/release of the contracture with Z-plasty as the sole closure technique at Dr. Moewardi General Hospital between 2016 and 2026. Z-plasty involves transposition of two opposing triangular local flaps to lengthen the scar axis and reorient the scar without donor tissue. Data are obtained retrospectively from medical records; the procedure was performed as part of routine clinical care and was not assigned by the study.

Procedure: Z-Plasty

Full-Thickness Skin Graft (FTSG)

Patients with extremity joint contracture (shoulder, elbow, wrist/hand, hip, knee, or ankle) who underwent surgical excision/release of the contracture with full-thickness skin graft (FTSG) as the sole closure technique at Dr. Moewardi General Hospital between 2016 and 2026. FTSG involves covering the post-release defect with a graft containing the epidermis and full dermis harvested from a donor site. Data are obtained retrospectively from medical records; the procedure was performed as part of routine clinical care and was not assigned by the study.

Procedure: Full-Thickness Skin Graft

Interventions

Z-Plasty PROCEDURE

Surgical release of extremity joint contracture using Z-plasty as the sole closure technique. After incision/excision of the contracted scar band, two opposing triangular local flaps are transposed to lengthen the scar axis and reorient the scar along relaxed skin tension lines, without the need for donor-site tissue. Performed as part of routine clinical care; not assigned by the study.

Z-Plasty

Full-Thickness Skin Graft PROCEDURE

Surgical release of extremity joint contracture by excision of the contracted scar, followed by coverage of the resulting defect with a full-thickness skin graft (epidermis and entire dermis) harvested from a donor site, used as the sole closure technique without combined local flap transposition. Performed as part of routine clinical care; not assigned by the study.

Full-Thickness Skin Graft (FTSG)

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients of all ages with extremity joint contracture, predominantly post-burn scar contracture, who underwent surgical contracture release with either Z-plasty or full-thickness skin graft at the Department of Plastic, Reconstructive and Aesthetic Surgery, Dr. Moewardi General Hospital, a tertiary referral hospital in Surakarta, Indonesia, between 2016 and 2026. Participants are identified retrospectively from hospital medical records.

You may qualify if:

• Patients diagnosed with joint contracture of the extremities (shoulder, elbow, wrist/hand, hip, knee, or ankle)
• Underwent surgical excision/release of the contracture using either Z-plasty or full-thickness skin graft (FTSG) as the sole closure technique at Dr. Moewardi General Hospital between 2016 and 2026
• Complete medical records, including preoperative data, operative report, and postoperative follow-up records of at least 6 months

You may not qualify if:

• Contracture of non-burn etiology not comparable to post-burn contracture (e.g., congenital or purely neurogenic contracture)
• Combined surgical techniques in a single procedure (e.g., Z-plasty combined with skin graft) that prevent clear group allocation
• Incomplete or missing medical records, or loss to follow-up before the minimum recurrence-assessment period

Sponsors & Collaborators

• Universitas Sebelas Maret: lead

MeSH Terms

Conditions

Contracture; Cicatrix

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Muscular Diseases; Fibrosis; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Almas Mirza Murastomo, MD., M.Ked.Klin., Sp.B.P.R.E.

  Universitas Sebelas Maret / Dr. Moewardi General Hospital

  STUDY DIRECTOR

• Naufal Helmi Musyaffa, MD

  Universitas Sebelas Maret

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Naufal Helmi Musyaffa, MD

CONTACT

+6282236363445; naufalhelmimusyaffa@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical Student Researcher, Department of Plastic, Reconstructive and Aesthetic Surgery

Study Record Dates

• First Submitted: October 13, 2026
• First Posted: October 21, 2026
• Study Start: October 13, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 31, 2027
• Last Updated: October 21, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share