Use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures

BACKGROUND: Multiple reconstructive methods have been used for the treatment of postburn scar contractures including skin grafting, geometric relaxation techniques, local flaps and free flaps. PURPOSE: In the present study, the authors evaluated efficiency of the use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures. METHODS: Twelve white male with postburn scar contracture were treated using rhomboid and double Z-plasty technique. The cause of burn, duration of contracture, postoperative follow-up period, preoperative and postoperative motion lag of joints and improvement in motion were recorded. CONCLUSIONS: All operations were successful. Severe contracture lines crossing flexion folds can be released effectively by using rhomboid flap and double Z-plasty technique without distorting the specialized flexion areas and with broken scar lines which is essential to avoid from recurrence.     

Chronic postburn palmar contractures reconstruction using the medial pedis perforator flap

Chronic flexion contractures of the palm of the hand impair hand function considerably and cause a poor esthetic appearance. Various reconstructive methods have been used for the treatment. However, satisfactory esthetic and functional results are difficult to achieve due to the unique anatomic characteristics of the palmar region, such as thick, cornified, stratified squamous epithelium. In the present study, free medialis pedis flap was used in a number of patients who suffered from severe palmar flexion contractures due to burn injuries. Here, the experience, technique, and follow-up results are presented. Eleven patients admitting to our department with palmar flexion contracture were reconstructed with free medialis pedis flap from 2004 to 2007. All were men and ranged in age from 19 to 22 years old (average, 21 years). In all cases, different parts of palmar region were covered. In all cases except 2, arterial anastomosis was done to proper digital arteries. Although the concomitant vein and superficial vein were prepared in all cases, only superficial vein of flap was used for anastomosis. In one case, the donor site was closed primarily, the others were closed with skin graft. The transplanted flaps survived with satisfactory recovery in function and appearance. In 2 cases, transient venous insufficiency was observed and resulted in possible increase in flap thickness. Grasp function of the hand was dramatically improved. The follow-up period ranged from 10 to 22 months. In one case, the flap required debulking. Postoperative follow-up revealed no marked donor site morbidity. We determined that the medialis pedis flap was a remarkable alternative for palmar reconstruction of the hand and digits due to burn because of its glabrous skin, which was very similar to palmar skin, and low donor site morbidity.     

Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers

BACKGROUND: Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. PURPOSE: We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. METHODS: Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. CONCLUSION: The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.     

手部皮神经营养血管逆行岛状皮瓣修复手指创面

目的 报道应用逆行指背神经营养岛状皮瓣修复手指的皮肤软组织缺损.方法 20位患者,接受该皮瓣修复24指创面.结果 皮瓣全部成活,术后经3-12个月随访,皮瓣质地优良,外形与功能恢复满意.结论 该手术方法可靠,供区损伤小.     

前臂及拇背侧皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨前臂及拇背侧带皮神经营养血管蒂岛状皮瓣临床应用的适应证。方法利用以前臂外侧皮神经营养血管为蒂的岛状皮瓣修复拇指末节脱套伤2例,带拇背桡侧皮神经营养血管蒂岛状皮瓣及尺背侧皮神经营养血管蒂逆行岛状皮瓣修复拇指掌侧软组织缺损10例。皮瓣切取面积2cm×3cm～7cm×11cm。结果11例皮瓣全部成活,1例前臂外侧皮神经皮瓣因切取面积较大导致远端部分坏死。结论以前臂皮神经营养血管为蒂的岛状皮瓣适用于拇指末节脱套伤,但皮瓣长度不应超过11cm;拇背侧皮瓣宽度较小,仅适宜修复拇指较小面积的软组织缺损。     

拇指背侧皮神经营养血管蒂岛状皮瓣修复拇指指端缺损

目的探讨拇指背侧带皮神经营养血管蒂岛状皮瓣修复拇指指端缺损的临床效果。方法利用带拇指桡背侧或尺背侧皮神经营养血管蒂岛状皮瓣修复拇指指端软组织缺损12例。结果12例皮瓣全部成活,经6～24个月随访,拇指外形和功能恢复良好。结论拇指背侧皮神经营养血管蒂岛状皮瓣具有操作简单、成活率高、外形恢复满意等优点,是修复拇指指端缺损的理想方法。     

皮神经营养血管(丛)指背逆行岛状皮瓣的临床应用

目的 报道应用带皮神经营养血管(丛)的指背逆行岛状皮瓣修复指腹、指端侧方缺损及末节截指伤的临床效果。方法 根据手指损伤的部位、形状、面积设计带皮神经营养血管(丛)指背逆行岛状皮瓣修复19例手指损伤创面。结果 皮瓣全部成活，其中1例在术后36小时出现静脉危象，经皮缘拆线，伤口局部滴肝素钠等处理，4天后皮瓣颜色红润，肿胀消退。术后3～12个月随访皮瓣质地优良。外形与功能恢复满意。结论 该手术方法操作简单、安全可靠，是修复手指创面的较理想皮瓣。     

带拇背侧皮神经营养血管蒂岛状皮瓣修复拇指软组织缺损

目的 探讨带拇背侧侥、尺侧皮神经营养血管蒂的岛状皮瓣修复拇指软组织缺损的可行性及临床效果。方法 从1997年10月至2004年2月，利用拇背侧皮神经营养血管皮瓣修复拇指软组织缺损，并将皮瓣内皮神经与受区内指神经行外膜吻合，重建受区感觉。结果 临床应用101例皮瓣，其中97例皮瓣均成活，1例皮瓣坏化，3例皮瓣部分坏死，经吻合神经后皮瓣能恢复部分感觉。结论 该皮冲经皮瓣手术操作简单，皮瓣外形好，部分皮瓣能恢复感觉，是修复拇指软组织缺损的较为理想方法。     

The use of subcutaneous pedicle rhomboid flap in the treatment of postburn scar contractures

PURPOSE: To investigate the efficacy and versatility of subcutaneous pedicle rhomboid flap in the treatment of linear or wide postburn scar contractures located in various parts of the body. MATERIALS AND METHODS: Twenty-three patients (aged 5 to 35 years) with postburn linear and wide scar contractures were treated with 31 subcutaneous pedicle rhomboid flaps. Rhomboid flaps were applied in the trunk (4 flaps), head and neck (5 flaps), lower extremity (5 flaps), and upper extremity (17 flaps). In 3 cases, Z-plasty was incorporated to the technique due to inadequate release. RESULTS: All rhomboid flaps healed uneventfully. In 28 contractures, rhomboid flaps alone were efficient to release the tension line (90.3%). Tip necrosis of the triangular flaps of Z-plasty in 1 case was the only complication seen that later led to recontracture. CONCLUSION: Clinical results indicated that subcutaneous pedicle rhomboid flap is a simple, efficient, and versatile technique in release of any postburn scar contracture. As no undermining is carried out, the flaps are more reliable than commonly used Z-plasty. Again contrary to Z-plasty, displacement of anatomic landmarks such as axillary hair and areola is rare with the technique.     

尺动脉腕上皮支皮瓣修复手掌软组织缺损

目的探讨尺动脉腕上皮支皮瓣修复手掌软组织缺损的疗效。方法应用尺动脉腕上皮支皮瓣修复17例17块手掌皮肤软组织缺损。结果17块皮瓣全部成活,其中2例远端部分皮肤出现暗紫、水疱,予以换药表层脱痂愈合。15例获随访,时间5个月～3年,皮瓣色泽、质地均较满意,掌指关节伸屈活动范围0°～85°,虎口区角度50°～60°,拇指对掌功能恢复良好。结论应用尺动脉腕上皮支皮瓣修复手掌软组织缺损疗效满意。     

腓肠神经营养血管逆行岛状皮瓣的临床应用

目的探讨腓肠神经营养血管逆行岛状皮瓣的临床应用特点。方法1997年6月～2002年3月,对13例小腿中下段、踝关节周围及足跟、跟腱等处软组织缺损的患者,采用腓肠神经营养血管逆行岛状皮瓣转移修复。皮瓣面积最大15cm×9cm,最小5cm×6cm。结果13例腓肠神经皮瓣中11例皮瓣全部成活,一期愈合。2例远端部分坏死,经换药后愈合。随访3个月～4年,皮瓣质地满意,有保护性感觉恢复。结论腓肠神经营养血管逆行岛状皮瓣切取简便,血供可靠,不牺牲主要动脉,即使在下肢血管条件相对较差的患者也可成活,是较理想的修复小腿中下段、踝关节周围及足跟、跟腱等处软组织缺损的方法。     

隐神经营养血管蒂逆行岛状皮瓣的临床应用

目的探讨隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损的临床应用。方法自1998年6月～2000年12月,对8例小腿下1/3、踝关节周围及足软组织缺损的患者,行隐神经营养血管蒂逆行岛状皮瓣转移修复术,其中3例皮瓣的血管筋膜蒂上保留1.5cm宽的皮桥,作为切开隧道的顶部,这样可避免皮瓣蒂经皮下隧道时血管受压。皮瓣面积最大15cm×9cm,最小6cm×5cm,平均9cm×6.3cm。结果7例全部成活,1例部分坏死,随访6个月～2年,皮瓣质地满意。结论隐神经营养血管蒂逆行岛状皮瓣修复下肢软组织缺损,取材方便,血供可靠,不牺牲主要动脉,即使下肢受区皮肤血运条件差的患者也可成活。     

以第一指掌侧总动脉为蒂的手背逆行岛状皮瓣的应用解剖

目的 为以第一指掌侧总动脉为蒂的手背逆行岛状皮瓣修复拇指大面积软组织缺损术式提供解剖学基础。方法 成人手动脉注和铸型标本共５６只,观测第一指掌侧总动脉,第二掌背动脉和第二指蹼动脉的形态特点及其连接类型,２只成人手血管透明标本观测皮瓣面积并进行模拟修复术式。（结果）（１）第一指掌侧总动脉恒定存在,其起始有３种类型;（２）第二掌背动脉出现率高;（３）第二指蹼动脉恒定存在,并与掌侧和背侧动脉存在交通吻合     

Bilateral side finger transposition flaps in the treatment of chronic postburn flexion contractures of the fingers

The authors present a surgical method of releasing postburn flexion contracture of the finger by two separate transverse incisions and covering the skin defects by transposing two random-pattern flaps from both sides of the finger. One of the proximally based flaps was transposed from one side of the proximal phalanx and the other flap was transposed from the opposite side of the middle phalanx. Because the flaps were raised from different sides of different phalanxes, the donor sites were closed primarily. A total of 37 fingers (14 hands, 11 patients) were treated with this method. The patients were all men aged 20 to 24 years old. The mean follow-up period was 9 months. The lack of extension of the proximal interphalangeal joints of the fingers was improved by approximately 45 deg using the described method. The authors conclude that this method can be used effectively in the treatment of mild to moderate postburn flexion contractures of the fingers.     

尺动脉腕背降支为蒂的岛状皮瓣的临床应用

目的总结尺动脉腕背降支为蒂的岛状皮瓣移植修复手背软组织缺损的临床应用。方法应用这种方法修复6例手部软组织缺损,右手4例,左手2例;年龄:16～46岁(平均30岁),缺损范围:3cm×3cm～4cm×7cm,切取尺背侧岛状皮瓣范围:最大5cm×8cm,最小3.5cm×4cm。供区2例直接缝合,4例行中厚网状游离植皮。结果1例术后供区发生远端尖部小片植皮坏死,经2周交换敷料逐渐自行愈合,所有皮瓣全部成活,取得了满意的临床效果。结论该岛状皮瓣以尺动脉腕背降支为血供,血运丰富、血管解剖恒定以及血管蒂长,适宜修复手部软组织缺损。     

Double opposing rectangular advancement flap is an alternative technique in the treatment of wide linear postburn scar contractures

Background

Double opposing rectangular advancement is a new and alternative technique in the treatment of postburn scar contractures. The technique consists of opposing two adjacent subcutaneously pedicled rectangular flaps by advancement and lengthening a contracture band. Experimental studies demonstrated that the technique is efficient to elongate a tension line as much as Z-plasty in the rat inguinal skin. In this clinical study we investigated the efficiency and versatility of the technique in the treatment of wide linear postburn scar contractures in various parts of the body.

Materials and method

We applied 16 double opposing rectangular advancement in 7 patients (aged 4–56). Flaps were applied in the upper extremity (11 flaps), lower extremity (4 flaps) and trunk (1 flap).

Results

Average follow-up was 1-year. All flaps achieved adequate relaxation postoperatively and healed uneventfully. Postoperative measurements indicated that the lengthening provided with the technique ranged from 72 to 100%. The subcutaneous pedicle of the rectangular flaps provided a distinct advantage in terms of vascularity. Recontracture was seen in one patient to whom two double opposing rectangular flaps in series were applied in the axilla.

Conclusion

Clinical results indicated that double opposing rectangular advancement is effective in the treatment of wide linear postburn scar contractures. Preoperative planning and application of flaps are simple. One knows preoperatively the exact elongation along the contracture line and narrowing perpendicular to this line which will be provided with the technique. Since the flaps are subcutaneously pedicled, the vascularity of the flaps are reliable. However the technique may not avoid recontracture in the axilla.