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Schematic representation of the elevation of the free groin flap. The perforator to the skin flap has been identified. 1. Main branch, 2. Superficial branch, 3. Deep branch, 4. Perforator from deep branch supplying the skin, 5. Sartorius fascia

Schematic representation of the elevation of the free groin flap. The perforator to the skin flap has been identified. 1. Main branch, 2. Superficial branch, 3. Deep branch, 4. Perforator from deep branch supplying the skin, 5. Sartorius fascia

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Severe post burns contracture in children not only leads to functional impairment but also has profound psychological impact on the child. Untreated neck contractures have been shown to inhibit mandibular growth. Skin grafting in children has a higher rate of recurrence and in these cases a thin pliable flap seems to provide a durable solution. To...

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Purpose: Neck defects usually occur after burn contracture release and benign or malignant neck tumor excisions. Frequently used neck skin reconstruction methods are skin grafting, Z-Plasties, skin pedicled or perforator flaps, and free flaps. Pre-expanded perforator skin flaps are useful options for skin defect reconstructions. Pre-expansion of th...
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Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse u...
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Burns account for a significant proportion of injuries, and of these the face, neck, and anterior torso are commonly affected. Burn scars remain a lasting reminder of the insult both for the patient and the outside world. There is little doubt that the change in appearance and the limitation imposed by a burn scar contribute to negative body image....
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Undoubtedly, the main function of the hand is to perform a palmar and pincer grasp. This capacity may be impaired in diverse conditions, specifically, when there is a hand contracture in adduction or in severe cases of decreased first interdigital space. Many techniques are available in order to free the first interdigital space; options include sk...
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Burn contractures produce restrictions in motion and unacceptable aesthetic results, frequently with persistent wounds. Proper planning and tissue selection are essential to minimize donor site morbidity optimizing outcomes. The principle of burn reconstructive surgery requires that the defects after release should be replaced with donor tissues wh...

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Article
One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients still remains a challenge for the surgeons. Eleven children (aged 5 to 14 years) with post burn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for post burn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.
Article
Introduction Free tissue transfer is a rarely indicated procedure in burns. However, in well selected cases it may play a pivotal role in optimizing outcomes in both primary and secondary burn reconstruction. We undertook a systematic review, based on the PRISMA statement for systematic reviews, of all published literature relating to the use of free flaps in acute burns and in secondary reconstructive procedures. Methods Inclusion and exclusion criteria were defined and Medline, Embase, PubMed and Google Scholar databases were searched from 1980 onwards to May 2013 with the search terms: “free flaps”, “free tissue transfer”, “microvascular”, “burns”, “acute burns”, “primary reconstruction” and “secondary reconstruction”. Results A total of 346 studies were retrieved following the search of which 30 studies met the inclusion criteria and were included in the review. Discussion We present the indications, timing, complications and failure rates for free flaps in primary and secondary reconstruction based on the available literature. We also provide a list of the various free flap options for the commonest sites undergoing reconstruction following burns. Finally an algorithm to ensure optimal success of free flaps when used in primary and in secondary burn reconstruction is presented.
Article
Background Anterior cervical hypertrophic scars caused by severe burn are prone to contracture deformation. Even after multiple skin graft procedures, limitation of neck motion still occurs, especially in patients with hypertrophic scarring. This study examines the feasibility of associating the free scapular flap and platysmaplasty for reconstruction of recurrent neck contracture. Methods Patients with severe scar contracture after multiple skin grafting and with hypertrophic scarring were under investigation. After complete release of the anterior cervical scar, a transection of platysma combined with suture fixation of platysma muscle flap to the surface of chin bone was performed, and the vascular anastomotic free scapular flap was covered. Functional exercise was strengthened postoperatively. Results All flaps (12 cases) survived well with obvious improvement of neck motion and satisfactory appearance. Conclusions Free scapular flap associated to platysmaplasty is one of the preferred alternatives for scar reconstruction in patients with recurrent neck contracture or severe hypertrophic scarring. Level of Evidence: Level IV, therapeutic study.
Article
The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. The authors with their experience combined to a review of the literature, try to clarify these indications for each anatomical location. From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.
Article
The objective of this study was to summarize our experience of using local flaps for the reconstruction of neck defects after cervical contractures release, particularly of using the extended deltopectoral flaps whose distal margin was beyond the anterior axillary line even reaching dorsalis for reconstruction of anterior neck scar contractures in a single-stage procedure. From 1987 to 2008, neck scar contractures were reconstructed using various local flaps in 68 patients with postburn anteriorly located neck contractures. The local flaps used consisted of 36 deltopectoral flaps, 6 extended deltopectoral flaps, 4 free scapular flaps, 8 neck-shoulder flaps, and 14 Z-plasties. The distal end of extended deltopectoral flaps was transferred as microvascular-free flap provided by the posterior circumflex humeral artery, but the proximal end as pedicle flap supplied by the anterior perforating branches of internal mammary artery. Other flaps were elevated conventionally as described previously in the articles. Of 68 patients, there were 59 cases (86.8%) whose release of the contractures was excellent. For 51 patients, the whole process of treatment was finished only in a single-stage procedure. We used extended deltopectoral flap, which was developed from our own anatomic studies and from previous reports in the literature, in 6 patients. This new flap extends the volume of the original deltopectoral flap, from 22 to 32 cm in length and 10 to 22 cm in width (at the apex). Postoperatively, all flaps survived completely. Patients were satisfied with their results. The follow-up period ranged 1 to 10 years; no obvious recontractures have been noted. There were no severe donor-site complications. The local flap with matching texture, color, elasticity, and pliability is still the best choice for reconstruction of postburn anteriorly located neck contractures. The extended deltopectoral flap has been used successfully to yield satisfactory outcomes for the scar contractures in the anterior neck and should be conserved as a selective method for reconstructive surgeons.