Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns

Zhang Wei; Zhang Weidong; Chen Lan; Luan Xiagang; Yang Fei; Li Ze; Liu Feng; Wang Deyun

doi:10.3760/cma.j.cn501225-20230706-00248

Volume 39 Issue 9

Sep. 2023

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2023 > 39(9): 826-834

Yang CP,Tang LF,Liu ZJ,et al.Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities[J].Chin J Burns Wounds,2023,39(9):842-848.DOI: 10.3760/cma.j.cn501225-20220726-00310.

Citation:

Zhang W,Zhang WD,Chen L,et al.Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns[J].Chin J Burns Wounds,2023,39(9):826-834.DOI: 10.3760/cma.j.cn501225-20230706-00248.

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Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns

doi: 10.3760/cma.j.cn501225-20230706-00248

Department of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan 430060, China

Funds:

Scientific Research Fund of Health Commission of Hubei Province of China WJ2019H433

Clinical Medical Research Project of Wuhan WX17A03, WX11A04

Medical Science and Research Project of Wuhan WG19B02

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Corresponding author: Wang Deyun, Email: 13971239318@163.com
Received Date: 2023-07-06

Abstract

Abstract

Objective To investigate the clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns. Methods A retrospective observational study was conducted. From May 2016 to September 2022, 17 patients with scar contracture deformities in the face and neck after extensive burns were admitted to Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, including 13 males and 4 females, aged 23 to 55 years, with 3 patients having degree Ⅱ cervical contracture, 14 patients having degree Ⅲ cervical contracture, and 12 patients having facial scar contracture deformity. In the first stage, 34 rectangular skin and soft tissue expanders (hereinafter referred to as expanders) with rated capacity of 100-600 mL were inserted into the face, chest, shoulder, and abdomen, and then the normal saline was injected for expansion. In the second stage, the scar tissue was removed and the contracture was released to correct the deformity. Two expanded facial flaps were transplanted in local fashion, 17 expanded flaps were transplanted in pedicled fashion, and 15 expanded flaps were freely transplanted to repair the secondary wounds after release, with artery pressurization was performed in 7 flaps. Indocyanine green fluorescence imaging was used to evaluate the arterial blood perfusion and venous return of the flaps during transplantation. The incision area of 32 flaps except 2 facial flaps was 10 cm×8 cm-36 cm×16 cm. The wounds of 31 flap donor sites were closed by direct suture, and the wound of 1 flap donor site was repaired by autologous split-thickness scalp transplantation. The skin condition of inserted place, expansion time, and total amount of normal saline injection of expanders, complications of skin and soft tissue expansion surgery, and survival of flap after the second stage surgery were observed and recorded. The long-term face and neck reconstruction effect and recovery of flap donor area were followed up. At the last follow-up, the 5-level Likert scale was used to evaluate the efficacy satisfaction of patients. Results Of the 34 expander inserted places in 17 patients, 22 places were superficial scar skin after deep partial-thickness burns, 8 places were superficial scar skin after multiple skin donations, and 4 places were normal skin. After 4 to 15 months of expansion, the total normal saline injection volume was 238 to 2 000 mL, with no complications occurred. After the second stage surgery, the distal part of 2 pedicled flaps was partially necrotic, and the necrotic wounds were healed after flap dressing and free transplantation of contralateral expanded triangular flaps, respectively; the other flaps survived completely. During 6 to 18 months of follow-up, except for 2 expanded paraumbilical flaps and 1 expanded groin flap, which were bloated and improved by flap thinning, the appearance and texture of the other flaps were good, and all the flap donor sites recovered well. At the last follow-up, the face and neck scar contracture deformities were significantly improved in all patients, and the satisfaction of curative effect of patient was very satisfactory in 8 patients and relatively satisfactory in 9 patients. Conclusions The expanded flaps of chest, abdomen, and other parts, combined with local advance, pedicled, and free transplantation, can effectively reconstruct scar contracture deformities in the face and neck after extensive burns, restore the function of operative area and improve the appearance simultaneously, with high degree of patient satisfaction, which is worthy of promotion in clinic.
- Burns,
- Cicatrix,
- Neck,
- Contracture,
- Dilatation,
- Perforator flap,
- Microsurgery

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References

[1]	De DeckerI, HoeksemaH, VerbelenJ, et al. A single-stage bilayered skin reconstruction using Glyaderm® as an acellular dermal regeneration template results in improved scar quality: an intra-individual randomized controlled trial[J/OL]. Burns Trauma, 2023,11:tkad015[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/37143955/. DOI: 10.1093/burnst/tkad015.
[2]	王炜 .整形外科学[M].杭州:浙江科学技术出版社,1999:826.
[3]	PukancsikD, KelemenP, GulyásG, et al. Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: a retrospective cohort study[J]. Eur J Surg Oncol, 2017,43(7):1244-1251. DOI: 10.1016/j.ejso.2017.01.236.
[4]	KongW, XiaoY, WangB, et al. Comorbidities of scars in China: a national study based on hospitalized cases[J/OL] Burns Trauma, 2021,9:tkab012[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/34212062/. DOI: 10.1093/burnst/tkab012.
[5]	吕国忠,许瓅文.重视大面积烧伤早期康复预防后期严重并发症[J].中华烧伤杂志,2017,33(5):257-259.DOI: 10.3760/cma.j.issn.1009-2587.2017.05.001.
[6]	GreenhalghDG. Management of facial burns[J/OL]. Burns Trauma,2020,8:tkaa023[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/32665953/. DOI: 10.1093/burnst/tkaa023.
[7]	韩军涛,谢松涛,陶克,等.自体瘢痕复合皮修复大面积深度烧伤后期畸形12例[J].中华烧伤杂志,2014,30(5):457-458.DOI: 10.3760/cma.j.issn.1009-2587.2014.05.025.
[8]	沈余明.深度烧伤后瘢痕增生挛缩畸形的手术治疗[J].中华烧伤杂志,2019,35(6):401-404.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.001.
[9]	MinP, LiJ, BrunettiB, et al. Pre-expanded bipedicled visor flap: an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males[J/OL]. Burns Trauma, 2020,8:tkaa005[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/32341918/. DOI: 10.1093/burnst/tkaa005.
[10]	AcartürkTO, BengürFB. Reconstruction of burn contractures of the anterior neck with pre-expanded free anterolateral thigh flaps[J]. Injury, 2020,51 Suppl 4:S63-67. DOI: 10.1016/j.injury.2020.02.112.
[11]	OgawaR. Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL]. Burns Trauma, 2019,7:7[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/30891462/. DOI: 10.1186/s41038-019-0144-5.
[12]	陈璧,贾赤宇,徐明达,等. 自体皮源奇缺条件下瘢痕挛缩畸形的晚期临床修复[J]. 中华烧伤杂志,2003,19(6):361-364. DOI: 10.3760/cma.j.issn.1009-2587.2003.06.014.
[13]	RoseEH. Aesthetic reconstruction of the severely disfigured burned face: a creative strategy for a "natural" appearance using pre-patterned autogenous free flaps[J/OL]. Burns Trauma,2015,3:16[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/27574662/. DOI: 10.1186/s41038-015-0014-8.
[14]	何永静,朱礼昆,杨蔚琪,等.预扩张肩胛皮瓣游离移植修复大面积面颈部瘢痕[J].中华整形外科杂志,2017,33增刊:50-53.DOI: 10.3760/cma.j.issn.1009-4598.2017.s1.011.
[15]	马显杰,李杨,王璐,等.颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩[J].中华烧伤杂志,2012,28(4):256-259.DOI: 10.3760/cma.j.issn.1009-2587.2012.04.005.
[16]	楚菲菲,唐银科,刘超华,等.扩张后胸三角皮瓣修复儿童面颈部病损[J].中华小儿外科杂志,2022,43(4):294-298.DOI: 10.3760/cma.j.cn421158-20210513-00238.
[17]	KhoongYM, HuangX, GuSC, et al. Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL]. Burns Trauma, 2021,9:tkab042[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/34926708/. DOI: 10.1093/burnst/tkab042.
[18]	刘云菡,黄昕,李海洲,等. 扩张的胸廓内动脉穿支皮瓣联合血管增压在面颈部瘢痕整复中的临床应用[J]. 中华烧伤与创面修复杂志,2022,38(4):313-320. DOI: 10.3760/cma.j.cn501120-20210928-00334.
[19]	QingLM, WuPF, ZhouZB, et al. A design for the dual skin paddle circumflex scapular artery perforator flap for the reconstruction of complex soft-tissue defects in children: anatomical study and clinical applications[J]. Ann Plast Surg, 2019,83(4):439-446. DOI: 10.1097/SAP.0000000000001814.
[20]	张淼淼,潘晓峰,刘坤,等. 旋肩胛动脉穿支皮瓣治疗腋窝严重瘢痕挛缩[J]. 实用医学杂志,2022,38(10):1298-1301. DOI: 10.3969/j.issn.1006-5725.2022.10.024.
[21]	傅秀军,王琛,梁奕敏,等. 双侧扩张肩胛皮瓣在儿童、青少年大面积颌颈部瘢痕修复中的应用:7例报道[J]. 上海口腔医学,2021,30(3):332-336. DOI: 10.19439/j.sjos.2021.03.022.
[22]	GohTLH, ParkSW, ChoJY, et al. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases[J]. Plast Reconstr Surg, 2015,135(2):592-601. DOI: 10.1097/PRS.0000000000000951.
[23]	陈斓,张伟,谢卫国,等.扩张髂腹股沟皮瓣游离移植整复大面积烧伤后严重瘢痕挛缩畸形的临床效果[J].中华烧伤与创面修复杂志,2022,38(4):321-327.DOI: 10.3760/cma.j.cn501225-20220210-00021.
[24]	AkitaS, HayashidaK, TakakiS, et al. The neck burn scar contracture: a concept of effective treatment[J/OL]. Burns Trauma, 2017,5:22[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/28717655/. DOI: 10.1186/s41038-017-0086-8.
[25]	MahboubT,KhalilH.Post-transfer flap expansion for management of severe post-burn contraction neck[J].J Craniomaxillofac Surg,2010,38(5):365-367.DOI: 10.1016/j.jcms.2009.10.007.
[26]	张伟,谢卫国,张卫东,等.吻合血管的扩张皮瓣治疗大面积烧伤患者瘢痕挛缩畸形[J].中华烧伤杂志,2019,35(6):410-416.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.003.
[27]	顾舒晨,李海洲,高雅姗,等. 吲哚菁绿荧光造影在背部扩张穿支皮瓣设计中的应用[J]. 中华整形外科杂志,2020,36(3):251-256. DOI: 10.3760/cma.j.cn114453-20200218-00056.
[28]	ZhangYX, XiaoWT, NgS, et al. Infrared thermography-guided designing and harvesting of pre-expanded pedicled flap for head and neck reconstruction[J]. J Plast Reconstr Aesthet Surg, 2021,74(9):2068-2075. DOI: 10.1016/j.bjps.2020.12.102.
[29]	DongC, ZhuMH, HuangLG, et al. Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases[J/OL]. Burns Trauma, 2021, 9: tkaa037[2023-07-06]. https://pubmed.ncbi.nlm.nih.gov/33426134/. DOI: 10.1093/burnst/tkaa037.
[30]	董琛,余州,刘维,等. 皮肤软组织扩张器置入部位感染风险的临床预测模型的构建与验证[J]. 中华烧伤杂志,2021,37(9):846-852. DOI: 10.3760/cma.j.cn501120-20200619-00314.

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Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns

doi: 10.3760/cma.j.cn501225-20230706-00248

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Clinical effects of expanded flaps in reconstructing scar contracture deformities in the face and neck after extensive burns

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