Application effects of the expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females

Liu Changling; Zhang Zhi; Li Gang; Huang Jun; Hu Yiping; Tang Wenbin; Sheng Congcong

doi:10.3760/cma.j.cn501225-20241230-00514

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Liu Changling,Zhang Zhi,Li Gang,et al.Application effects of expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females[J].Chin J Burns Wounds,2025,41(4):1-7.DOI: 10.3760/cma.j.cn501225-20241230-00514.

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Application effects of the expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females

doi: 10.3760/cma.j.cn501225-20241230-00514

Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, China

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Program of Guangzhou Science and Technology Bureau 2023A03J0523, 2024A03J0570

General Guidance Project of Guangzhou Health Science and Technology Project 20221A010016

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Corresponding author: Zhang Zhi, Email: zhangzhicc48@163.com
Received Date: 2024-12-30
Available Online: 2025-04-03

Abstract

Abstract

Objective To investigate the effects of the expanded lateral thoracic artery perforator flap in the reconstruction of breast scar contracture deformity after burns in minor females. Methods The study was a retrospective observational study. From October 2021 to October 2023, 8 minor female patients aged 5 to 12 years and with breast scar contracture deformity after burns, who met the inclusion criteria, were admitted to the Department of Burns and Plastic Surgery of Guangzhou Red Cross Hospital of Jinan University. The skin and soft tissue expander was placed in the first stage. After the completion of water injection, the contracture scar was removed and released in the second stage, and the wound area was 9 cm×8 cm to 15 cm×10 cm after the scar was removed. The expanded lateral thoracic artery perforator flap was designed and transferred to repair the wound with resected flap area of 10 cm×9 cm to 16 cm×11 cm, and the flap donor area was directly sutured. The complications such as incision infection, hematoma, and expander exposure were observed after the first stage operation. After the second stage operation, the survival of the flap and the healing of the flap donor site were observed. During the 1-year follow-up after the second stage operation, the breast development was evaluated according to the Tanner staging performance of female pubertal breast development, the aesthetic effect of the affected breast was evaluated by the aesthetic effect evaluation standard after breast surgery, the Vancouver Scar Scale was used to score the scar condition of the flap donor area and recipient area, and the satisfaction of the children's family members with the surgical effect was investigated by the self-made scale. Results After the first stage operation, no incision infection, hematoma, expander exposure, and other complications occurred in 8 children. After the second stage operation, only one child had tissue necrosis at the distal end of the flap with a size of about 2 cm×1 cm, which healed after dressing change, and the flap in other children had good blood supply, soft texture, moderate thickness, and similar color to the skin in the recipient area. All flap donor areas healed well. During the 1-year follow-up after the second stage operation, the breast of 7 children developed normally, and their breast volume, height, and shape were almost the same as or close to the healthy side (all at grade Ⅰ); the breast in one child had not yet developed, and these indicators were not evaluated. The location of nipple areola complex in 8 cases was almost the same as or close to those in the healthy side (all at grade Ⅰ). The shapes of nipple and areola in 5 cases were inconsistent with those in the healthy side because of the original scar (all at grade Ⅱ), and the shapes of nipple and areola in the other 3 cases were consistent with those in the healthy side (all at grade Ⅰ). The skin color, integrity, texture, and elasticity of the partial breast repaired by the transferred flap in 8 children were close to those in the healthy side (all at grade Ⅰ). The VSS score of the scar in flap recipient area was 2-5, and the VSS score of the scar in the flap donor area was 1-3. Seven children's family members were satisfied with the operation effect, and one child's family member was basically satisfied with the operation effect. Conclusions For the breast scar contracture deformity of minor females after burns, the expanded lateral thoracic artery perforator flap is used for reconstruction before puberty, which has fewer postoperative complications, good breast shape, hidden scar in the flap donor area. It is beneficial for the normal breast development at puberty, and is one of the safe and effective methods for the treatment of breast scar contracture deformity in minor females after burns.
- Cicatrix,
- Burns,
- Dilatation,
- Perforator flap,
- Minors,
- Breast,
- Lateral thoracic flap

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