BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results. AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures. MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery. Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture. RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%). Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs. Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results. CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures. Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.
BACKGROUND: Jaw bone benign tumors and dysplasia in childhood often have an aggressive growth pattern, which requires early radical operations. Uneven growth and changing morphological characteristics of the childs dentofacial apparatus imply stage-by-stage bone and plastic surgery in the maxillofacial region. CLINICAL CASE: The paper presents a clinical observation of the medical rehabilitation of a patient from 5 to 24 years old with lower jaw osteoblastoclastoma following our proposed algorithm. DISCUSSION: The presented clinical observation demonstrates all the main stages of medical rehabilitation of a child with a benign lower jaw neoplasm. Along with timely and fully operative neoplasm removal, rational dental prosthetics, and dispensary observation with X-ray diagnostics play an important role in the childs growth period. All these measures were important to prevent a possible neoplasm recurrence, partially maintain the masticatory function for the growth period, and avoid secondary postoperative dental apparatus deformities. The age of repeated surgery to replace the titanium structure with autosteal tissue depends on the individual characteristics of patients. The operation can be performed, in some cases, starting from age 1617 years. CONCLUSIONS: Successful treatment of children with benign neoplasms of the lower jaw after post-resection defects is a complex multi-stage process of medical rehabilitation, of which the completion, most often, passes into the adult period.
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