Repair of Severe Post-Burn Cicatricial Contractures and Deformations of the Lower Limb

Abstract

Objective: To improve the outcomes of surgical treatment of severe contractures, deformities, and lower limb (LL) soft tissue defects using optical magnification and precision techniques. Methods: 54 patients with sequelae of traumatic injury underwent surgical repair of severe contractures, deformities, and soft tissue defects of the LL. Contractures were accompanied by extended cicatricial deformities and soft tissue defects of the LL. Traumatic injuries often lead to sequelae in children, as observed in 39 patients. The leading causes of burn injuries were boiling water and hot oil. Results: Various types of Z-plasty were used in 29 (53.7%) cases to correct contracture and toe and foot deformities. Tailored surgeries were performed for severe injuries and extended cicatricial deformities with residual defects covered with skin grafts. Optical magnification with precision technique contributed to adequately mobilizing the fasciocutaneous flaps and the neurovascular bundle (NVB) release. By using ultrasonic dopplerography (USDG), it was possible to determine how the degree circulatory disorders in the affected LL is dependent on the duration between injury and presentation at our center, the severity of the contracture, and the size and depth of the soft tissue damage. Purulent wound infection and superficial partial necrosis of the fasciocutaneous flaps occurred in 3 and 5 patients, respectively Conclusion: In managing concomitant injuries, including assessing their extent, appropriately evaluating the initial severity of the trauma is essential. The evaluation requires using additional diagnostic methods and selecting the optimal reconstruction method. Optical magnification and precision techniques enable the effective mobilizing of fasciocutaneous flaps while preserving their blood supply. This leads to adequate mobilization and decompression of the NVB, effectively preventing NVB iatrogenic damage. Keywords: Lower limb, burn, contracture, deformity, soft tissue defect, local plastic surgery.