Skin Grafting in the Repair of Contractures Due to Burns

Vincent, Beth; Green, Robert M.; Tomkies, James F.; Graham, William T.

doi:10.1056/nejm191108171650703

Cited by 1 publication

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“…12 Our experience suggests the most common approach involves contracture release, followed by resurfacing of the resulting defect with a skin graft—a procedure first introduced over 100 years ago. 13 Flaps are used when the resulting defect has exposed bone, tendon, joint capsule, or any other non-graftable surface. It may be that even in cases where the wound base is graftable, the thicker, more pliable coverage afforded by a flap is desirable; a perforator flap represents 1 flap option.…”

Section: Introductionmentioning

confidence: 99%

A Review of Perforator Flaps for Burn Scar Contractures of Joints

et al. 2018

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Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking. Methods: MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained !10 patients with burn scar contracture were considered. Results: Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n ¼ 218) and knee (n ¼ 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n ¼ 26 patients) and venous congestion (n ¼ 17 patients). Conclusions: Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches. Résumé Objectif : Les lambeaux perforateurs font partie des traitements chirurgicaux des contractures des cicatrices de brûlure, mais il n'y a pas d'analyse des données probantes sur le sujet. Méthodologie : Les chercheurs ont effectué une recherche dans MEDLINE pour extraire les articles liés aux lambeaux perforateurs pour les contractures causées par des brûlures. Après un filtrage en fonction des titres et des résumés, ils ont fouillé les textes intégraux et retenu les articles décrivant les lambeaux perforateurs pour corriger les contractures causées par des cicatrices de brûlure. Ils ont extrait les données et procédé à un résumé descriptif. Ils n'ontévalué que les articles portant sur au moins dix patients ayant des contractures causées par des cicatrices de brûlure. Résultats : Les chercheurs ont extrait 248 articles, dont 17 respectaient les critères d'analyse. De ce nombre, 16étaient des séries de cas de faible qualité et un, un essai aléatoire et contrôlé ouvert. Au total, 339 patients (de trois à 75 ans) ont reçu des lambeaux perforateurs, et les contracturesétaient surtout situées dans la région du cou (n ¼ 218) et du

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Section: Introductionmentioning

confidence: 99%