The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture

Wang, Chunmei; Zhang, Jun‐Yi; Yang, Sifen; Song, Ping; Pu, Lee Li-Qun

doi:10.1097/sap.0000000000000711

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…Cosmetically, perforator flaps were believed by the authors to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall appearance of the patient. There was no standardized approach Cervical contractures Grishkevich et al 15 Case series 4 Grishkevich et al 16 Case series 4 Li et al 17 Case series 4 Mun et al 18 Case series 4 Tsai et al 19 4 Vinh et al 20 Case series 4 Wang et al 21 Case series 4 Wang et al 22 Case series 4 Upper extremity contractures El-Khatib et al 23 Case series 4 El-Khatib et al 24 Case series 4 Er et al 25 Case series 4 Uygur et al 26 Case series 4 Lower extremity contractures Gupta et al 27 Case series 4 Ismail et al 28 Case series 4 Kim et al 29 Case series 4 Miscellaneous contractures Stekelenburg et al 30 Randomized controlled trial 2 Tucker et al 31 Case series 4 Overall grade of recommendation C a Quality level was based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence Scale from 1 to 5, where level 1 represents the highest quality level and level 5 represents the lowest quality level. Overall quality of evidence is determined based on the quality level of all studies reviewed on a scale from "a" to "d," where level "a" represents consistently high-quality level 1 evidence and level "d" represents consistently level 5 evidence or troublingly inconsistent or inconclusive studies of any level.…”

Section: Resultsmentioning

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: Resultsmentioning

confidence: 99%

A Review of Perforator Flaps for Burn Scar Contractures of Joints

et al. 2018

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Section: Discussionmentioning

confidence: 99%

“…The expansion and prefabrication of a super-thin skin perforator flap can possibly provide a super-thin skin flap that can be used for reconstruction of larger defects, achieving better cosmetic results than traditional prefabricated flaps. 19 Overall, the etiology of PWS has not been fully understood and the treatment of PWS is still developing. It has been reported that site-specific pharmaco-laser therapy, which combines conventional laser therapy with the administration of thermosensitive drug delivery system may enhance PWS blanching.…”

Section: Discussionmentioning

confidence: 99%

Individualized Surgical Management of Refractory Port-Wine Stains in the Scalp and Face: A Single-Center Retrospective Study and a Discussion of Surgical Strategies

Wang¹,

Chen²,

Wang³

et al. 2022

CCID

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Objective Refractory port-wine stain (PWS) usually contains hypertrophic, nodular lesions or severe scars due to improper treatment, making surgical treatment a necessity. This study aims to introduce our experiences in surgical management of refractory PWSs in the scalp and face. Methods From January of 2013 to September of 2018, 25 patients with refractory PWSs in the scalp and face received surgeries in our department. Clinical manifestation of the disease, the surgical procedures and postoperative complications were reviewed. A Visual Analog Scale (VAS) was applied to evaluate the outcomes. Results In this study, surgical procedures included serial resection (4 cases), complete resection followed by local flap transplantation (6 cases) or skin grafting (7 cases), and two-staged surgeries using expanded flaps (5 cases) or expanded prefabricated flap (3 cases). All the skin grafts and flaps survived well. Follow-up evaluation with VAS showed that most patients were satisfied with the surgery. Conclusion The surgical procedures should depend on the site, area and type of the lesions and patients’ personal requirement. Individualized surgical treatment of refractory PWSs achieved satisfactory results in re-establishing symmetric facial contour and improving the overall appearance.

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“…Many expanded cervical flaps, such as prefabricated flaps, superthin flaps, perforator flaps, and other random cervical flaps (advancement, rotation or interposition), have been used [6][7][8][9][10][11][12][13], which have similar color, texture, and thickness to the face and are large enough to cover lesions, providing good functional and aesthetic outcomes for patients with extensive facial subcutaneous deformities and undamaged muscles and deep structures. However, systematic evaluations focusing on different types of expanded cervical flaps in facial reconstruction remain limited.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs

Luo,

Yang,

et al. 2023

Facial Plast Surg

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Over the past 20 years, we have designed various types of expanded cervical flaps for large facial defects and achieved excellent tissue matching. This study was performed to propose a treatment strategy for flap selection for the reconstruction of different facial units. The authors retrospectively reviewed the application of cervical expanded flaps for facial rehabilitation in our department between January 2003 and January 2023. The study included 122 patients with unilateral (62.3%) and bilateral (37.7%) facial deformities ranging from the zygomatic arch to the chin. The median area of the tissue defect was 15.2 × 8.5 cm2 (ranging from 6 × 4 cm2 to 27 × 12 cm2). The expansion period ranged from 61 to 175 days (mean: 86.5 days). Maximum and minimum sizes of pre-expanded cervical flaps were 30 × 13 cm2 to 7 × 5 cm2. All the flaps could be summarized into type 1, an advanced expanded cervical flap; type 2, a wing-shaped expanded cervical flap with overlapping tissue expansion; and type 3, an expanded single-lobed transposition flap rotated based on the anterior neck. Cervical flaps reliably meet the reconstructive requirements for different facial units, especially for large cutaneous defects in the clinic. The selection of these flaps can be planned preoperatively according to the location and size of the defect or lesion.

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The Clinical Application of Preexpanded and Prefabricated Super-Thin Skin Perforator Flap for Reconstruction of Post-Burn Neck Contracture

Cited by 15 publications

References 10 publications

A Review of Perforator Flaps for Burn Scar Contractures of Joints

A Review of Perforator Flaps for Burn Scar Contractures of Joints

Individualized Surgical Management of Refractory Port-Wine Stains in the Scalp and Face: A Single-Center Retrospective Study and a Discussion of Surgical Strategies

A 20-Year Experience with Tissue Expansion for Large Cervical Fascial Defects: An Algorithm Based on Different Clinical Flap Designs

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