Management of Scar Contractures of the Hand-Our Therapeutic Strategy and Challenges.

The essence of treating scar contractures lies in covering the skin deficit after releasing the contractures, typically using flaps or skin grafts. However, the specific characteristics of scar contractures, such as their location, shape, and size, vary among patients, which makes surgical planning challenging. To achieve excellent outcomes in the treatment of scar contractures, we have developed a dimensional classification system for these contractures. This system categorizes them into four types: type 1 (superficial linear), type 2-d (deep linear), type 2-s (planar scar contractures confined to the superficial layer), and type 3 (planar scar contractures that reach the deep layer, i.e., three-dimensional scar contractures). Additionally, three factors should be considered when determining surgical approaches: the size of the defect, the availability of healthy skin around the defect, and the blood circulation in the defect bed. Type 1 and type 2-d are linear scars; thus, the scar is excised and sutured in a straight line, and the contracture is released using z-plasty or its modified methods. For type 2-s, after releasing the scar contracture band, local flaps are indicated for small defects, pedicled perforator flaps for medium defects, and free flaps and distant flaps for large defects. Type 2-s has good blood circulation in the defect bed, so full-thickness skin grafting is also a suitable option regardless of the defect's size. In type 3, releasing the deep scar contracture will expose important structures with poor blood circulation, such as tendons, joints, and bones. Thus, a surgical plan using flaps, rather than skin grafts, is recommended. A severity classification and treatment strategy for scar contractures have not yet been established. By objectively classifying and quantifying scar contractures, we believe that better treatment outcomes can be achieved.

Comisuroplastia mediante colgajo de perforante digital en secuelas cicatriciales de quemaduras / Commissuroplasty using a digital perforator flap in the cicatricial sequelae of burns

Introducción y objetivo: Las bridas cicatriciales en mano como secuela de quemaduras pueden suponer impotencia funcional. El colgajo de perforante de la arteria digital tomado de la cara lateral de los dedos constituye una excelente opción terapéutica para el manejo de estas lesiones. Describimos nuestra experiencia con esta técnica quirúrgica y mostramos sus resultados morfológicos y funcionales. Material y método: Presentamos nuestra experiencia con 14 colgajos en 7 pacientes afectos de bridas comisurales en mano. Estos colgajos, basados en perforantes de la arteria digital, toman como zona donante la cara lateral de la falange proximal adyacente. Cubrimos la zona donante con injertos de piel de espesor total. Los pacientes fueron sometidos a rehabilitación precoz, presoterapia y férulas nocturnas. Resultados: La supervivencia de los colgajos fue completa en los 14 casos. En 1 caso se produjo necrosis del injerto en la zona donante del colgajo, solucionada con curas. Resolvimos la brida comisural en el 85.7 % de los casos (13 de 14 casos). El seguimiento medio fue de 27.3 meses (rango 12-45 meses). En 1 caso se produjo recidiva parcial a los 10 meses, solucionada mediante Z-plastias. Los pacientes experimentaron mejoría subjetiva de la funcionalidad y estética de la mano. La apertura del ángulo del espacio interdigital, medida en grados, mejoró desde una media de 22.5 grados preoperatorios (rango 150-350) a una media de 36.8 grados postoperatorios (rango 250-450). Conclusiones: En nuestra experiencia, el colgajo de perforante de arteria digital es una opción terapéutica rápida, sencilla y eficaz en el tratamiento de las contracturas tras quemaduras del segundo al cuarto espacio interdigital. Son fundamentales el adecuado cuidado postoperatorio, rehabilitación, presoterapia y ferulización para un resultado óptimo.(AU)

Background and objective: Scar contractures in the hand are a sequela of burns that can lead to functional impairment. The perforator flap from the digital artery, taken from the lateral aspect of the fingers, represents an excellent therapeutic option for managing these injuries. We present our experience with this surgical technique and our morphological and functional results. Methods: We present our experience with 14 flaps in 7 patients affected by web contractures in the hand. These flaps, based on perforators from the digital artery, use the adjacent lateral aspect of the proximal phalanx as the donor site. The donor area was covered with full-thickness skin grafts. Patients underwent early rehabilitation, pressure therapy, and nighttime splinting. Results: The survival of the flaps was successful in all 14 cases. One case experienced graft necrosis in the donor site of the flap, which resolved with conservative treatment. Commissural contractures were resolved in 85.7% of the cases (13 out of 14 cases). The mean follow-up period was 27.3 months (range 12-45 months). In 1 case, partial recurrence occurred at 10 months and it was successfully managed with Z-plasty. Patients reported subjective improvement in hand functionality and aesthetics. The interdigital space angle, measured in degrees, improved from a mean of 22.5 degrees preoperatively (range 15°-35°) to a mean of 36.8 degrees postoperatively (range 25°-45°). Conclusions: In our experience, the perforator flap from the digital artery represents a rapid, straightforward, and effective therapeutic option for treating contractures after burns in the second to fourth interdigital spaces. Adequate postoperative care, rehabilitation, pressure therapy and splinting are essential for optimal outcomes.(AU)

Burn Scar Management and Reconstructive Surgery.

This chapter highlights the importance of a comprehensive burn scar treatment plan in approaching a burn survivor. General concepts of burn scar physiology and a practical system to describe burn scars based on cause, biology, and symptoms are presented. Common scar management modalities including nonsurgical, surgical, and adjuvant therapies are further discussed.

A Case of Ectopic Scrotum with Inconspicuous Penis.

Introduction: Ectopic scrotum is characterized by a unilateral scrotum located above or below the inguinal region or in the perineum. Inconspicuous penis refers to a penis that appears short or small but is of average size, merely buried or restricted by surrounding tissue. Case report: A case of concurrent ectopic scrotum and inconspicuous penis is reported. Dicusssion: Orchiopexy and scrotoplasty may be performed for ectopic scrotum, while inconspicuous penis requires release or removal of surrounding tissue.

Therapeutic Potential of Adipose Stem Cell-Derived Conditioned Medium on Scar Contraction Model.

Scars are composed of stiff collagen fibers, which contract strongly owing to the action of myofibroblasts. To explore the substances that modulate scar contracture, the fibroblast-populated collagen lattice (FPCL) model has been used. However, the molecular signature of the patient-derived FPCL model has not been verified. Here, we examined whether the patient-derived keloid FPCL model reflects scar contraction, analyzing detailed gene expression changes using comprehensive RNA sequencing and histological morphology, and revealed that these models are consistent with the changes during human scar contracture. Moreover, we examined whether conditioned media derived from adipose stem cells (ASC-CM) suppress the scar contracture of the collagen disc. Detailed time-series measurements of changes in disc area showed that the addition of ASC-CM significantly inhibited the shrinkage of collagen discs. In addition, a deep sequencing data analysis revealed that ASC-CM suppressed inflammation-related gene expression in the early phase of contraction; in the later phase, this suppression was gradually replaced by extracellular matrix (ECM)-related gene expression. These lines of data suggested the effectiveness of ASC-CM in suppressing scar contractures. Therefore, the molecular analysis of the ASC-CM actions found in this study will contribute to solving medical problems regarding pathological scarring in wound prognosis.

Outcomes of a Trans-Web Approach to Fractures around the Finger Metacarpophalangeal Joint.

Background: A fracture around the finger metacarpophalangeal joint (MCPJ) can be difficult to access. We developed a trans-web approach that could lead surgeons directly to this site. An incision across the web is believed to result in a web contracture. The aim of this study is to present the outcomes of the trans-web approach. Methods: This is a retrospective study of all patients in whom a trans-web approach was used to fix fractures around the MCPJ in the period from October 2008 and September 2020. The outcomes of the trans-web approach were evaluated by appearance of the scar, presence of pain in relation to the scar, grading web creep, range of motion at the MCPJ and degree of abduction and adduction of the finger. Any complications of surgery were also recorded. Results: This study included 10 patients with 11 fractures around the MCPJ (6 avulsion fractures and 5 extra-articular fractures). The mean follow-up was 5 months. Skin contractures did not occur in any avulsion fracture case where original or extended trans-web skin incisions were used. However, they occurred in 2 extra-articular cases treated via a trans-web plus a mid-lateral approach. The mean range of motion of the MCP joint in all the patients was 80° (range, 70°-95°). There was a 10° loss of abduction in one patient and temporary sensory disturbance in another patient. Both these patients had been treated with extended incisions. Conclusions: The trans-web incision is a useful approach for the open reduction of fractures around the finger MCPJ, especially in avulsion fractures of the lateral volar base of the proximal phalanx with minimal risk of scar contracture. The risk of scar contracture is higher when the trans-web incision is combined with a mid-lateral incision for extra-articular fractures. Levels of Evidence: Level IV (Therapeutic).

Yoga and Cutaneous Functional Unit Recruitment for a Patient with Cervical and Upper Extremity Burn Scar Contracture: Case Report.

Burn scar contracture greatly limits function for burn survivors, particularly when the scarring crosses multiple joints. Previous research has identified fields of skin recruited during single joint motion, called cutaneous functional units (CFU), indicating that impairments may be seen distal to the injured tissue. This case report connects the principles of CFU and yoga-inspired therapy modalities in improving clinical outcomes for a burn survivor. The patient is a 38-year-old male who sustained deep partial-thickness electrical burns to his neck, chest, and bilateral upper extremities, presenting with significantly decreased range of motion. The patient attended physical therapy 4 days a week, where he performed a specific yoga asana program during each session. Outcomes including standard range of motion measures, the Vancouver Scar Scale (VSS), and the Neck Disability Index (NDI), which were recorded every 10 sessions. CFUs of cervical extension and shoulder flexion were analyzed via photographs comparing cutaneous position during specified yoga poses and resting anatomical position in standing. Over 30 visits, cervical and shoulder range of motion increased, although the VSS and NDI did not show significant improvement. Yoga poses showed overall cutaneous recruitment distal to the targeted joints, and burned skin was recruited similarly to nonburned skin in positions of stretch. Incorporating multijoint approaches for stretching, like yoga, appears to contribute to improved clinical range-of-motion outcomes when paired with traditional burn-rehabilitation interventions. Yoga poses involving multiple joints align with the principle of CFUs, warranting continued investigation.

[Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot].

OBJECTIVE: To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot. METHODS: Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly. RESULTS: The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites. CONCLUSION: The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.

The degree of joint range of motion limitations after burn injuries during recovery.

INTRODUCTION: The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD: The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS: At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION: The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.

Circumflex scapular perforator propeller flap for reconstruction of axillary scar contractures / 中华显微外科杂志

Objective:To estimate the preliminary result of circumflex scapular perforator propeller flap in reconstruction of axillary scar contractures.Methods:From January 2016 to June 2021, circumflex scapular perforator propeller flaps were used in 7 cases for reconstruction of soft tissue defect after axillary scar contractures. Patients were 5 males and 2 females. Age ranged from 23 to 38 years old, mean age of 27.7 years old. According to Kurtzman and Stern classification of axillary scar contractures, there were 1 case with type 1a, 1 with type 1b, 2 with type 2, and 3 with type 3. The preoperative range of motion of the shoulder joint were 40°-85°, with an average of 63.7°. All the patients were underwent scar release and circumflex scapular perforator propeller flap transfer. All flaps were transferred as the manner of perforator propeller flap. All the donor sites were closed directly. The defects after releasing ranged from 5.0 cm×7.0 cm to 11.0 cm×9.0 cm, and the flaps ranged from 16.0 cm×7.0 cm to 24.0 cm×9.0 cm. Flap survival, complications of donor site and recipient site were recorded after surgery. The range of motion of the shoulder joint, donor and recipient sites were reviewed in outpatient clinic.Results:All flaps survived uneventfully after surgery, besides 1 case complicated with distal venous congestion. The follow-up time ranged from 6 to 23 months, with an average of 12 months. The texture and contour of the flaps were good in all. At last follow-up, the range of motion of the shoulder joints were 90°-120°, with an average of 107°. Mild scar hyperplasia occurred in 2 cases.Conclusion:The circumflex scapular perforator propeller flap is an effective protocol in reconstruction of axillary scar contractures.

Trapezius fasciocutaneous flap for burn reconstruction.

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Bases anatomicas y quirúrgicas del colgajo de perforante axilar / Anatomic and surgical basis of the axillary perforator flap

Introducción y objetivo: Las cicatrices y bridas postquemadura provocan tracción del tejido sano y alteran la anatomía vascular normal. En casos severos, la localización exacta del pedículo vascular optimiza el uso de los tejidos sanos circundantes sin aumentar la morbilidad. El colgajo perforante romboidal de axila (CPA) es muy útil en reconstrucción de contracturas cicatriciales de tórax y miembro superior en quemados, especialmente en niños.El presente trabajo estudia la anatomía vascular axilar (AVA) para determinar la localización y procedencia de la irrigación de la pastilla de piel correspondiente al colgajo romboidal de axila.Material y método.Estudiamos la AVA mediante 4 pilares: 1) revisión bibliográfica; 2) disección anatómica en cadáver; 3) localización vascular de perforantes mediante flujometría doppler en axilas de voluntarios sanos; y 4) disección de colgajos en pacientes intervenidos por cicatrices retráctiles.Resultados.La búsqueda bibliográfica analiza técnicas de reconstrucción de zonas funcionales por colgajos de vecindad con diferentes diseños, pero no encontramos detalle de la descripción del pedículo. El colgajo se presenta de irrigación tipo random (al azar).En la disección en 6 axilas de 3 cadáveres humanos formolizados hallamos en promedio 3 perforantes por axila (1-2 mm de diámetro), de predominio en cuadrantes súpero e ínfero-externos; de ellas 12 nacían de la arteria axilar como ramas directas; 6 de arterias colaterales: torácica lateral (n=4) y toracodorsal (n=2).En la investigación doppler en 30 axilas sanas, hallamos mayor número de arteriolas en los cuadrantes ínfero-interno y súpero-interno.En 7 pacientes intervenidos, las disecciones de los vasos fueron de 3-4 cm de longitud y en profundidad hasta plano aponeurótico, lo que no permitió evaluar la procedencia del vaso perforante. (AU)

Background and objective: Postburn axillary contractures affect non burnt neighbor tissues, producing vascular distortion. When functional zones are burnt, the best reconstructive option is needed to optimize healthy skin in order to decrease morbidity. The axillar rhomboid propeller flap provides significant advantages on the treatment of large contractable scars of chest and upper limb in burnt patients, especially in children.This paper is based on the vascular anatomical study of axillary tissues. The aim is to localize the origin of small perforator vessels to increase good and safe results.Methods.This study identifies the anatomical knowledge of axillar irrigation on four steps: 1) bibliographic revision; 2) human cadavers dissection; 3) vascular perforators localization in not burnt patients using doppler flowmetry; and 4) flaps dissection in burnt patients with retractile scars.Results.Bibliographic revision identified several methods and local flaps for reconstruction of upper limb, using the perforator flaps. Axillar flap is mentioned as random type.Cadavers dissections of 6 axillas showed on average 3 perforators by side,(diameters of 1-2 mm), placed in superior and inferior external quadrants; 12 of them, rice from axillar artery as direct branches; 6 of them, rice from collateral arteries: 4 from lateral thoracic artery, and 2 from thoracodorsal artery.Using doppler flowmetry in 30 axilas from volunteer people, we found more arteries at internal-inferior and external-superior localizationsFinally, in 7 cases operated on with reconstructive surgery, the dissections reached 3-4 cm length; as a result, we could not observe the origin of the vessels. (AU)

Poly(lactide-co-ε-caprolactone) scaffold promotes equivalent tissue integration and supports skin grafts compared to a predicate collagen scaffold.

Dermal scarring from motor vehicle accidents, severe burns, military blasts, etc. is a major problem affecting over 80 million people worldwide annually, many of whom suffer from debilitating hypertrophic scar contractures. These stiff, shrunken scars limit mobility, impact quality of life, and cost millions of dollars each year in surgical treatment and physical therapy. Current tissue engineered scaffolds have mechanical properties akin to unwounded skin, but these collagen-based scaffolds rapidly degrade over 2 months, premature to dampen contracture occurring 6-12 months after injury. This study demonstrates a tissue engineered scaffold can be manufactured from a slow-degrading viscoelastic copolymer, poly(ι-lactide-co-ε-caprolactone), with physical and mechanical characteristics to promote tissue ingrowth and support skin-grafts. Copolymers were synthesized via ring-opening polymerization. Solvent casting/particulate leaching was used to manufacture 3D porous scaffolds by mixing copolymers with particles in an organic solvent followed by casting into molds and subsequent particle leaching with water. Scaffolds characterized through SEM, micro-CT, and tensile testing confirmed the required thickness, pore size, porosity, modulus, and strength for promoting skin-graft bioincorporation and dampening fibrosis in vivo. Scaffolds were Oxygen Plasma Treatment and collagen coated to encourage cellular proliferation. Porosity ranging from 70% to 90% was investigated in a subcutaneous murine model and found to have no clinical effect on tissue ingrowth. A swine full-thickness skin wound model confirmed through histology and Computer Planimetry that scaffolds promote skin-graft survival, with or without collagen coating, with equal safety and efficacy as a commercially available tissue engineered scaffold. This study validates a scalable method to create poly(ι-lactide-co-ε-caprolactone) scaffolds with appropriate characteristics and confirms in mouse and swine wound models that the scaffolds are safe and effective at supporting skin-grafts. The results of this study have brought us closer towards developing an alternative technology that supports skin grafts with the potential to investigate long-term hypertrophic scar contractures.

The Optimal Application of Medium Potency Topical Corticosteroids in Preventing Laser-Induced Inflammatory Responses-An Animal Study.

BACKGROUND: During ablative fractional resurfacing (AFR) laser therapy, thermal damage to the skin is inevitable, resulting in inflammatory responses and small wounds. Corticosteroids are known for their anti-inflammatory effect. However, inappropriate application of corticosteroids carries the risk of delayed wound healing. Therefore, we aimed to find the optimal administration route, timing, and duration of medium potency corticosteroid treatment to prevent AFR laser-induced inflammatory responses and to minimize the risk of delayed wound healing. METHODS: We determined the anti-inflammatory efficacy of corticosteroids by skin erythema and tissue biopsies on C57BL/6 mice. Wound healing was evaluated by crust area and epithelial gap. Finally, Masson's trichrome stain and α-SMA immunohistochemistry stain were used to analyze scar contracture. RESULTS: Our results demonstrated that one dose of medium-potency topical corticosteroid applied immediately after AFR laser treatment could prevent erythema effectively with minimal disruption to wound healing. Notably, when more than one dose was administered, wound healing was delayed and scar contracture was aggravated by the application of medium-potency topical corticosteroids in a dosage-dependent manner. CONCLUSION: Our findings suggested that single-dose medium-potency topical corticosteroids could potentially improve AFR laser-induced acute inflammatory responses in clinical applications.

Surgical treatment of joint burn scar contracture: a 10-year single-center experience with long-term outcome evaluation.

BACKGROUND: Burn patients often have functional problems due to joint scar contracture. Patients suffering from such contracture often experience considerable limitations in daily life. Therefore, surgical treatment is often necessary. Skin grafts, especially full-thickness skin grafts and flaps remain the most commonly used surgical methods in clinical practice. However, there are no clear guidelines stating which technique is the most effective treatment. Herein, we conducted a retrospective cohort study over 10 years of experience at a single center to investigate whether flaps or FTSGs exhibit a better long-term effect. METHODS: We performed a retrospective chart review of patients with joint burn scar contracture and collected data related to patient demographic profiles, and detailed descriptions of the scars, surgical procedures, and follow-up were collected. We performed follow-up evaluation of three aspects: adverse events (recontracture, ache, and pruritus), satisfaction scores for function and aesthetics, and scar quality (Vancouver Scar Scale score). RESULTS: Follow-up results 1 year after surgery from 88 patients were analyzed. In total, 4 (10%) patients in the flap group and 13 (27.1%) patients in the FTSG group had recontracture; the incidence of recontracture was lower in the flap group than in the FTSG group (P=0.043). The functional satisfaction score of the flap group was higher than that of the FTSG group (P=0.027). Moreover, follow-up results 5 year after surgery for 47 patients were analyzed. In total, 1 (4.8%) patient in the flap group and 7 (26.9%) patients in the FTSG group had recontracture; the incidence of recontracture was significantly lower in the flap group than in the FTSG group (P=0.044). The functional satisfaction score in the flap group was higher than that of the FTSG group (P=0.041). In this study, no significant differences in scar quality were observed between the two groups. CONCLUSIONS: If conditions permit, the application of different types of flaps may represent a better choice than FTSGs in terms of reducing the recontracture rate and improving joint function.

Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country.

OBJECTIVE: Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC. METHODS: This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively. RESULTS: In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM. CONCLUSIONS: Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre.

OBJECTIVE: To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. METHODS: An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3-12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. RESULTS: The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). CONCLUSION: The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.

A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures.

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO2 laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients' satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P < 0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.

Evaluation of effectiveness of three-dimensional printed ear splint therapy following ear elevation surgery in microtia patients: A randomized controlled trial.

AIM: This study aimed to compare the effectiveness of a 3D-printed ear splint with that of a conventional thermoplastic ear splint after microtia reconstruction. METHODS: Patients who underwent ear elevation surgery with postauricular fascia coverage between October 2017 and October 2018 were included. They were randomly divided into the experimental group (3D-printed ear splint) and the control group (thermoplastic ear splint) and underwent routine postoperative rehabilitation and antiscar therapy. Splint therapy was initiated 4 weeks postoperatively and continued until 24 weeks postoperatively. The evaluated indices were the Vancouver scar scale score (VSS score), cranioauricular distance, patient compliance, complications (dermatitis, skin ulcers, skin necrosis), and patient satisfaction. A two-group t-test was carried out to compare all variables except patient satisfaction, which was compared using the Mann-Whitney U-test; p < 0.05 was considered significant. RESULTS: Twenty patients were included in each group. At 4 weeks postoperatively, the VSS score (p = 0.748) and cranioauricular distance (p = 0.647) showed no significant differences between the groups. At 24 weeks postoperatively, the mean VSS scores were 4.85 ± 1.46 and 6.25 ± 1.74 (p = 0.009), the mean cranioauricular distances were 15.80 ± 1.82 mm and 13.95 ± 1.93 mm (p = 0.004), and the patient satisfaction scores were 4.5 ± 0.51 and 3.7 ± 0.47 (p < 0.001) in the experimental group and the control group, respectively, all showing significant differences. Two patients in each group exhibited skin irritation or skin ulcers, which resolved after 6 months of follow-up. CONCLUSION: The application of 3D-printed ear splints provides better inhibition of scar contracture, better maintenance of ear projection and higher patient satisfaction than conventional ear splints following ear elevation surgery in microtia patients. Therefore, 3D-printed ear splints should be preferred over conventional ear splints whenever possible.