Reconstruction of thoracic burn sequelae by scar release and flap resurfacing.

INTRODUCTION: In the USA, 450,000 thermal burns receive medical treatment annually. Burn scars are commonly excised and covered with skin grafts. Long-term, these treatments commonly leave patients with discomfort, reduced total lung capacity and forced vital capacity, and restriction of thoracic expansion and shoulder joint mobility. In this article, we present our experience with using scar release and immediate flap reconstruction to treat thoracic restriction due to burn sequelae. METHODS: From 1998 to 2014, we enrolled 16 patients with anterior thoracic burn sequelae that had previously been treated conservatively or with skin grafts that eventually recidivated. Preoperatively, we measured thoracic circumference in expiration and inspiration, %FVC, %FEV1, and shoulder mobility. All patients underwent anterior thoracic scar release and immediate flap resurfacing. RESULTS: At 2 weeks to 3 months postoperatively (mean, 2.6 months), mean thoracic circumference upon inspiration increased from 83.6 cm±5.7 to 86.5 cm±5.8 (p<0.0000000001). Mean %FVC improved from 76.0%±2.64% to 88.2%±4.69% (p<0.0000001). Mean %FEV1 improved from 79.2%±3.85 to 87.8%±2.98 (p<0.000001). All 14 patients who had restricted shoulder mobility preoperatively no longer had restricted shoulder mobility postoperatively. The mean patient-reported satisfaction was 4.6/5 (range, 3-5). At a mean follow up of 2.5 years, none of the contractures recidivated. Complications included 2 cases of tissue necrosis of the distal end of the flap. In one case, the flap was restored; in the other case, the patient eventually had to receive a new flap. Additional complications included two local infections that were successfully treated with oral and local antibiotics and two hematomas that were drained and eventually healed without tissue loss. CONCLUSIONS: Scar releases and flaps provide a safe and effective method for the correction of restricted thoracic expansion, respiratory restriction, decreased range of shoulder motion, and discomfort from thoracic burn sequelae.

Tratamiento de las secuelas por quemadura en cuello / Treatment of sequelae due to neck burn

Introducción: El cuello es una región con amplio rango de movimiento, además es visible porque suele estar al descubierto, y contiene un gran número de estructuras nobles. Estos puntos explican la complejidad que representan las secuelas por quemadura con esta ubicación. Nuestro objetivo en esta presentación es relatar nuestra experiencia en la reparación del cuello secuelado. Casos y métodos. Hemos categorizado estas secuelas en base a la clasifi cación de Yang, escogiendo 8 casos representativos de la misma, acontecidos en los últimos dos años. En la terapéutica instaurada en cada uno de ellos se tuvo en cuenta la clasifi cación antedicha y nuestro repertorio de tratamientos fueron los autoinjertos, los colgajos locales y los colgajos regionales. Resultados. Tanto a nivel funcional como estético se presentó una mejoría apreciable en todos los casos. Conclusiones. Creemos que la categorización de las secuelas por quemadura en cuello, en nuestro caso a través de la clasifi cación de Yang, nos permite seleccionar el tratamiento más idóneo, aumentando este en complejidad cuando la gravedad de la secuela es mayor.