Expanded flaps with vascular anastomosis for the treatment of scar contracture deformities of extensively burned patients / 中华烧伤杂志

ABSTRACT

Objective@#To explore the effect of expanded flaps with vascular anastomosis in the treatment of scar contracture deformities of extensively burned patients.@*Methods@#From April 2016 to February 2018, 9 patients with severe scar contracture deformities caused by extensive burns were hospitalized in our unit, including 7 males and 2 females, aged 23-54 years. There were 14 sites of scar contracture deformities and dysfunction, including 8 in face and neck, 2 in elbow, and 4 in wrist and hand. The expander was inserted into the chest or abdomen and was expanded by 2 to 3 times of its rated volume with injection of normal saline. After satisfied expansion, the expanded flap was harvested and transplanted with arteriovenous anastomosis onto the recipient site, where the scar was removed, the deformity was corrected, and the contracture was released. The number of expanders, the volume of normal saline injected, the period of expansion, the complications of skin and soft tissue expansion, the number, size, thickness, transplantation modes, and survival of flaps, and the repair method of donor site were observed and recorded. The reconstruction effect of scar contracture deformity was followed up. The patients′ satisfaction with the therapeutic effect of various surgical sites during follow-up was investigated with a 5-point Likert Scale. The Burn Specific Health Scale-Brief was used to evaluate the quality of life of the patients pretreatment and during follow-up. Data were processed with paired sample t test or Wilcoxon signed-rank sum test.@*Results@#A total of 16 expanders were inserted in this group of patients, including 6 in the chest and 10 in the abdomen. The volume of normal saline injected at the end of expansion was (1 421±348) mL. The expansion time was (8.1±2.6) months. One case of expander leakage and one case of injection port turnover resulted in failure of water injection occurred during expansion. Totally 17 flaps were resected from 16 expanded areas. The size of flaps ranged from 15 cm×13 cm to 30 cm×25 cm. The thickness was (0.49±0.06) cm in 6 chest flaps and (0.76±0.15) cm in 11 abdomen flaps. Free transplantation with vascular anastomosis was performed in 14 flaps, and pedicled transplantation supercharged with distal vascular anastomosis was performed in 3 flaps, one of which the vascular pedicle was divided and re-anastomosed to the other side of the recipient area 2 weeks later. Except for one donor site of abdomen flap which was transplanted with thin split-thickness scalp, the other donor sites were sutured directly. After operation, 2 flaps were slightly necrotic at the distal end and healed after dressing change and thin split-thickness scalp transplantation respectively, while the remaining 15 flaps all survived. During the follow-up of 6-24 months, the texture of the flaps was soft. The abdomen flap transplanted to the palm of hand in one patient was slightly hypertrophic, which was thinned 3 months after operation, while the other flaps were good in thickness. At the last follow-up, the appearance and function of the sites repaired by flaps of all patients were obviously improved compared with those before operation, the satisfaction score of the patients with the therapeutic effect of the surgical site was (4.4±0.6) points, the total score of quality of life and the scores of heat sensitivity, treatment antipathy, body image, and affect of patients were significantly higher than those before treatment (t=3.232, 2.683, 3.969, 2.884, 2.588, P<0.05), while the scores of hand function, sexuality, interpersonal relationship, simple function abilities, perception in returning to work of patients were close to those before treatment (t=0.778, 1.000, 1.664, Z=1.826, 1.633, P>0.05).@*Conclusions@#Expanded flaps with vascular anastomosis are suitable for the treatment of scar contracture deformities of extensively burned patients. The flaps are large in size and suitable in thickness. The donor sites are easy to be closed directly. The treatment can obviously improve the appearance, function, and the quality of life of the patients, with a high satisfaction of patients.