Trapezoid Adipose Scar Local Flap: Postburn Lateral Truncal Contracture Elimination With Trapeze-Flap Plasty


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Abstract

Trunk burns result in various complications, deformities, and contractures. Contracture of the lateral surface of the trunk is one of the serious complications that limits movements of the spine; children experience structural changes in the form of scoliosis. Therefore, the lateral truncal contracture should be the subject of early surgical treatment. The currently used method has been the stage-by-stage incisions on the contracture scars and skin grafting or Z-plasty. Skin grafts have a tendency to shrink; thus, compression garments are recommended for an extended period of time after surgery. Triangular flaps are small to complete contracture elimination. The need for development of a more effective surgical technique is apparent. Lateral truncal contracture is caused by a crescent-shaped fold; both sheets of the fold are scars. The sheets have a trapeze-shaped surface deficit in length, which causes the contracture and creates the skin surplus in width. The contracture is of medial type; therefore, it is subject to treatment with local tissues using trapeze-flap plasty. The fold and the adjacent contracted scars are converted into trapezoid flaps by radial incisions. The distance among incisions ranges from 4 to 5 cm, which determines the width of the flap's top. One or several trapezoid flap pairs are planned. The scar flaps are elevated with the subcutaneous fat layer and transposed one toward another with tension, so that the end of one flap reaches the base of the counter flap. As a result, the zone of the plasty is elongated by 100 to 150%. Twelve patients with lateral truncal contractures were operated using trapeze-flap plasty. Good immediate and late results have been achieved. It is the author's belief that trapeze-flap plasty is the most effective technique in light of today's proposed methodology.

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