Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps

Background Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perfo...

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Veröffentlicht in:ANZ journal of surgery 2021-09, Vol.91 (9), p.E578-E583
Hauptverfasser: Chang, Lan Sook, Kim, Youn Hwan, Kim, Sang Wha
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creator Chang, Lan Sook
Kim, Youn Hwan
Kim, Sang Wha
description Background Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. Methods Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12–66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. Results Twenty‐one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow‐up was 17.2 months (range 6–36 months). Conclusion Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture. Total scar release and replacement is the main goal of reconstruction. First, the entire scar needs to be excised. Second, this resulting defect must be reconstructed.
doi_str_mv 10.1111/ans.16640
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Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. Methods Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12–66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. Results Twenty‐one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow‐up was 17.2 months (range 6–36 months). Conclusion Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture. Total scar release and replacement is the main goal of reconstruction. First, the entire scar needs to be excised. Second, this resulting defect must be reconstructed.</description><identifier>ISSN: 1445-1433</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.16640</identifier><identifier>PMID: 33792136</identifier><language>eng</language><publisher>Melbourne: John Wiley &amp; Sons Australia, Ltd</publisher><subject>burn ; Extremities ; free tissue transfer ; Morbidity ; Patients ; Reconstruction ; Resurfacing ; scar ; Scars ; Skin grafts ; Surfacing ; Thigh</subject><ispartof>ANZ journal of surgery, 2021-09, Vol.91 (9), p.E578-E583</ispartof><rights>2021 Royal Australasian College of Surgeons</rights><rights>2021 Royal Australasian College of Surgeons.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4190-e9efeb4d88700be10ac0bedfe83fdfabe81f609359e49117906c9cd6ff9282b03</citedby><cites>FETCH-LOGICAL-c4190-e9efeb4d88700be10ac0bedfe83fdfabe81f609359e49117906c9cd6ff9282b03</cites><orcidid>0000-0003-0430-3458 ; 0000-0003-3365-1232</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.16640$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.16640$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33792136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Lan Sook</creatorcontrib><creatorcontrib>Kim, Youn Hwan</creatorcontrib><creatorcontrib>Kim, Sang Wha</creatorcontrib><title>Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>Background Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. Methods Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12–66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. Results Twenty‐one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow‐up was 17.2 months (range 6–36 months). Conclusion Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture. Total scar release and replacement is the main goal of reconstruction. First, the entire scar needs to be excised. Second, this resulting defect must be reconstructed.</description><subject>burn</subject><subject>Extremities</subject><subject>free tissue transfer</subject><subject>Morbidity</subject><subject>Patients</subject><subject>Reconstruction</subject><subject>Resurfacing</subject><subject>scar</subject><subject>Scars</subject><subject>Skin grafts</subject><subject>Surfacing</subject><subject>Thigh</subject><issn>1445-1433</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kU1LxDAQhoMofh_8AxLwoofVpOk2zVEWv0AU_DiXNJ1opduskxRdf72ju3oQnENmmHnmJczL2J4Ux5LixPbxWBZFLlbYpszz8SiTRq8ua5krtcG2YnwRgiAzXmcbSmmTSVVsso87cKGPCQeX2tDz4Hk9YM-js8hpktC6NCDwBnzAaZvmX0h6Bg7vCYEaLUQ-xLZ_om7b0xNoJTQBo-24xQQ45zNA2rYpIPcIwH1nZ3GHrXnbRdhd5m32eH72MLkcXd9eXE1Or0cul0aMwICHOm_KUgtRgxTWUWo8lMo33tZQSl8Io8YGciOlNqJwxjWF9yYrs1qobXa40J1heB0gpmraRgddZ3sIQ6yysdBaqUKXhB78QV8CXYN-R5SWIqebaaKOFpTDECOCr2bYTi3OKymqL0MqMqT6NoTY_aXiUE-h-SV_HCDgZAG8tR3M_1eqTm_uF5KfYE6X5g</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Chang, Lan Sook</creator><creator>Kim, Youn Hwan</creator><creator>Kim, Sang Wha</creator><general>John Wiley &amp; Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0430-3458</orcidid><orcidid>https://orcid.org/0000-0003-3365-1232</orcidid></search><sort><creationdate>202109</creationdate><title>Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps</title><author>Chang, Lan Sook ; Kim, Youn Hwan ; Kim, Sang Wha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4190-e9efeb4d88700be10ac0bedfe83fdfabe81f609359e49117906c9cd6ff9282b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>burn</topic><topic>Extremities</topic><topic>free tissue transfer</topic><topic>Morbidity</topic><topic>Patients</topic><topic>Reconstruction</topic><topic>Resurfacing</topic><topic>scar</topic><topic>Scars</topic><topic>Skin grafts</topic><topic>Surfacing</topic><topic>Thigh</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Lan Sook</creatorcontrib><creatorcontrib>Kim, Youn Hwan</creatorcontrib><creatorcontrib>Kim, Sang Wha</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Lan Sook</au><au>Kim, Youn Hwan</au><au>Kim, Sang Wha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2021-09</date><risdate>2021</risdate><volume>91</volume><issue>9</issue><spage>E578</spage><epage>E583</epage><pages>E578-E583</pages><issn>1445-1433</issn><eissn>1445-2197</eissn><abstract>Background Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. Methods Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12–66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. Results Twenty‐one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow‐up was 17.2 months (range 6–36 months). Conclusion Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture. Total scar release and replacement is the main goal of reconstruction. First, the entire scar needs to be excised. Second, this resulting defect must be reconstructed.</abstract><cop>Melbourne</cop><pub>John Wiley &amp; Sons Australia, Ltd</pub><pmid>33792136</pmid><doi>10.1111/ans.16640</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-0430-3458</orcidid><orcidid>https://orcid.org/0000-0003-3365-1232</orcidid></addata></record>
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subjects burn
Extremities
free tissue transfer
Morbidity
Patients
Reconstruction
Resurfacing
scar
Scars
Skin grafts
Surfacing
Thigh
title Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps
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