Browse > Article

Correction of Burn Scar Contracture: Indication and Choice of Free Flap  

Hur, Gi Yeun (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Lee, Jong Wook (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Koh, Jang Hyu (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Seo, Dong Kook (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Choi, Jai Koo (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Jang, Young Chul (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Oh, Suk Joon (Department of Plastic and Reconstructive Surgery, School of Medicine, Hallym University)
Publication Information
Archives of Plastic Surgery / v.35, no.5, 2008 , pp. 521-526 More about this Journal
Abstract
Purpose: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures Methods: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. Results: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. Conclusion: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.
Keywords
Burn scar contracture; Free flap; Reconstruction;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Shanahan RE, Gingrass RP: Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg 64: 295, 1979   DOI   ScienceOn
2 Hahn SB, Park HJ, Park HW, Kang HJ, Cho JH: Treatment of severe equinus deformity associated with extensive scarring of the leg. Clin Orthop Relat Res 393: 250, 2001   DOI
3 Price RI, Ecker ML: Z-plasty skin closure after lengthening the Achilles tendon: Case report. Plast Reconstr Surg 52: 309, 1973   DOI
4 Hunt JA, Moisidis E, Haertsch P: Initial experience of Integra in the treatment of post-burn anterior neck contracture. Br J Plast Surg 53: 652, 2000   DOI   ScienceOn
5 Choi WS, Jeon BC, Rah SK, Choi CU, Kim HH: Experience of microsurgery using dorsalis pedis artery. J Korean Orthop Assoc 16: 731, 1981
6 Avery CM, Pereira J, Brown AE: Suprafascial dissection of the radial forearm flap and donor site morbidity. Int J Oral Maxillofac Surg 30: 37, 2001   DOI   ScienceOn
7 Ho T, Couch M, Caron K, Schimberg A, Manley K, Byrne PJ: Radial forearm free flap donor site outcomes comparison by closure methods. Otolaryngol Head Neck Surg 134: 309, 2006   DOI   ScienceOn
8 de Bree R, Hartley C, Smeele LE, Kuik DJ, Quak JJ, Leemans CR: Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap. Laryngoscope 114: 1973, 2004   DOI   ScienceOn
9 Angrigiani C: Aesthetic microsurgical reconstruction of anterior neck burn deformities. Plast Reconstr Surg 93: 507, 1994   DOI
10 Lee JW, Jang YC, Oh SJ: Use of the artificial dermis for free radial forearm flap donor site. Ann Plast Surg 55: 500, 2005   DOI   ScienceOn
11 Tark KC, Yoo WM, Lee HB, Lew JD: Clinical application of sensate instep flaps. J Korean Soc Plast Reconstr Surg 22: 641, 1995
12 Weinzweig N, Davies BW: Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases. Plast Reconstr Surg 102: 1999, 1998   DOI