Uygur Fatih, Sever Celalettin, Tuncer Serhan, Alagöz Şahin
Istanbul, Ankara, and Kocaeli, Turkey From the Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital; Department of Plastic and Reconstructive Surgery, Gazi University Medical School; and Department of Plastic and Reconstructive Surgery, Kocaeli University Medical School.
Plast Reconstr Surg. 2009 May;123(5):1544-1552. doi: 10.1097/PRS.0b013e3181a07439.
Full-thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable if the affected areas are not managed properly. Proper treatment requires complete release and radical excision of the scar tissue, followed by reconstruction using durable tissue that will not contract during long-term follow-up.
Nine patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator flaps between 2004 and 2008. All of the patients were male, and their ages ranged from 20 to 23 years (mean, 21.4 years). The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean, 8.0 cm) and 16.0 to 21.0 cm in length (mean, 20.0 cm). All of the patients were followed up for 6 to 12 months (mean, 9.3 months).
All of the flaps used on the postburn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps during the early postoperative period. A complete range of motion at the elbow joint was achieved in all patients by the end of the reconstruction period.
This study revealed that the pedicled thoracodorsal artery perforator flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts well to forearm skin and the donor-site scar is considered cosmetically acceptable.
累及肘前区的全层烧伤会导致严重挛缩。如果对受影响区域处理不当，功能障碍将不可避免。恰当的治疗需要彻底松解并彻底切除瘢痕组织，随后使用在长期随访中不会挛缩的耐用组织进行重建。
2004年至2008年期间，对9例屈曲挛缩患者采用带蒂胸背动脉穿支皮瓣进行重建。所有患者均为男性，年龄在20至23岁之间（平均21.4岁）。根据缺损大小和方向规划皮岛的大小和方向。皮瓣宽度为6.5至9.0厘米（平均8.0厘米），长度为16.0至21.0厘米（平均20.0厘米）。所有患者均随访6至12个月（平均9.3个月）。
用于烧伤后肘前挛缩的所有皮瓣均完全存活。术后早期，两片皮瓣出现轻微短暂性静脉淤血。到重建期结束时，所有患者的肘关节均实现了完全的活动范围。
本研究表明，带蒂胸背动脉穿支皮瓣是烧伤后肘部挛缩的合适替代方案。可获得非常长的蒂，将皮瓣转移至肘前区时无张力。其质地薄且柔韧、面积大，能很好地适应前臂皮肤，供区瘢痕在美容方面可接受。
