Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences, Moscow, Russia.
Burns. 2009 Nov;35(7):1026-35. doi: 10.1016/j.burns.2008.12.008. Epub 2009 May 5.
Thermal injuries to the anterior chest in pre-pubescent girls result in breast contracture. During puberty, the breast parenchyma develops and grows underneath the scars, resulting in being flattened and disfigured. The breast mound, as well as the nipple-areolar complex, is partially or completely levelled out and displaced. The contours are unclear and the inframammary fold is effaced. This feature of the most severe breast contracture still poses a challenge for most surgeons. This type of breast contracture can be successfully eliminated with the author-suggested, improved free-skin grafting technique. The scars are excised and the shifted area of parenchyma is mobilised symmetrically to the border of the undamaged breast. Then, the shape and positioning of the breast as well as the nipple-areolar complex are reconstructed with the help of circular suturing through the fat layer on two to three breast levels. The suture ends are led beyond the wound area and are affixed with certain tension contralateral to the breast displacement. The suture ends, being in state of tension, are tied into untied knots around bolsters and are retained in place for about 3 months. During this time, the form and the positioning of the breast can be corrected using the traction of the untied sutures; the skin transplants are stabilised, under which the scar tissue is formed. Skin transplant and the scar tissue hold the shape and positioning of the breast and the sutures can be removed at this stage. In this series, 11 patients were operated upon and 13 breasts were reconstructed. Good results were achieved in all cases: the breast's shape and skin was restored and the positioning was corrected.
未成年女孩前胸的热烧伤会导致乳房挛缩。在青春期，乳房实质在疤痕下发育和生长，导致乳房变平并畸形。乳房丘，以及乳头乳晕复合体，部分或完全平坦和移位。轮廓不清晰，乳房下皱襞消失。这种最严重的乳房挛缩特征仍然对大多数外科医生构成挑战。通过作者建议的改良游离皮片移植技术，可以成功消除这种类型的乳房挛缩。切除疤痕，对称地向未受损乳房的边界移动移位的实质区域。然后，通过在两个到三个乳房水平的脂肪层进行圆形缝合，重建乳房的形状和位置以及乳头乳晕复合体。缝合线末端超出伤口区域，并在与乳房移位相对的一侧施加一定的张力。在有张力的状态下，缝合线末端在垫环周围打成未系紧的结，并保留大约 3 个月。在此期间，通过未系紧的缝线的牵引可以纠正乳房的形状和位置；皮片移植稳定，在其下形成瘢痕组织。皮片移植和瘢痕组织保持乳房的形状和位置，可以在此阶段去除缝线。在这一系列中，对 11 名患者进行了手术，重建了 13 个乳房。所有病例均取得良好效果：恢复了乳房的形状和皮肤，纠正了位置。
