Grishkevich Viktor M
Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Sciences. Moscow, Russia.
J Burn Care Res. 2010 Mar-Apr;31(2):286-91. doi: 10.1097/BCR.0b013e3181d0f45e.
The hand burns can be complicated with the scar contracture of the ulnar or radial hand border. The contracture restricts the mobility of adjacent joints (fifth interphalangeal, wrist joints), causing deviation of the small finger and the whole hand. The contracture and deviation are caused by semilunar fold sheets of which are scars (medial contracture). The fold sheets have the trapeze-shaped surface deficiency in length and surface surplus in width. Thus, the local tissue flaps should have the corresponding form (trapeze-shaped flaps) for surface deficiency compensation. The sheets are transformed into trapezoid flaps along the total length of the semilunar fold with radial incisions until the full tension release is achieved. The incision's ends are split to complete the scar tension release. The distance between radial incisions at the fold's top is approximately 2 to 3 cm, which matches the width of the flap's end. The flaps are mobilized with the full fatty layer and transposed toward each other until the end of one flap reaches the base of the opposite flap. As a result, the skin surface lengthens by two to three times, which allows complete contracture elimination. The contractures were liquidated in all 16 patients without complications. The trapeze-flap plasty is recommended for a wide use in treatment of hand boarder contractures.
手部烧伤可能会并发尺侧或桡侧手部边缘的瘢痕挛缩。这种挛缩会限制相邻关节（第五指间关节、腕关节）的活动，导致小指和整个手部出现偏斜。挛缩和偏斜是由半月形褶皱瘢痕（内侧挛缩）引起的。这些褶皱瘢痕在长度上呈梯形表面缺损，在宽度上呈表面多余。因此，局部组织瓣应具有相应的形状（梯形瓣）以补偿表面缺损。沿着半月形褶皱的全长进行桡侧切口，将瘢痕转变为梯形瓣，直至完全解除张力。切口两端进行劈开以完成瘢痕张力的解除。褶皱顶部桡侧切口之间的距离约为2至3厘米，与瓣的末端宽度相匹配。将带有完整脂肪层的瓣进行游离，并相互移位，直到一个瓣的末端到达相对瓣的基部。结果，皮肤表面延长了两到三倍，从而能够完全消除挛缩。16例患者的挛缩均得以解除，且无并发症发生。建议广泛应用梯形瓣成形术治疗手部边缘挛缩。
