Grishkevich Viktor M
Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences, Moscow, Russia.
J Burn Care Res. 2010 Nov-Dec;31(6):949-54. doi: 10.1097/BCR.0b013e3181f93957.
Trunk burns result in various complications, deformities, and contractures. Contracture of the lateral surface of the trunk is one of the serious complications that limits movements of the spine; children experience structural changes in the form of scoliosis. Therefore, the lateral truncal contracture should be the subject of early surgical treatment. The currently used method has been the stage-by-stage incisions on the contracture scars and skin grafting or Z-plasty. Skin grafts have a tendency to shrink; thus, compression garments are recommended for an extended period of time after surgery. Triangular flaps are small to complete contracture elimination. The need for development of a more effective surgical technique is apparent. Lateral truncal contracture is caused by a crescent-shaped fold; both sheets of the fold are scars. The sheets have a trapeze-shaped surface deficit in length, which causes the contracture and creates the skin surplus in width. The contracture is of medial type; therefore, it is subject to treatment with local tissues using trapeze-flap plasty. The fold and the adjacent contracted scars are converted into trapezoid flaps by radial incisions. The distance among incisions ranges from 4 to 5 cm, which determines the width of the flap's top. One or several trapezoid flap pairs are planned. The scar flaps are elevated with the subcutaneous fat layer and transposed one toward another with tension, so that the end of one flap reaches the base of the counter flap. As a result, the zone of the plasty is elongated by 100 to 150%. Twelve patients with lateral truncal contractures were operated using trapeze-flap plasty. Good immediate and late results have been achieved. It is the author's belief that trapeze-flap plasty is the most effective technique in light of today's proposed methodology.
躯干烧伤会导致各种并发症、畸形和挛缩。躯干侧面挛缩是限制脊柱活动的严重并发症之一；儿童会出现脊柱侧弯形式的结构变化。因此，躯干侧面挛缩应成为早期手术治疗的对象。目前使用的方法是在挛缩瘢痕上分期进行切口并植皮或采用Z成形术。植皮有收缩的倾向；因此，建议术后长时间使用压迫衣。三角形皮瓣较小，无法完全消除挛缩。显然需要开发一种更有效的手术技术。躯干侧面挛缩是由新月形褶皱引起的；褶皱的两层都是瘢痕。这两层在长度上有梯形表面缺损，导致挛缩并在宽度上形成皮肤多余。这种挛缩属于内侧型；因此，可采用梯形皮瓣成形术用局部组织进行治疗。通过放射状切口将褶皱和相邻的挛缩瘢痕转化为梯形皮瓣。切口之间的距离为4至5厘米，这决定了皮瓣顶部的宽度。计划一个或几个梯形皮瓣对。将瘢痕皮瓣连同皮下脂肪层掀起，并在张力下相互移位，使一个皮瓣的末端到达对侧皮瓣的基部。结果，成形区域延长了100%至150%。12例躯干侧面挛缩患者采用梯形皮瓣成形术进行手术。取得了良好的近期和远期效果。作者认为，根据目前提出的方法，梯形皮瓣成形术是最有效的技术。
