Department of Reconstructive and Plastic Surgery, A.V. Vishnevsky Institute of Surgery of the Russian Academy of Medical Sciences, Moscow, Russia.
Burns. 2011 May;37(3):484-9. doi: 10.1016/j.burns.2010.09.003. Epub 2010 Dec 13.
Perioral contractures after burn (microstomia) is a common consequence of facial burns. A small oral opening creates a problem for oral hygiene, food intake and intubation. Therefore, contracture treatment is beneficial once severe limitation of function is realised. Traditionally, this type of contracture is released and the defect is closed with Y-V or Z-plasty. A commonly used technique consists of scar excision in the zone of the commissural apex down to the mucosal lining; the mobilised mucosal flaps are rotated up and down to cover the defect. Anatomical studies and surgical treatment experience for scar microstomia (345 patients) showed that a microstomia contracture could be described as an 'edge' contracture and is caused by a fold located at the oral angle. The lateral (exterior) sheet of the fold the scar causing the contracture; the medial sheet is the mucosa. The scar-surface deficit exists in the exterior sheet of the fold and the angle zone. Therefore, additional excision of scar deforms the oral angle. The contracture release, with a Y-shaped incision, and wound coverage (scar-surface-deficit compensation) with the single mucosal flap allows complete microstomia release and oral angle restoration. After the incisional contracture release, the wound, as a rule, accepts a trapezoid form. The defect (wound) is closed with a similar-shaped mucosal advancement flap. Good functional and cosmetic results were achieved in all cases. The commissural angle accepted a normal shape; the mucosal flap was invisible when the mouth was closed; the mouth had a normal appearance when the mouth orifice was open. After an adequate correction, no recurrence of contractures took place. Thus, scar dissection and wound coverage with the trapeze-flap plasty becomes a preferred reconstructive technique for microstomia release after burn.
口周烧伤（小口畸形）后出现的挛缩是面部烧伤的常见后果。口腔开口小会导致口腔卫生、进食和插管困难。因此，一旦发现功能严重受限，就应进行挛缩治疗。传统上，这种类型的挛缩是通过 Y-V 或 Z 成形术来释放和关闭缺陷。一种常用的技术是在口角顶点的区域切除疤痕，直到粘膜内层；然后将移动的粘膜瓣向上和向下旋转以覆盖缺陷。解剖学研究和对疤痕性小口畸形（345 例患者）的手术治疗经验表明，小口畸形挛缩可以被描述为“边缘”挛缩，是由位于口角的褶皱引起的。褶皱的外侧（外部）片是引起挛缩的疤痕；内侧片是粘膜。疤痕表面缺陷存在于褶皱的外部片和口角区域。因此，额外切除疤痕会使口角变形。通过 Y 形切口进行挛缩松解，并使用单个粘膜瓣进行创面覆盖（疤痕表面缺陷补偿），可以完全释放小口畸形并恢复口角。在切口性挛缩松解后，伤口通常呈梯形。用类似形状的粘膜推进瓣闭合缺损。所有病例均获得良好的功能和美容效果。口角接受了正常的形状；当嘴巴闭合时，粘膜瓣不可见；当嘴巴张开时，嘴巴看起来正常。在充分矫正后，没有再次发生挛缩。因此，对于烧伤后小口畸形的释放，疤痕切开和用梯形瓣成形术覆盖创面成为首选的重建技术。
