Baskent University, Department of Plastic and Reconstructive Surgery, Bilkent 3 Ufuk Sitesi D1/1 06800, Bilkent, Ankara, Turkey.
Burns. 2011 Dec;37(8):1449-57. doi: 10.1016/j.burns.2011.08.006. Epub 2011 Oct 2.
Double opposing rectangular advancement is a new and alternative technique in the treatment of postburn scar contractures. The technique consists of opposing two adjacent subcutaneously pedicled rectangular flaps by advancement and lengthening a contracture band. Experimental studies demonstrated that the technique is efficient to elongate a tension line as much as Z-plasty in the rat inguinal skin. In this clinical study we investigated the efficiency and versatility of the technique in the treatment of wide linear postburn scar contractures in various parts of the body.
We applied 16 double opposing rectangular advancement in 7 patients (aged 4-56). Flaps were applied in the upper extremity (11 flaps), lower extremity (4 flaps) and trunk (1 flap).
Average follow-up was 1-year. All flaps achieved adequate relaxation postoperatively and healed uneventfully. Postoperative measurements indicated that the lengthening provided with the technique ranged from 72 to 100%. The subcutaneous pedicle of the rectangular flaps provided a distinct advantage in terms of vascularity. Recontracture was seen in one patient to whom two double opposing rectangular flaps in series were applied in the axilla.
Clinical results indicated that double opposing rectangular advancement is effective in the treatment of wide linear postburn scar contractures. Preoperative planning and application of flaps are simple. One knows preoperatively the exact elongation along the contracture line and narrowing perpendicular to this line which will be provided with the technique. Since the flaps are subcutaneously pedicled, the vascularity of the flaps are reliable. However the technique may not avoid recontracture in the axilla.
双反对称矩形推进术是一种治疗烧伤后瘢痕挛缩的新技术和替代技术。该技术包括通过推进和延长挛缩带，将相邻的两个皮下蒂矩形皮瓣进行对向。实验研究表明，该技术在大鼠腹股沟皮肤中延长张力线的效率与 Z 成形术相当。在这项临床研究中，我们研究了该技术在治疗身体各部位宽线性烧伤后瘢痕挛缩的效果和多功能性。
我们在 7 名患者（年龄 4-56 岁）中应用了 16 个双反对称矩形推进术。皮瓣应用于上肢（11 个皮瓣）、下肢（4 个皮瓣）和躯干（1 个皮瓣）。
平均随访时间为 1 年。所有皮瓣术后均获得充分松解，愈合顺利。术后测量表明，该技术提供的延长长度范围为 72%至 100%。矩形皮瓣的皮下蒂在血供方面具有明显优势。有 1 名患者在腋窝应用了两个连续的双反对称矩形皮瓣，出现了再挛缩。
临床结果表明，双反对称矩形推进术治疗宽线性烧伤后瘢痕挛缩是有效的。术前规划和皮瓣应用简单。术前可以知道沿着挛缩线的确切延长以及垂直于该线的变窄程度，这些都可以通过该技术实现。由于皮瓣具有皮下蒂，皮瓣的血供可靠。然而，该技术可能无法避免腋窝处的再挛缩。
