El-Otiefy M A E, Darwish A M A
Assiut University, Egypt.
Ann Burns Fire Disasters. 2011 Mar 31;24(1):42-5.
Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients' median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue.
胸部和腹部前部以及有时颈部和腋窝前部的烧伤在埃及非常常见，大多由家庭事故中的火焰引起。如果烧伤较深，这些烧伤可在女性儿童期或青春期导致乳房畸形。这项研究纳入了55例患者的74个女性乳房，这些患者因儿童期或成年早期的事故导致烧伤后乳房畸形。患者的中位年龄为21岁（范围为13至42岁）。病因是烫伤18例，火焰烧伤37例。发现以下情况：26个乳房（35%）出现向上挛缩，涉及21例患者；32个乳房（43%）出现向下挛缩，涉及25例患者；16个乳房（22%）出现乳头/乳晕复合体缺失或变形，涉及9例患者。手术矫正包括：Z成形术、瘢痕修复、瘢痕切除并通过局部皮瓣或皮肤移植进行重建，以及使用组织扩张器。重建乳房获得了足够的突出度，并形成了外观正常的乳房下皱襞。无重大并发症。2例患者的中厚皮片出现部分皮肤丢失，3例患者乳晕边缘出现部分丢失。这些烧伤导致了不同程度的乳房畸形，矫正手术也相应有所不同。结论是，在这种情况下，必须应用瘢痕修复的一般原则，通过Z成形术矫正挛缩，或者在可行的情况下通过局部皮瓣矫正，或者如果周围区域受到烧伤后瘢痕形成的影响或完全松解后出现大的缺损，则通过中厚皮片移植矫正。如果瘢痕区域被正常健康组织包围，组织扩张器在某些情况下可发挥作用。
