Grishkevich Viktor M, Grishkevich Max, Menzul Vasiliy
From the 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. 2015 May-Jun;36(3):e112-9. doi: 10.1097/BCR.0000000000000118.
One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.
烧伤的一个严重后果是瘢痕挛缩和颈部畸形。儿童颈部挛缩尤其危险，会导致面部畸形和脊柱后凸；因此，需要早期进行重建手术。尽管存在多种手术技术，但小儿患者颈部挛缩的成功治疗对外科医生来说仍然是一项挑战。我们对11名（年龄在5至14岁之间）烧伤后颈部前侧挛缩的儿童进行了研究，以开发一种新的重建方法，即使用局部瘢痕筋膜瓣。我们开发了一种新的小儿烧伤后挛缩治疗方法和技术，该方法在治疗无法接受旨在消除挛缩和恢复颈部皮肤的复杂且长时间手术的儿童时特别有效。该技术包括两个梯形瘢痕筋膜瓣的 mobilization（此处原文可能有误，推测为“游离”之类的意思），其覆盖颈部所有前侧表面，由瘢痕、脂肪层、颈阔肌和颈深筋膜组成。瓣的反向转移使拉长的颈部前侧表面产生100%至200%的张力。挛缩被完全消除，颈部轮廓、颏颈角和头部活动得以恢复。在严重挛缩的情况下，下颌下区域和锁骨上方的残留创面进行了植皮。所有11例患者均实现了头部的全方位运动（功能结果）。瓣持续生长，植皮收缩适度。在无法或不宜采用更复杂技术的情况下，局部梯形瓣成形术可消除儿童的颈部挛缩。早期手术干预可预防继发性并发症，为患者留出足够时间成熟并为更复杂的手术做好准备。
