Lewinson Ryan T, Capozzi Lauren C, Johnson Kody, Harrop Alan Robertson, Fraulin Frankie O G, Nickerson Duncan
Leaders in Medicine Program, University of Calgary, Calgary, Alberta, Canada.
Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada.
Plast Surg (Oakv). 2019 Feb;27(1):66-77. doi: 10.1177/2292550318767433. Epub 2018 Apr 19.
Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking.
MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained ≥10 patients with burn scar contracture were considered.
Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n = 218) and knee (n = 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n = 26 patients) and venous congestion (n = 17 patients).
Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches.
穿支皮瓣是烧伤瘢痕挛缩的一种可能的手术治疗方法；然而，目前缺乏关于该主题的证据综述。
在MEDLINE数据库中检索与用于烧伤挛缩的穿支皮瓣相关的文章。在进行标题和摘要筛选后，检索全文以确定描述用于烧伤瘢痕关节挛缩的穿支皮瓣的文章。对数据进行提取并进行描述性总结。仅纳入包含≥10例烧伤瘢痕挛缩患者的文章。
共识别出248篇文章，其中17篇符合综述标准。其中，16篇为低质量病例系列，1篇为开放性随机对照试验。总共对339例患者（年龄范围：3 - 75岁）进行了穿支皮瓣手术，最常见的挛缩部位是颈部（n = 218）和膝部（n = 41）。17篇文章中有9篇描述了康复策略。总体而言，功能结局良好，大多数患者关节活动范围恢复正常且无再次挛缩。与全厚皮片相比，穿支皮瓣在关节活动范围方面有更大改善。在外观上，穿支皮瓣与周围组织颜色匹配良好，解剖标志周围轮廓良好，患者整体外观得到改善。最常见的并发症是皮瓣边缘坏死（n = 26例患者）和静脉淤血（n = 17例患者）。
来自低质量病例系列和1项高质量试验的初步证据表明，穿支皮瓣可能成功用于修复松解后的烧伤瘢痕挛缩；然而，需要进行更多试验来比较穿支皮瓣与其他方法。
