Ma Zhouji, Mo Ran, Chen Chen, Meng Xueyong, Tan Qian
Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Burns & Plastic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University, Nanjing, China.
Ann Transl Med. 2021 Feb;9(4):303. doi: 10.21037/atm-20-4947.
Burn patients often have functional problems due to joint scar contracture. Patients suffering from such contracture often experience considerable limitations in daily life. Therefore, surgical treatment is often necessary. Skin grafts, especially full-thickness skin grafts and flaps remain the most commonly used surgical methods in clinical practice. However, there are no clear guidelines stating which technique is the most effective treatment. Herein, we conducted a retrospective cohort study over 10 years of experience at a single center to investigate whether flaps or FTSGs exhibit a better long-term effect.
We performed a retrospective chart review of patients with joint burn scar contracture and collected data related to patient demographic profiles, and detailed descriptions of the scars, surgical procedures, and follow-up were collected. We performed follow-up evaluation of three aspects: adverse events (recontracture, ache, and pruritus), satisfaction scores for function and aesthetics, and scar quality (Vancouver Scar Scale score).
Follow-up results 1 year after surgery from 88 patients were analyzed. In total, 4 (10%) patients in the flap group and 13 (27.1%) patients in the FTSG group had recontracture; the incidence of recontracture was lower in the flap group than in the FTSG group (P=0.043). The functional satisfaction score of the flap group was higher than that of the FTSG group (P=0.027). Moreover, follow-up results 5 year after surgery for 47 patients were analyzed. In total, 1 (4.8%) patient in the flap group and 7 (26.9%) patients in the FTSG group had recontracture; the incidence of recontracture was significantly lower in the flap group than in the FTSG group (P=0.044). The functional satisfaction score in the flap group was higher than that of the FTSG group (P=0.041). In this study, no significant differences in scar quality were observed between the two groups.
If conditions permit, the application of different types of flaps may represent a better choice than FTSGs in terms of reducing the recontracture rate and improving joint function.
烧伤患者常因关节瘢痕挛缩而出现功能问题。患有此类挛缩的患者在日常生活中往往会受到很大限制。因此，手术治疗通常是必要的。皮肤移植，尤其是全厚皮片移植和皮瓣，仍然是临床实践中最常用的手术方法。然而，目前尚无明确的指南说明哪种技术是最有效的治疗方法。在此，我们对单一中心10年的经验进行了一项回顾性队列研究，以调查皮瓣或全厚皮片移植是否具有更好的长期效果。
我们对关节烧伤瘢痕挛缩患者进行了回顾性病历审查，并收集了与患者人口统计学资料相关的数据，以及瘢痕、手术过程和随访的详细描述。我们从三个方面进行了随访评估：不良事件（再次挛缩、疼痛和瘙痒）、功能和美学满意度评分以及瘢痕质量（温哥华瘢痕量表评分）。
分析了88例患者术后1年的随访结果。皮瓣组共有4例（10%）患者出现再次挛缩，全厚皮片移植组有13例（27.1%）患者出现再次挛缩；皮瓣组再次挛缩的发生率低于全厚皮片移植组（P=0.043）。皮瓣组的功能满意度评分高于全厚皮片移植组（P=0.027）。此外，分析了47例患者术后5年的随访结果。皮瓣组共有1例（4.8%）患者出现再次挛缩，全厚皮片移植组有7例（26.9%）患者出现再次挛缩；皮瓣组再次挛缩的发生率显著低于全厚皮片移植组（P=0.044）。皮瓣组的功能满意度评分高于全厚皮片移植组（P=0.041）。在本研究中，两组之间在瘢痕质量方面未观察到显著差异。
如果条件允许，在降低再次挛缩率和改善关节功能方面，应用不同类型的皮瓣可能比全厚皮片移植是更好的选择。
