Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea.
Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, South Korea.
ANZ J Surg. 2021 Sep;91(9):E578-E583. doi: 10.1111/ans.16640. Epub 2021 Apr 1.
Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures.
Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12-66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures.
Twenty-one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow-up was 17.2 months (range 6-36 months).
Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture.
四肢，尤其是关节部位的严重烧伤瘢痕挛缩会导致美观问题和功能受限。释放烧伤瘢痕挛缩需要彻底切除瘢痕并修复由此产生的缺陷。在这里，我们描述了胸背动脉穿支（TDAP）游离皮瓣用于重建烧伤瘢痕挛缩。
2013 年 8 月至 2018 年 7 月，25 例四肢严重烧伤瘢痕挛缩患者采用 TDAP 游离皮瓣进行重建。男性 12 例，患者平均年龄 38.1 岁（12-66 岁）。5 例上肢挛缩，20 例下肢挛缩。
21 例患者单独采用 TDAP 皮瓣重建，3 例患者采用 2 个穿支皮瓣，即 TDAP 皮瓣和股前外侧皮瓣或腹壁下动脉穿支皮瓣（DIEP）皮瓣。其余 1 例患者接受了 3 个穿支皮瓣，2 个 TDAP 皮瓣和 1 个股前外侧皮瓣。重建后 14 例患者的运动范围得到改善。除 4 例患者 TDAP 皮瓣部分坏死外，所有皮瓣均存活。1 例患者供区部分皮片坏死。平均随访 17.2 个月（6-36 个月）。
理想的烧伤瘢痕挛缩重建需要彻底切除瘢痕组织并进行重建，以获得功能和美观效果。根据缺损的范围，TDAP 皮瓣组织薄而有弹性，供区并发症少，可能是重建烧伤瘢痕挛缩的最佳选择。
