Skin Graft Versus Local Flaps in Management of Post-burn Elbow Contracture

Abstract

IntroductionContracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications. MethodologyA retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3). ResultsFemales were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups. ConclusionGrafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.

Prevention and Treatment of Burn Scar Contracture: A Practical Review

“…20 For the elbow, flaps were compared with grafts and shown to be the superior option, largely due to the mobility required at this area and risk for recurrent contracture with grafts. 21 If grafting was used in the upper extremity, full-thickness skin grafts were preferred, [22][23][24] but dermal regeneration templates and substitutes showed comparable results in terms of decreasing recurrent contracture rates when used as intermediate steps before grafting. [25][26][27][28][29][30][31][32][33][34] Additional techniques used to improve contracture appearance included the use of fat grafting for hand reconstruction, 35,36 tumescence to improve the surgeon's visual field in initial burn debridements, 37 and the use of basic-fibroblast growth factor 38,39 or silicone.…”

Kết quả sử dụng vạt nhánh xuyên hình cánh quạt điều trị sẹo co kéo khuỷu tay

“…Mohamed Issa và cộng sự (2021) nghiên cứu giữa ghép da và vạt tại chỗ trong việc quản lý điều trị sẹo co kéo vùng khuỷu sau bỏng, chia làm 3 nhóm ghép da đơn thuần, vạt tại chỗ, kết hợp. Sau 12 tháng theo dõi, ghi nhận tái phát co kéo nhóm ghép da là 60%, nhóm vạt là 22,8% [11]. Tổ chức sẹo co kéo vùng khuỷu được giải phóng, che phủ bởi tổ chức vạt da tương thích vùng khuỷu, cải thiện rõ rệt về chứng năng và thẩm mỹ, nhất là biên độ vận động khớp.…”

Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury

“…This often results in a large soft tissue deficit when tight contractures are released. Split-thickness grafting alone for these defects presents a three-fold higher risk of re-contracture ( 70 ) and bringing in vascularized tissue represents the best opportunity to maintain the reconstruction in the setting of large extension deficits. If contracture has been prolonged, this may need to be combined with additional procedures such as biceps lengthening, myotomy and/or joint capsule release ( 71 ).…”