Double reverse V-Y-plasty in postburn scar contractures: a new modification of V-Y-plasty

Abstract

Several techniques have been defined to use in surgical treatment of postburn scar contractures. However, distal flap necrosis is frequently seen since most of these techniques require random-pattern flaps and there is often poor vascular supply to scar tissue. In the Z-plasty, V-Y-plasty and their analogues, excess tissue requires excision of the dog-ear. A new modification of V-Y-plasty, called “double reverse V-Y-plasty”, is discussed. Nineteen postburn scar contractures were successfully treated with double reverse V-Y-plasty. The postoperative results represent the versatility of this technique in the surgical treatment of postburn scar contractures, especially neck and extremities. There was no distal flap necrosis. Double reverse V-Y-plasty is effective and alternative to the current techniques in surgical treatment of every kind of postburn scar contractures with one or more contracture lines. It does not need any surgical knack. Advantages: (i) double reverse V-Y-plasty is safely useful, when skin tension across the contracture line is too great to use any local flaps; (ii) when superficial scarring is localized in the contracture site, it is superior to other local flaps because of rich vascularity and mobility; (iii) double reverse V-Y-plasty is advised to the inexperienced surgeon, since it is easy to use; (iv) color and texture matches are cosmetically acceptable, and the resultant contracture is as much as with other techniques; (v) there is no necessity to use excision of the dog-ear; (vi) it can be utilized under local anesthesia almost in all cases; and (vii) it requires a shorter period of operation, and hospitalization.