Maximizing Gain of Advancement Expanded Flaps by Both Vertical and Horizontal Back Cuts in Cases of Post Burn Deformities

Abstract

Background: Tissue expansion can be considered one ofthe fundamental steps in reconstruction ladder. It is a techniquethat can provide similar tissues to the defect without sacrificingother tissues. Tissue expansion offers lots of benefits, itprovides tissue similar in texture and colour for coverage ofdefects especially post burn deformities. The high percent ofcomplications and need of multiple stages has always beenan obstacle to this technique. However in limited donor areasapplication of large expanders is very difficult and the gainof small expanders is limited with need of repeated sessionswith its high complications and risks. In this study, we userectangular expanded flaps which yields tissues more thanother circular or crescent expanders and backcuts are addedin order to increase both length and width of the flap.Aim of Work: To study the value of both vertical andhorizontal back-cuts added to expanded advancement flapsin reconstruction of post burn deformities in safe andeffective way.Patients and Methods:• Twenty expanders were used for 16 patients as two expanderswere applied in 4 cases. The expanders were implanted inthe scalp (n=10), neck (n=3), chest and abdomen (n=3) andshoulders (n=4). Rectangular expanders were used in allcases. The capacity of the expanders employed varied from250 to 750ml.• Cases were divided into two groups. In group A; we did twohorizontal back cuts located at the base of expanded flap atthe time of expander delivery while in group B; a thirdvertical backcut was added on the distal limb of the flap.• The measurement of length of expanded flap is measuredbefore doing any back cut and after the two horizontalbackcuts in group A. It is also measured before and afterall back cuts in group B.• Results during 3 years period from 2015-2017, 16 caseswere subjected to application of 20 rectangular expandersfor reconstruction of post burn scarinng of different partsof the body, cases were divided into two groups complicationsincluded infection, port exposure, and superficial flapnecrosis of the edges. In group A measurement of the lengthof expanded skin was done before and after horizontal backcuts for both vertical limbs AC, BD. In group B measurementwas taken for the same limbs before and after all the 3backcuts. The average increase in length in group; A=3.12±cm, while the average increase in group; B=4.35cm.171Conclusion: Using both vertical and horizontal backcuts added to both length and width of expanded flap gain,enabled us to remove more scarred tissue bilaterally. It alsopreserved normal tissues infront of the scarred tissue frombeing discarred.