Trapeze-Flap Plasty: An Effective Technique for Postburn Edge Elbow Contracture Elimination

Abstract

Background Scar flexion elbow contracture is a common complication of burns that restricts upper limb function and requires surgical elimination. In spite of the many surgical techniques that have been suggested, the contracture reconstruction still presents a challenge for surgeons. Methods One hundred and twenty-six patients with 174 edge elbow contractures were operated on. Edge elbow contracture, comprising 70% of all elbow contractures, is characterized by the presence of the fold located on the medial or/and lateral edge of cubital fossa. A crescent-shaped fold consists of a lateral sheet, comprising scars; the medial sheet and cubital fossa consists of healthy skin. The fold's crest is the edge of the scar sheet. The contracture is caused by the scar sheet's surface deficit in length; the scar's surface deficit is present all the way from the fold's crest to the joint rotation axis, and possesses a trapezoid shape. The best tissue for scar sheet deficit compensation and contracture elimination the comprises healthy skin of the cubital fossa and medial fold sheet. After fold sheet division, scar sheet dissection and joint extension, the trapeze-shaped wound is formed as a rule. The adipose-cutaneous trapezoid flap, which includes all the cubital fossa and medial fold sheet surface, is elevated. The flap advances on the wound with tension. As a result of flap tension, the adjacent skin of the contralateral side and the back surfaces of the elbow are displaced towards the cubital fossa, participating in donor wound coverage and contracture elimination. Results Mild edge elbow contractures were eliminated with a single trapezoid flap. In the case of moderate and severe contractures, additional trapezoid adipose-scar flaps were elevated from the scar sheet in order to cover the donor wound on the sides of the main flap. The adipose-cutaneous and adipose-scar trapezoid flaps are large, have no acute angles, do not undergo rotation and have steady blood circulation. Contractures were eliminated completely in 166 cases. Local flap end necrosis of the adipose-scar flap occurred in eight cases. The extended healthy flap's skin continued to grow. Full range of flexion and extension was achieved in all cases, except for eight cases with articular changes; there was no contracture recurrence and no re-operations were needed. The cubital fossa as the donor site preserved a normal shape as a result of growth of the stretched skin. Conclusion The single-staged trapeze-flap technique using cubital fossa flap is easy to plan and perform; edge elbow contractures of different severity were eliminated in full and definitively without skin grafting, pedicled and free flaps.