Adequate Relaxation Research Articles

Hemodynamic Responses and intubating conditions in laryngeal mask airway insertion a comparative study of propofol versus sevoflurane

Background: LMA is an effective alternative to the endotracheal tube for securing the airway in short surgical procedures. Propofol is a widely used anaesthetic agent for the insertion of Laryngeal Mask Airway. Sevoflurane is a volatile anaesthetic agent, which combines rapid, smooth inhalational induction of anaesthesia with rapid recovery, making it ideal for day care anaesthesia. Objective: To study if the use of sevoflurane can be used as an alternative to IV propofol for laryngeal mask airway insertion. Primary objective: Hemodynamic responses during Laryngeal mask insertion. Secondary objective: Intubating conditions during laryngeal mask airway insertion. Study design: A Randomized control trial. Methods: 100 adults were allocated by randomization into two groups of 50 each; group P (Propofol) and group S (Sevoflurane). Patients in group P were induced with 2.5mg/kg intravenous propofol with 50%O2 & 50%N2O and in group S with 8% sevoflurane in 50%O2 & 50% N2O vital capacity breath technique. Laryngeal mask airway was inserted after adequate jaw relaxation was attained and hemodynamic responses like pulse rate, blood pressure were monitored. The grading of conditions for laryngeal mask airway insertion and number of attempts were noted. All the data collected was analysed statistically. Results: We observed that more number of attempts were required for LMA insertion in Group S (14.0%) compared to Group P (0.0%) which is statistically significant with P=0.012. Heart rate at one minute and 2 minutes after LMA insertion showed a fall with Propofol which was statistically significant as compared to Sevoflurane. There is a significant difference of fall in mean arterial blood pressure in group P during induction, one minute, 2 minutes and 5 minutes when compared between the two groups. Sevoflurane took longer time for induction and LMA insertion compared to Propofol which is statistically significant. Moderate patient movement were noticed in 5 patients of group S and no patient movement were noticed in group P and is statistically significant (P – 0.022). Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory. Conclusion: Sevoflurane is associated with good hemodynamic stability but intubating conditions provided with propofol is superior. Prolonged time for jaw relaxation with sevoflurane when compared to propofol may delay laryngeal mask airway insertion. Quality of insertion with propofol was excellent in all patients. With sevoflurane quality of insertion ranged from excellent to satisfactory.

Anesthesia on pediatric laparoscopic

Laparoscopic surgery has several advantages compared to a regular surgical procedures. This technique can reduce the stress of surgery, reduce the need for postoperative analgesia, decreased respiratory and wound complications, lowering long hospitalization, including in the intensive therapy, and the patient can go back to eat quickly. The magnitude of changes in vital signs that occur will be influenced by the patient's age, cardiovascular function, and anesthetic agents are used. Physiological changes in pediatric laparoscopic surgery were similar to adults. Children have a higher vagal tone and sometimes a stimulus to the peritoneum by gas insufflation or laparoscopic penetration and trocar can lead to bradycardia and asystole. Intra-abdominal pressure is an important determinant for maintaining cardiovascular stability during laparoscopy. Adequate relaxation needed during the duration of the surgery.

Erratum. A prospective randomized trial of the optimal dose of mannitol for intraoperative brain relaxation in patients undergoing craniotomy for supratentorial brain tumor resection.

OBJECTIVE Mannitol is used intraoperatively to induce brain relaxation in patients undergoing supratentorial brain tumor resection. The authors sought to determine the dose of mannitol that provides adequate brain relaxation with the fewest adverse effects. METHODS A total of 124 patients were randomized to receive mannitol at 0.25 g/kg (Group A), 0.5 g/kg (Group B), 1.0 g/kg (Group C), and 1.5 g/kg (Group D). The degree of brain relaxation was classified according to a 4-point scale (1, bulging; 2, firm; 3, adequate; and 4, perfectly relaxed) by neurosurgeons; Classes 3 and 4 were considered to indicate satisfactory brain relaxation. The osmolality gap (OG) and serum electrolytes were measured before and after mannitol administration. RESULTS The brain relaxation score showed an increasing trend in patients receiving higher doses of mannitol (p = 0.005). The incidence of satisfactory brain relaxation was higher in Groups C and D than in Group A (67.7% and 64.5% vs 32.2%, p = 0.011 and 0.022, respectively). The incidence of OG greater than 10 mOsm/kg was also higher in Groups C and D than in Group A (100.0% in both groups vs 77.4%, p = 0.011 for both). The incidence of moderate hyponatremia (125 mmol/L ≤ Na+ 5.0 mmol/L) was observed in 12.9% of patients in Group D only. CONCLUSIONS The higher doses of mannitol provided better brain relaxation but were associated with more adverse effects. Considering the balance between the benefits and risks of mannitol, the authors suggest the use of 1.0 g/kg of intraoperative mannitol for satisfactory brain relaxation with the fewest adverse effects. Clinical trial registration no.: NCT02168075 ( clinicaltrials.gov ).

A prospective randomized trial of the optimal dose of mannitol for intraoperative brain relaxation in patients undergoing craniotomy for supratentorial brain tumor resection.

OBJECTIVE Mannitol is used intraoperatively to induce brain relaxation in patients undergoing supratentorial brain tumor resection. The authors sought to determine the dose of mannitol that provides adequate brain relaxation with the fewest adverse effects. METHODS A total of 124 patients were randomized to receive mannitol at 0.25 g/kg (Group A), 0.5 g/kg (Group B), 1.0 g/kg (Group C), and 1.5 g/kg (Group D). The degree of brain relaxation was classified according to a 4-point scale (1, bulging; 2, firm; 3, adequate; and 4, perfectly relaxed) by neurosurgeons; Classes 3 and 4 were considered to indicate satisfactory brain relaxation. The osmolality gap (OG) and serum electrolytes were measured before and after mannitol administration. RESULTS The brain relaxation score showed an increasing trend in patients receiving higher doses of mannitol (p = 0.005). The incidence of satisfactory brain relaxation was higher in Groups C and D than in Group A (67.7% and 64.5% vs 32.2%, p = 0.011 and 0.022, respectively). The incidence of OG greater than 10 mOsm/kg was also higher in Groups C and D than in Group A (100.0% in both groups vs 77.4%, p = 0.011 for both). The incidence of moderate hyponatremia (125 mmol/L ≤ Na+ < 130 mmol/L) was significantly higher in Group D than in other groups (38.7% vs 0.0%, 9.7%, and 12.9% in Groups A, B, and C; p < 0.001, p = 0.008, and p = 0.020, respectively). Hyperkalemia (K+ > 5.0 mmol/L) was observed in 12.9% of patients in Group D only. CONCLUSIONS The higher doses of mannitol provided better brain relaxation but were associated with more adverse effects. Considering the balance between the benefits and risks of mannitol, the authors suggest the use of 1.0 g/kg of intraoperative mannitol for satisfactory brain relaxation with the fewest adverse effects. Clinical trial registration no.: NCT02168075 ( clinicaltrials.gov ).

Propofol Pharmacokinetics and Estimation of Fetal Propofol Exposure during Mid-Gestational Fetal Surgery: A Maternal-Fetal Sheep Model.

BackgroundMeasuring fetal drug concentrations is extremely difficult in humans. We conducted a study in pregnant sheep to simultaneously describe maternal and fetal concentrations of propofol, a common intravenous anesthetic agent used in humans. Compared to inhalational anesthesia, propofol supplemented anesthesia lowered the dose of desflurane required to provide adequate uterine relaxation during open fetal surgery. This resulted in better intraoperative fetal cardiac outcome. This study describes maternal and fetal propofol pharmacokinetics (PK) using a chronically instrumented maternal-fetal sheep model.MethodsFetal and maternal blood samples were simultaneously collected from eight mid-gestational pregnant ewes during general anesthesia with propofol, remifentanil and desflurane. Nonlinear mixed-effects modeling was performed by using NONMEM software. Total body weight, gestational age and hemodynamic parameters were tested in the covariate analysis. The final model was validated by bootstrapping and visual predictive check.ResultsA total of 160 propofol samples were collected. A 2-compartment maternal PK model with a third fetal compartment appropriately described the data. Mean population parameter estimates for maternal propofol clearance and central volume of distribution were 4.17 L/min and 37.7 L, respectively, in a typical ewe with a median heart rate of 135 beats/min. Increase in maternal heart rate significantly correlated with increase in propofol clearance. The estimated population maternal-fetal inter-compartment clearance was 0.0138 L/min and the volume of distribution of propofol in the fetus was 0.144 L. Fetal propofol clearance was found to be almost negligible compared to maternal clearance and could not be robustly estimated.ConclusionsFor the first time, a maternal-fetal PK model of propofol in pregnant ewes was successfully developed. This study narrows the gap in our knowledge in maternal-fetal PK model in human. Our study confirms that maternal heart rate has an important influence on the pharmacokinetics of propofol during pregnancy. Much lower propofol concentration in the fetus compared to maternal concentrations explain limited placental transfer in in-vivo paired model, and less direct fetal cardiac depression we observed earlier with propofol supplemented inhalational anesthesia compared to higher dose inhalational anesthesia in humans and sheep.

Anaesthetic Management of a Patient with Palatal Defect

Airway management of an adult patient with palatal defect is a challenging case to Anesthesiologist. We report an adult patient who is an operated case of nasopharyngeal Angiofibroma posted for palatal defect (3.5 × 4.5 cm) repair. It was a major surgery lasted for 10 hours involving free flap from radial aspect of forearm along with radial artery and repositioning on palatal defect and anastomosis with facial artery. Challenges involved in this case management were airway, analgesia and fluid electrolytes. Intraoperative period was uneventful. Patient was electively shifted to ICU for prophylactic ventilatory support with ET Tube in situ post procedure because it being a major surgery with compromised airway with poor pharyngeal reflexes, copious secretions, bite block. Patient was postoperatively managed with adequate analgesia, sedation and relaxation and was extubated on 3rd postoperative day. The details would be discussed later.

The impact of silica encapsulated cobalt zinc ferrite nanoparticles on DNA, lipids and proteins of rat bone marrow mesenchymal stem cells

Nanomaterials are currently the subject of intense research due to their wide variety of potential applications in the biomedical, optical and electronic fields. We prepared and tested cobalt zinc ferrite nanoparticles (Co0.5Zn0.5Fe2O4+γ [CZF-NPs]) encapsulated by amorphous silica in order to find a safe contrast agent and magnetic label for tracking transplanted cells within an organism using magnetic resonance imaging (MRI). Rat mesenchymal stem cells (rMSCs) were labeled for 48 h with a low, medium or high dose of CZF-NPs (0.05; 0.11 or 0.55 mM); silica NPs (Si-NPs; 0.11 mM) served as a positive control. The internalization of NPs into cells was verified by transmission electron microscopy. Biological effects were analyzed at the end of exposure and after an additional 72 h of cell growth without NPs. Compared to untreated cells, Annexin V/Propidium Iodide labeling revealed no significant cytotoxicity for any group of treated cells and only a high dose of CZF-NPs slowed down cell proliferation and induced DNA damage, manifested as a significant increase of DNA-strand breaks and oxidized DNA bases. This was accompanied by high concentrations of 15-F2t-isoprostane and carbonyl groups, demonstrating oxidative injury to lipids and proteins, respectively. No harmful effects were detected in cells exposed to the low dose of CZF-NPs. Nevertheless, the labeled cells still exhibited an adequate relaxation rate for MRI in repeated experiments and ICP-MS confirmed sufficient magnetic label concentrations inside the cells. The results suggest that the silica-coated CZF-NPs, when applied at a non-toxic dose, represent a promising contrast agent for cell labeling.

Interference Removal for Autofocusing of GPR Data From RC Bridge Decks

Strong interferences can substantially deteriorate the performance of autofocusing techniques in ground penetrating radar (GPR) data analysis for reinforced concrete (RC) bridge deck evaluation. In this paper, we propose a new approach based on F–K dip filtering to remove interferences, including direct waves and cross rebar reflections. Different from previously related work, the surface roughness and uneven cross rebar reflections resulted from GPR signals propagating through rough surface and inhomogeneous medium are carefully modeled as reflectors with small dipping angles, and hence dip relaxations are introduced in the F–K dip filtering to remove strong interferences. The mechanism of the F–K filter without dip relaxation and the correctness of the rebar modeling are first illustrated using simulation data. Then its effectiveness with adequate dip relaxation is demonstrated by both experimental and field data. Additionally, the performance of the F–K dip filter with adequate dip relaxation is also compared with that of the background subtraction (BS) method that is commonly used for direct wave removal in GPR data processing for RC bridge deck evaluation.

Length difference effect on dynamic behaviors of double-walled carbon nanotubes

The effect of length difference on oscillation and rotation of the inner tube in a double-walled carbon nanotube (DWNT) is investigated. In the analysis, the inner tubes of the DWNTs are assumed to be of the same length but the length of the outer tubes may be different from that of inner tubes. Further, the outer tube is entirely fixed after adequate relaxation at 300 K and the inner tube is unconstrained and can move freely in the outer tube. In the simulations, each bi-tube system initially has a symmetric cross-section, and the inner tube oscillates while rotating along its own axis. The dynamic behavior studied includes oscillation and rotation of the inner tubes. The oscillation decreases along with an increase in the length difference. A greater length difference between the two tubes in a bi-tube system leads to a smaller amplitude of oscillation of mass center of the inner tube (MCIT) and a higher self-rotating speed. Moreover, the inner tube in a bi-tube with different chirality of the two tubes may have different self-rotational directions.

Per-oral endoscopic myotomy white paper summary

Achalasia is an uncommon esophageal motility disorder in which there is selective loss of inhibitory neurons resulting in loss of peristalsis and failure of adequate relaxation of the lower esophageal sphincter (LES) in response to food bolus. There is no current curative treatment that reverses the pathophysiology of achalasia. The treatment options are aimed at improving the passage of solids and liquids through the gastroesophageal junction (GEJ). The traditional treatment options include surgical myotomy and endoscopic methods that disrupt or weaken the LES, such as endoscopic balloon dilation and botulinum toxin injection (BI). Per-Oral Endoscopic Myotomy (POEM) represents a Natural Orifice Translumenal Endoscopic Surgery (NOTES ) approach to Heller myotomy. Preliminary data suggest that this minimally invasive endoscopic procedure may achieve clinical results similar to those of surgical myotomy. As part of the annual Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR ) meeting held in Chicago in July 2012, a conference was organized to collaboratively review POEM and develop a consensus document on the current status of POEM. An International POEM Survey (IPOEMS) was designed and conducted by the session moderators as part of this NOSCAR initiative to attempt to supplement the scant published literature with current data from POEM early adopters. The survey, which has now been published in This article is being published simultaneously in both Gastrointestinal Endoscopy and Surgical Endoscopy.

A comparative study of low dose Bupivacaine vs high dose Bupivacaine along with Fentanyl and Phenylephrine on Pregnant women undergoing elective Caesarean Section under Spinal Anesthesia

Background: This randomized study was conducted to evaluate the effect of low dose vs high dose Bupivacaine+Fentanyl, with or without Phenylephrine infusion on hemodynamics, motor recovery, adequacy of block and side effects, on pregnant women undergoing caesarean section under spinal anaesthesia. Methods: One hundred sixty pregnant women were randomized into four groups of fourty each. Group-A (n=40) received 10 mg(2ml) of Bupivacaine + Fentanyl 25µg(0.5ml) along with Phenylephrine i.v. infusion of 0.25µg/Kg/min. Group-B (n=40) recieved same drugs, without Phenylephrine infusion. Group-C (n=40) received 7 mg(1.4ml) of Bupivacaine+Fentanyl 25µg(0.5ml) along with Phenylephrine i.v. infusion of 0.25µg/Kg/min. Group-D (n=4) received same drugs , without Phenylephrine infusion. Result: When given with fentanyl, low dose bupivacaine (1.4 ml / 7 mg) was as effective as of high dose buypivacaine (2ml/ 10mg) in producing adequate relaxation and analgesia. Addition of low dose phenylephrine infusion decreased the incidence of hypotension maintains the pulse rate nearer to baseline for better hemodynamic stability. The motor recovery was quick in case of low dose bupivacaine groups with or without phenylephrine which aids in early mobilization of pregnant women. Conclusion: When given along with an opioid like fentanyl, low dose bupivacaine (1.4 ml / 7 mg) was as effective as of high dose buypivacaine (2ml/ 10mg) in producing adequate relaxation and analgesia. Addition of low dose phenylephrine infusion decreased the incidence of hypotension and maintained better hemodynamic stability

Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm.

Comparative evaluation of fentanyl and midazolam with propofol induction on laryngeal mask airway insertion conditions: A study

Background: Propofol alone for laryngeal mask airway (LMA) insertion is unsatisfactory. To overcome the problems associated with it, a number of co-induction drugs have been introduced. The present study was conducted to compare the insertion conditions using midazolam and fentanyl co administered with propofol during intravenous induction of anesthesia. Materials and Methods: This prospective, double-blinded, randomized study was conducted at a tertiary healthcare teaching hospital at Imphal. Ninety American Society of Anesthesiologists (ASA) I and II patients aged 18-60 years were randomly divided into three equal groups and received intravenous (IV) fentanyl 2 μg/kg (Group I), IV midazolam 0.05 mg/kg (Group II), and control (saline) group (Group III) followed by induction with propofol 2.5 mg/kg. LMA was inserted after 90 s. The insertion conditions and hemodynamic changes were noted. Data were collected and analyzed with Statistical Package for Social Sciences (SPSS) v.20. Results: There were no statistical differences in the demographic profile (P > 0.05). Adequate jaw relaxation was present in 21 (70%) patients in Group II and 14 (46.6%) patients in Group I (P > 0.05). Excellent insertion conditions were present in 80% of the patients in both fentanyl and midazolam groups, respectively. Conclusion: Midazolam and fentanyl provides adequate conditions for LMA insertion, although midazolam provides better jaw relaxation.

Volume fraction dependent magnetic behaviour of ferrofluids for rotating seal applications

Ferrofluid samples consisting of magnetite nanoparticles (NPs) coated with oleic acid and dispersed in a non-polar organic solvent have been synthesized by chemical routes. Different volume fractions, φ, of magnetic NPs were considered. The overall structural characterization of NPs has been performed by x-ray diffractometry, with lattice parameters and average coherence lengths evaluated via Rietveld refinements. The magnetic properties of different samples have been analysed by SQUID magnetometry and temperature-dependent Mössbauer spectroscopy and finally explained by adequate magnetic relaxation mechanisms. Zero field cooling–field cooling protocols provided useful information about specific volume fraction dependent magnetic relaxation and de-freezing processes, the lack of the Verwey transition and stronger dipolar interactions at higher volume fractions. Anisotropy energies as obtained by both temperature dependent Mössbauer spectroscopy and magnetometry data are compared and a new procedure for a quantitative characterization of the dipolar interactions is proposed.

Spontaneous electromyographic activity of the tongue in amyotrophic lateral sclerosis

Detection of denervation in muscles in the craniobulbar area is important to assure widespread lower motor neuron involvement in the diagnosis of amyotrophic lateral sclerosis (ALS). The value of spontaneous activity analysis in needle electromyography (EMG) of the tongue has been questioned in the recent literature. Spontaneous activity in the tongue and sternocleidomastoid (SCM) muscles was reviewed retrospectively in 17 ALS patients. Needle EMG showed spontaneous activity in the tongue in 14 of 17 patients (82%) and in 6 patients of 17 (35%) in SCM. Spontaneous EMG activity in the tongue was found in patients with and without bulbar symptoms. Needle EMG is a valuable method for assessing clinical and subclinical involvement of the tongue in patients with bulbar and limb onset ALS. Adequate relaxation of the tongue is a prerequisite for proper spontaneous activity recording.

Competing Misfit Relaxation Mechanisms in Epitaxial Correlated Oxides

Strain engineering of functional properties in epitaxial thin films of strongly correlated oxides exhibiting octahedral-framework structures is hindered by the lack of adequate misfit relaxation models. Here we present unreported experimental evidence of a four-stage hierarchical development of octahedral-framework perturbations resulting from a progressive imbalance between electronic, elastic, and octahedral tilting energies in La(0.7)Sr(0.3)MnO(3) epitaxial thin films grown on SrTiO(3) substrates. Electronic softening of the Mn-O bonds near the substrate leads to the formation of an interfacial layer clamped to the substrate with strongly degraded magnetotransport properties, i.e., the so-called dead layer, while rigid octahedral tilts become relevant at advanced growth stages without significant effects on charge transport and magnetic ordering.

Magnetic properties of iron–carbon nanocomposites obtained by laser pyrolysis in specific configurations

New nanometric systems were produced by using specific parameters of the laser pyrolysis process. Relevant results related to the magnetic behavior of the samples were obtained via SQUID magnetometry and Mössbauer spectroscopy, the data being corroborated with those previously obtained from X-ray diffraction, transmission electron microscopy and energy dispersive X-ray spectroscopy. The formed nanocomposites contain iron carbides, iron oxides and metallic iron nanoparticles which relative content and average size depend strongly on experimental specific parameters of the pyrolysis process. The magnetic properties and the local interaction mechanisms were explained by adequate magnetic relaxation and static models.

JDSA Journal Abstracts

JDSA Journal Abstracts

A Randomised Crossover Study Comparing The Disposable Laryngeal Mask Airway Supreme With The Laryngeal Mask Airway Proseal In Unparalysed Anaesthetised Patients

Study Objective: To compare performance of the LMA Supreme and LMA ProSeal in unparalysed adult patients.Design: A randomised crossover study, using a non-inferiority study design aiming to demonstrate that first time insertion success rate with the LMA Supreme is no more than 15% lower than with the LMA ProSeal.Setting: Operating theatre.Patients: 50 ASA 1 or 2 adult patients undergoing general anaesthesia for elective surgery, without neuromuscular blocking agents. Interventions: After a standardised induction of anaesthesia and adequate jaw relaxation, the initial airway was inserted, in a randomized order. Adequate placement was confirmed by a square wave form on the capnograph. A maximum of two attempts was allowed. Measurements were taken before the device was removed and replaced by the second and the measurements repeated. Measurements: Number of insertion attempts with each device was recorded. Insertion time (from picking up the device until one complete capnograph square wave seen), oropharyngeal leak pressure, fibreoptic laryngeal view and ease of insertion and removal were recorded. Blood pressure, heart rate and oxygen saturations were recorded before and after insertion of each device.Main Results: First time insertion success rates were 88% (44/50) and 94% (47/50) (95% CI -19 to 7%) for the LMA Supreme and LMA ProSeal respectively. The lower limit of the 95% CI (-19%) lies outside the -15% limit of non-inferiority. Overall success was 96% (48/50) and 98% (49/50), (95% CI -12% to 7%), mean leak pressures were 22cmH2O and 26cmH2O (p=0.005) and insertion times were 23 and 26 seconds (p=0.198) for the LMA Supreme and LMA ProSeal respectively. There was no significant difference in the fibreoptic view obtained (p=0.086).Conclusions: We failed to demonstrate that the LMA Supreme is non-inferior to the LMA ProSeal in terms of its first time insertion success rate in unparalysed patients, and must conclude our results to be equivocal. This work was supported by Intavent Orthofix Ltd who donated all Laryngeal Mask Airways, free of charge.

Double opposing rectangular advancement flap is an alternative technique in the treatment of wide linear postburn scar contractures

Background Double opposing rectangular advancement is a new and alternative technique in the treatment of postburn scar contractures. The technique consists of opposing two adjacent subcutaneously pedicled rectangular flaps by advancement and lengthening a contracture band. Experimental studies demonstrated that the technique is efficient to elongate a tension line as much as Z-plasty in the rat inguinal skin. In this clinical study we investigated the efficiency and versatility of the technique in the treatment of wide linear postburn scar contractures in various parts of the body. Materials and method We applied 16 double opposing rectangular advancement in 7 patients (aged 4–56). Flaps were applied in the upper extremity (11 flaps), lower extremity (4 flaps) and trunk (1 flap). Results Average follow-up was 1-year. All flaps achieved adequate relaxation postoperatively and healed uneventfully. Postoperative measurements indicated that the lengthening provided with the technique ranged from 72 to 100%. The subcutaneous pedicle of the rectangular flaps provided a distinct advantage in terms of vascularity. Recontracture was seen in one patient to whom two double opposing rectangular flaps in series were applied in the axilla. Conclusion Clinical results indicated that double opposing rectangular advancement is effective in the treatment of wide linear postburn scar contractures. Preoperative planning and application of flaps are simple. One knows preoperatively the exact elongation along the contracture line and narrowing perpendicular to this line which will be provided with the technique. Since the flaps are subcutaneously pedicled, the vascularity of the flaps are reliable. However the technique may not avoid recontracture in the axilla.