Burn Sequelae Research Articles

Satisfaction With Appearance Scale—SWAP: Adaptation and validation for Brazilian burn victims

AimMethodological study that aimed to adapt the Satisfaction with Appearance Scale (SWAP) into Brazilian Portuguese language and to assess the validity, the reliability and the dimensionality of the adapted version in a sample of Brazilian burn victims. MethodsWe carried out the adaptation process according to the international literature. Construct validity was assessed by correlating the adapted version of SWAP scores with depression (Beck Depression Index), self-esteem (Rosenberg Self-Esteem Scale), health-related quality of Life (Short Form Health Survey-36) and health status of burn victims (Burn Specific Health Scale–Revised), and with gender, total body surface area burned, and visibility of the scars. We tested dimensionality using Exploratory Factor Analysis (EFA) and the reliability by means of Cronbach's alpha. ResultsParticipants were 106 adult burned patients. The correlations between the Brazilian version of the SWAP scores and the correlated construct measures varied from moderate to strong (r=.30–.77). The participants who perceived their burn sequelae was visible reported being more dissatisfied with their body image than the participants who answered that their scars would not be visible (p<.001). Cronbach's alpha for the adapted version was 0.88 and the item-total correlation varied from moderate to strong (r=.35–.73). The EFA resulted in three factors with a total explained variance percentage of 63.2%. ConclusionThe Brazilian version of the SWAP was valid and reliable for use with Brazilian burn victims.

L’expansion cutanée chez l’enfant : indications et gestion des complications. Notre expérience sur 10 ans

Tissue expansion is a plastic surgery technique which enables optimal quality and skin surface reconstruction in case of soft tissue defect. Despite the good results obtained, both from a functional and aesthetic point of view, there is a high rate of complications whose management seems to be essential to ensure satisfactory results. We retrospectively reviewed the medical files of 45children treated in our department between 2002and 2012: 73expanders were placed during 51protocols. The studied protocols gathered a large variety of situations. Varied pathologies were treated: burn sequelae (39%), giant congenital naevus (GCN) (27%), scars (20%), hamartoms (8%), cutis aplasia (6%), as well as diverse sites: scalp (45%), trunk (35%), head and neck (8%), lower extremity (8%), upper extremity (4%). Complications occurred in 17protocols representing 26% of total expanders. GCN is a pathology with a significantly lower complication rate (P=0.013) whereas trunk is an anatomical location with a significantly higher complication rate (P=0.026). Overall, 84% of reconstructions were evaluated as having a good result. This rate reached 76% for complicated protocols. Tissue expansion in paediatric patients remains an efficient therapy in order to achieve a satisfactory reconstruction. Despite a high complication rate, good results can be obtained even in those complicated cases as long as they are well managed and anticipated. We also think that specific paediatric material would help to reduce supervention of some complications.

Tissue expansion for the repair of operative defects of the face in children

Burn sequelae, posttraumatic lesions and congenital giant nevi can occur on the face of children. Parents are distressed by these events, and there is a pressing demand to remove the disfiguring lesion. Tissue expansions has contributed significantly to the repair these wounds, but are we able to apply this method in the early age and how do we ensure success?

Use with Tissue Expander Face, Scalp and Neck Reconstruction

The tissue expander has found widespread use in reconstructive surgery. The donor area is needed, the recipient site with similar characteristics (color, thickness, hair follicle) features, minimal scarring and leads to donor site morbidity. In our study, presented face, scalp and neck reconstruction results obtained with the use of expander. The face, scalp and neck areas expander was used to evaluate patients in the Plastic, Reconstructive and Aesthetic Surgery Department of Yuzuncu Yil University. Age, gender, expander indication, defect or scar area localization, expander residential area, expander shape, volume, valve location (internal-external), expansion time, major and minor complications were reviewed. 30 number expanders were used in 17 patients (8 male, 9 female patients). Expanders were used burn sequelae in 14 patients, tumor- related defects in 2 patients and due to giant hairy nevus in 1 patient. The expanders are scalp (19 cases), face (3 cases), supraclaviculer (7 cases) and the neck (1 case) has to be placed. In 4 of 17 patients (three major and one minor) complications were encountered. Use the expander is a good option especially in the reconstruction of soft tissue defects in the head and neck region.

Reconstruction of thoracic burn sequelae by scar release and flap resurfacing

IntroductionIn the USA, 450,000 thermal burns receive medical treatment annually. Burn scars are commonly excised and covered with skin grafts. Long-term, these treatments commonly leave patients with discomfort, reduced total lung capacity and forced vital capacity, and restriction of thoracic expansion and shoulder joint mobility. In this article, we present our experience with using scar release and immediate flap reconstruction to treat thoracic restriction due to burn sequelae. MethodsFrom 1998 to 2014, we enrolled 16 patients with anterior thoracic burn sequelae that had previously been treated conservatively or with skin grafts that eventually recidivated. Preoperatively, we measured thoracic circumference in expiration and inspiration, %FVC, %FEV1, and shoulder mobility. All patients underwent anterior thoracic scar release and immediate flap resurfacing. ResultsAt 2 weeks to 3 months postoperatively (mean, 2.6 months), mean thoracic circumference upon inspiration increased from 83.6cm±5.7 to 86.5cm±5.8 (p<0.0000000001). Mean %FVC improved from 76.0%±2.64% to 88.2%±4.69% (p<0.0000001). Mean %FEV1 improved from 79.2%±3.85 to 87.8%±2.98 (p<0.000001). All 14 patients who had restricted shoulder mobility preoperatively no longer had restricted shoulder mobility postoperatively. The mean patient-reported satisfaction was 4.6/5 (range, 3–5). At a mean follow up of 2.5 years, none of the contractures recidivated. Complications included 2 cases of tissue necrosis of the distal end of the flap. In one case, the flap was restored; in the other case, the patient eventually had to receive a new flap. Additional complications included two local infections that were successfully treated with oral and local antibiotics and two hematomas that were drained and eventually healed without tissue loss. ConclusionsScar releases and flaps provide a safe and effective method for the correction of restricted thoracic expansion, respiratory restriction, decreased range of shoulder motion, and discomfort from thoracic burn sequelae.

Nivel de autoconcepto en niños con secuelas de quemaduras: estudio comparativo

IntroductionSelf-concept is the set of ideas and attitudes that a person has about him/herself. ObjectiveTo evaluate whether there are differences in the level of self-concept in children 8-12 years old with and without burns sequelae. To identify predictive variables of self-concept in children with sequelae. Patients and methodA comparative cross-sectional study of self-concept in 109 children with burns sequelae, from 8 to 12 years old, with 109 children without burns sequelae, and of the same age and socioeconomic status. The Piers-Harris self-concept scale is used, which provides a general measurement of self-concept and behavioural, intellectual and school status, appearance, and physical attributes, anxiety, popularity, happiness and satisfaction dimensions. ResultsThere were no significant differences in the level of general self-concept or their dimensions (P>.05). In the group with burns sequelae, the protective factor was the variable number of sequels was associated with the dimensions of anxiety, popularity, happiness-satisfaction and general self-concept. The location variable emerged as a risk factor for the behavioural dimension. DiscussionThe absence of differences in self-concept between children with burns sequelae and children without them is similar to that reported in the literature. The finding in the risk and protective factors encourages to further research, and perhaps incorporating pre-morbidity and family background.

Cervical burns sequelae: epidemiological, clinical and therapeutic aspects in Morocco

Les séquelles de brûlures cervicales représentent une entité fréquente des séquelles de brûlure, elles affectent la fonction, l'esthétique et l’état psychologique des patients et peuvent être de traitement difficile. Il s'agit d'une étude rétrospective étalée sur 5 ans de Mars 2009 au Octobre2014, réalisée au centre national des brûlés et de chirurgie plastique au CHU Ibn Rochd Casablanca. Nous avons analysé les caractéristiques épidémiologiqueset cliniques ainsi que les indications et les résultats thérapeutiques chez 300 patients présentant des rétractions cervicales post-brûlure, suivis dans notre formation. Les jeunes femmes étaient le plus souvent touchées (56%). la brûlure thermique par flamme de butane dans le cadre d'accident domestique était l’étiologie la plus fréquente (91%).75% des patients ont été pris en charge dans un délai de 18 mois après avoir présenté une incapacité fonctionnelle. Les brides cervicales modérées et sévères sont les plus fréquentes et représentent respectivement 60% et 16% des cas. Le traitement chirurgical a fait appel aux greffes cutanées dans 67%des cas, aux plasties locales dans 24%des cas et aux lambeaux dans 24% des cas, les résultats sont jugés bons dans 75%des cas et moyens dans 18% des cas, tandis que les cas restants (7%) ont nécessité une reprise chirurgicale. Le traitement des brides cervicales doit être associé à un programme de rééducation adapté, afin d'assurer la pérennité des résultats fonctionnels et esthétiques.

Treatment of extrinsic ectropion on burned face with facial suspension technique

The extrinsic ectropion is a condition with low prevalence characterized by an ectropion with normal eyelid and anatomy unchanged and the cause is found in tissues adjacent orbits. There are not many studies in the literature regarding their treatment, especially without addressing the eyelid respecting its anatomical integrity. PurposeTo evaluate the outcome of 8 extrinsic ectropions secondary to facial burns treated with facial suspension technique. Patients and methodsFive patients were evaluated with sequelae of facial burns and extrinsic unilateral or bilateral ectropion, a total of 8 ectropions. The technique used was the endoscopic facial suspension with or without release of the facial scar retraction. We evaluated the position of the lower lid over medium-pupillary line, symptoms, complications and patient satisfaction in a 24 months follow-up. Results6 Peri-orbital regions showed good results and two moderate results, all cases had clinical improvement of the ectropion, the symptoms and the esthetic aspect; there was not any complication or reoperation. There was a gain of 2.2–26.2% of the lower eyelid margin position in relation to the horizontal mid-pupillary line. ConclusionThe endoscopic facial suspension proved to be a surgical technique with low morbidity and efficient treatment in 8 facial extrinsic ectropion.

Adipose-Derived Stromal Vascular Fraction Cells and Platelet-Rich Plasma

Actually, autologous fat grafts have many clinical applications in breast surgery, facial rejuvenation, buttock augmentation, and Romberg syndrome as well as a treatment of liposuction sequelae. The aim of this article was to describe the preparation and isolation procedures for stromal vascular fraction (SVF), the preparation of platelet-rich plasma (PRP), and the clinical application in the treatment of the scar on the face. Ten patients with burns sequelae (n = 6) and post-traumatic scars (n = 4) were treated with SVF-enhanced autologous fat grafts obtained by the Celution System. Another 10 patients with burns sequelae (n = 5) and post-traumatic scars (n = 5) were treated with fat grafting based on the Coleman technique mixed with 0.5 mL of PRP.To assess the effects of their treatment, the authors compared their results with those of a control group consisting of 10 patients treated with centrifuged fat. In the patients treated with SVF-enhanced autologous fat grafts, we observed a 63% maintenance of contour restoring after 1 year compared with only 39% of the control group (n = 10) treated with centrifuged fat graft (P < 0.0001). In the patients treated with fat grafting and PRP, we observed a 69% maintenance of contour restoring after 1 year compared with that of the control group (n = 10). Autologous fat grafting is a good method for the correction of scars on the face instead of the traditional scar surgical excision.

Alkali-Related Ocular Burns

Alkali burns are known to possess high pathological potential because of their inherent ability to lyse cell membranes and penetrate intraocular structures with devastating results. The authors aimed to evaluate the most common cause of this presentation, the current treatment approaches to injury, and eventual outcome as related to severity. The authors performed a retrospective review of all patients who sustained chemical-related ocular injuries seen at the Concord Hospital Burns Unit, Australia between January 2005 and March 2012. Management was based on cooperation between ophthalmic staff and the burns unit, with emphasis on early aggressive intervention and rigorous follow-up. The records of 39 patients who presented with chemical-related injury were assessed, 12 of whom had confirmed alkali burns involving the cornea. The most commonly implicated agent was sodium hydroxide, usually in the context of otherwise trivial domestic accidents. Acute medical management included copious irrigation and the use of analgesics, cycloplegics, and topical antibiotics. In half the cases, steroid drops and oral vitamin C were also used. Ten of the 12 patients (83%) had return to premorbid visual acuity. Complications included cicatrical ectropion (n = 1), pseudoexfoliative syndrome (n = 1), and symblepharon (n = 1). Surgical correction was needed in the one patient with cicatrical ectropion. This case series shows that appropriate acute management minimizes the potentially devastating sequelae of ocular alkali burns. Emphasis should be placed on prevention of domestic and workplace injuries when using alkaline products.

Evaluation of a Facial Transplant Candidate with a Facegram

Sir: Facial transplantation has emerged as the next step on the reconstructive ladder for severe facial disfigurement, but functional recovery and return of facial sensation and motion will vary, be difficult to predict, and may take months or years.1,2 Motor recovery following composite tissue allotransplantation has been reported to be slower and often less optimal when compared with the sensory recovery outcomes.3–5 The facial appearance of the recipient improves gradually along with nerve regrowth, with changes in expression and the appearance of nasolabial folds. A kinematic preoperative evaluation may be important for further analysis of the results. A 22-year-old man with severe sequelae of thermal burns (55 percent total burn surface area), a candidate for facial transplantation, was analyzed with a novel quantitative method: facegram (Fig. 1).Fig 1: Male patient, 22 years old, with severe sequelae of thermal burns (55 percent total burn surface area).In order to reliably capture the dynamics of the smile movements, we developed specialized software capable of simultaneously tracking the position over time of a number of anatomical points (commissures, midpoints, and Cupid’s bow), using video recordings of the subject. The programing environment MATLAB (R2011a; MathWorks, Natick, Mass.) was used for computing the facegrams. The software provides a graphic user interface (GUI) to assist the user in different tasks, such as drawing a line setting the face’s vertical axis of symmetry or pointing and clicking on the colored dots marking the anatomical landmarks. The main element is the plot, in scale, of the paths followed by each anatomical landmark, as shown in Figure, Supplemental Digital Content 1,https://links.lww.com/PRS/A823. In every pathway, six points mark important times: T1, start of recording; T2, start of contraction; T3, end of contraction; T4, start of relaxation; T5, end of relaxation; and T6, end of recording; as shown in Figure, Supplemental Digital Content 2, https://links.lww.com/PRS/A824. The complete facegram includes four additional elements: the absolute horizontal (and vertical) displacements and the differential horizontal (and vertical) displacements of each landmark as a function of time. Facegram analysis in this patient revealed symmetry/balance and temporal consistency, despite the reduction in range of motion over time (Fig. 2). The hold period is not properly maintained (there is a progressive loss of extension). Vertical movement appears to be superior in relation to horizontal movement. The extension of the commissures is clearly superior to that of the midpoints or Cupid’s bow, which may be explained by cicatricial retraction of the central part of the patient’s lips.Fig 2: Facegram analysis shows symmetry/balance and temporal consistency. The hold period is not properly maintained (there is a progressive loss of extension). The extension of the commissures is clearly superior to that of the midpoints or Cupid’s bow.Muscles would regain motion through the facial nerve, and if this nerve was being dissected proximally to include all branches, regeneration would take a long time to enable muscular activity within the graft. Mobile facial expression also depends on the depth of scarring before the operation. There are then two possibilities: (1) the patient has a deformity so obvious that any degree of functional recovery after transplantation means a significant gain on facial expression, or (2) as in this patient, despite scarring caused by burns, it will be difficult to recover motor function that will achieve the same degree of muscle contraction. In this case, the facegram can provide a baseline pattern, which will be important to accompany functional recovery. PATIENT CONSENT The patient provided written consent for the use of his image. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Niño quemado gran secuelado. Perfil clínico y calidad de vida

Burns are an important cause of morbidity in children. The medical advances in acute trauma care have led to an increase in the number of children with extense area of burned skin, whose sequelaes are cause of complications along their growth. Objective. To characterize population with over 25% of sequelae burn skin at the COANIQUEM Rehabilitation Center, Santiago. Additionally to measure their quality of life and suggest interventions to improve medical attention. Methods. Quantitative, non experimental, descriptive, comparative study. Results. A sample of 59 children were identified as having post-traumatic burned on more&#x0D; than 25% of total body surface. 47% of them were men and 53% female. Most them (64%) were patients who lived outside the capital city, Santiago. 54% was burned during the ages between to 2 to 6 years old. 42% was burned with fire and 56% by scalding. Half the patients were admitted to rehabilitation before 2 month after injury. 64% has good adherence to treatment and a regular follow-up. A group of 29 KIDSCREEN-27 survey was analyzed. There were no significant differences between gender, age, residence or visibility scars. Conclusions. Epidemiology found in children with severe burn sequelae is consistent with findings from literature. Quality of life outcomes are similar to general population. The concept of pediatric major burn sequela is established for future research in this area.

Release of hand burn contracture: Comparing the ALT perforator flap with the gracilis free flap with split skin graft

BackgroundThe use of microsurgery in the management of burn sequelae is not a new idea. According to the properties of various types of free flaps different goals can be achieved or various additional procedures have to be combined. We report the comparison of two different free flaps on a single patient for reconstruction of both upper extremities for burn sequelae. Case reportA 1-year-old child sustained severe burns on both hands, arms and thorax and was initially only treated conservatively. This resulted in severe contractures. At the age of 4-years a free gracilis flap was selected for reconstruction of his left hand and a free anterolateral thigh flap for the right hand. ResultsWe noticed a better functional and esthetic result for the gracilis flap associated with a shorter operative time and a minor donor site morbidity. The intraoperative technique and time, postoperative complications, functional and esthetic results and donor site morbidities were studied in the two types of flaps chosen. A review of literature was also performed. ConclusionOur experience reported a better success of the gracilis muscle flap covered with a split skin graft compared to the anterolateral thigh flap in the reconstruction of hand function after severe burn sequelae.

5% Lidocaine Medicated Plaster Use in Children with Neuropathic Pain from Burn Sequelae

Neuropathic pain is a challenge in children with burn sequelae. Although relatively infrequent, the intensity and chronicity of neuropathic pain negatively impact functionality and quality of life. The use of 5% lidocaine medicated plaster has not previously been reported in children. We explored the effectiveness and safety of 5% lidocaine medicated plaster to treat neuropathic pain in children with burn sequelae. Three-month prospective, uncontrolled study. Corporation of Aid to Burned Children (COANIQUEM), a nonprofit pediatric burn rehabilitation center in Chile. Fourteen pediatric patients with burn sequelae neuropathic pain. Demographics, burn and pain evolution (type, intensity [using Wong-Baker FACES], and Douleur Neuropathique 4 [DN4]), and patient functionality. Plasma lidocaine levels were measured at 0, 12, 36, and 60 hours after treatment commencement. Fourteen patients were evaluable for plasma lidocaine levels. Twelve patients were available for clinical assessment (two patients lost to follow-up) [mean (standard deviation)]: age, 11 years 7 months (2 years 6 months); weight, 45 kg (11.9 kg); burn evolution, 5 years 6 months (4 years); time between burn and pain onset, 3 years 6 months (3 years 2 months); time between pain onset and treatment, 5.1 months (4.8 months); lidocaine, between < and ½ plaster; initial pain intensity (FACES), 6.8 (1.6); final pain intensity, 0 in 11/12 patients; DN4, initial-6, final-2.3. All patients reported improved functionality. Plasma lidocaine levels were ≤27.45 ng/mL (>180 times below critical levels). No adverse reactions occurred. These are the first published data suggesting that 5% lidocaine medicated plaster improves patient functionality, and is effective and safe for the treatment of neuropathic pain in pediatric patients with burn sequelae.

Microsurgical Reconstruction In Pediatric Patients: A Series Of 30 Patients

Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. Initial concerns as to the feasibility and reliability of the procedure in children were resolved over time. Thirty children (15 boys, 15 girls) were treated in Sisli Etfal Training and Research Hospital, Plastic and Reconstructive Surgery Clinic. Their mean age was 10.8 years. Defects were located on the lower extremity (n=22), head and neck (n=5) and upper extremity (n=3). The etiologies of the defects included vehicle accident, sequelae of burn, traumatic contractures, crush injury, epulis in the maxilla, and gunshot wound. The free flaps performed in our series were latissimus dorsi muscle flap, combined latissimus dorsi and serratus muscle flaps, serratus anterior muscle flap, cross latissimus dorsi muscle flap, scapular osteomyocutaneous flap, parascapular fasciocutaneous flap, fibular osteocutaneous flap, anterolateral thigh flap, medial circumflex femoral artery perforator flap, and crista iliaca osteocutaneous flap. The advantages of free flaps in children, which include better adaptation of the flap growth and better learning capacity of the children, provide the surgeon with more satisfactory functional and aesthetic results.

Classification of post-burn contracture neck

Post-burn neck contracture (PBC) is one of the most common burn sequela. These contractures affect the patient significantly causing both functional limitations and esthetic disfigurements. Hence, the reconstruction of this area is a challenge to surgeons who must choose a technique, which restores the function and also improves the esthetic appearance. Aims: The aims of this study are to provide a simple classification of PBC and offer surgical solutions for each section of our classification. Materials and Methods: This retrospective study was carried out on 140 patients with PBC neck who were classified according to the functional defect and the anatomical type of scar. Results: We offer a simple classification system for PBC neck depending on the degree of contracture into mild, moderate and severe and also according to the type of the scar into linear, band or broad type.

Uso de matriz dérmica associado ao curativo por pressão negativa na abordagem da contratura em pacientes queimados

INTRODUÇÃO: O aperfeiçoamento no tratamento inicial do paciente queimado, por meio da reposição volêmica e, principalmente, com excisão e enxertia precoce das lesões, resultou em profundo impacto na evolução dos indivíduos queimados, ocorrendo aumento da taxa de sobrevida. Com a maior sobrevida desses pacientes surgiu um novo desafio para a cirurgia reparadora, o tratamento das sequelas de queimaduras, principalmente compostas pelas contraturas. O objetivo deste estudo é demonstrar o uso da matriz dérmica artificial associado a terapia por pressão negativa no tratamento de sequelas de queimaduras. MÉTODO: Foram selecionados 10 pacientes com contratura por queimadura. Os pacientes selecionados foram submetidos a liberação da contratura cicatricial e colocação de matriz dérmica artificial (Integra®), conforme técnica padrão, e curativo por pressão negativa para cobertura. A cada 5 dias, foram realizadas trocas do curativo até completar período de 3 semanas a 4 semanas. Após esse período, o leito foi submetido a enxertia de pele. Os pacientes foram questionados, no pré e pós-operatório, quanto a sua satisfação com os aspectos estético e funcional da região abordada. RESULTADOS: Houve integração de cerca de 98% da matriz de regeneração dérmica na área em que a contratura foi ressecada. Também ocorreu integração de aproximadamente 85% dos enxertos utilizados. Todos os pacientes abordados referiram significativa melhora estética e, principalmente, funcional da região abordada. CONCLUSÕES: O uso da matriz de regeneração dérmica associado a terapia por pressão negativa promove maior taxa de sucesso na abordagem da contratura cicatricial, proporcionando melhor resultado tanto funcional como estético nos pacientes com sequelas graves de queimadura.

Rehabilitation of burn patients: An underestimated socio-economic burden

PurposePatients with burns utilise intensive medical care and rehabilitation. Deep dermal burns lead to scar contractures. Virtually no published data exists on costs for treatment of acute burns in comparison to burn sequelae. Our purpose was to collect financial data on burn therapy to estimate the socio-economic burden of thermal injuries. MethodsGerman-DRG for in-patient treatment of burns was collected from our burn center. DRG-related T95.- coding served as a search tool for burn associated sequelae. To include rehabilitation costs, data from the largest health care insurance and a workmen compensation fund were acquired. FindingsAcute burn treatment comprised 92% of costs for intensive care with approximately 4.600 EUR per percent total burned surface area (TBSA). Expenses for non-intensive care patients were significantly lower than for burn sequelae. Rehabilitation expenses were 4.4-fold higher than costs for acute burns including 59% for manual therapy and 37% for auxiliary material. ConclusionsTBSA multiplied by factor 4600 could serve for cost calculation of severely burned patients. Approximately 0.3 billion EUR in total or 270.000 EUR per patient/year were spent on burn sequelae. Early admission to specialized burn centers is advocated with state-of-the-art treatment to minimize burn sequelae and health care expenses.

USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH PATHOLOGY OF THE SHOULDER JOINT

Objective: 9 patients with sequela of serious injuries and burns of the shoulder joint region operated in Vreden’s Scientific Research Institute of traumatology and orthopaedics (Saint-Petersburg, Russia) within the period from 2000 to 2011. Methods: 12 microsurgical operations having used 12 flaps were performed. In 10 cases it was pedicled flap transfer, in 2 cases - free tissue transfer. Patients with defects of bones have been additionally fulfilled 4 operations of shoulder arthrodesis and 2 operations of interlocking intramedullary nailing of proximal humerus. The results of treatment were estimated according to modified UCLA end-results score. Results: for reconstruction of isolated scar deformations and defects of skin in the shoulder joint region in 6 cases we used pedicled latissimus dorsi musculocutaneous flaps, in 1 case - pedicled trapezius musculocutaneous flap, and in 1 case - free radial forearm flap. In cases of shoulder arthrodesis we used pedicled latissimus dorsi osseous musculocutaneous flap with a segment of the 8th rib and free vascularized graft of iliac bone in patients with defects of bones. In two patients with circular defects of proximal humerus we fulfilled osteoplasty of the area of contact of fragments with pedicled grafts from the lower corner of scapula. 4 patients with scar contractures of shoulder-joint had excellent results, others had good results. Conclusion: tactics of using microsurgical technologies and choice of flaps in patients with pathology of shoulder-joint region should be specified for every concrete occasion. Microsurgical operations form an important part of the system of surgical treatment and are usually fulfilled simultaneously with other orthopedic operations.

Face allotransplantation and burns: a review.

Burns may represent one of the main indications for face allotransplantation. Severely disfigured faces featuring a devastating appearance and great functional impairments are not only seen as burn sequelae but also occur as a result of other traumatic injuries, oncological surgical resections, benign tumors (eg, neurofibromatosis), and major congenital malformations. To date, 20 human face composite tissue allotransplants have been performed with success. Despite the initial scepticism about its applicability, due mainly to ethical and technical reasons, the previous worldwide cases and their associated positive outcomes, including acceptable immunosuppressive regimens, excellent aesthetic and functional results, and good psychological acceptance by the recipient, enable the conclusion that face composite tissue allotransplantation has become another therapeutic strategy in the reconstructive surgical armamentarium, which bears special consideration when dealing with severely disfigured burned patients. The aim of this review is to describe the basics of face composite tissue allotransplantation and give an overview of some of the cases performed until now, with special attention paid to debating the pros and cons of its applicability in burn patients.