Scar Contracture Research Articles

Cleft Lip Scar Appearance is Associated With Speech Outcomes After Primary Palatoplasty.

This study aims to investigate the correlation between the quality of cleft lip scar and velopharyngeal insufficiency (VPI). Clinical photographs from 56 patients with repaired cleft lip and palate (CLP) were collected and anonymized by cropping the image to the region of interest around the lip and nose. A survey displaying each cleft lip scar image with five associated scar quality features, including scar color, thickness, width, lip shortening, and overall appearance, was distributed. Surveys were distributed using Amazon Mechanical Turk (MTurk), an online crowdsourcing platform, to obtain ratings from 330 laypeople. The same surveys were also distributed to 45 medical students. Hypernasality was used as the primary speech outcome measure. Ordinal logistic regression was used to compare the ratings for each of the five scar quality categories with the patients' CAPS-A-AM hypernasality rating for both MTurk and medical student raters. Significance was set at α = 0.05. For medical student ratings', ordinal logistic regression showed a statistically significant relationship between lip shortening (P=0.019) and overall appearance (P=0.044) with CAPS-A-AM hypernasality score, whereas the other scar categories showed no significant association. There was no statistically significant relationship between MTurk ratings and hypernasality for any of the scar categories. The association found between lip shortening and overall scar appearance, thought by the authors to indicate scar contracture, and hypernasality, an indicator of VPI severity, provides an interesting insight into how to potentially identify patients who may be at increased risk for developing VPI.

Scar revision for persistent pain and activity limitation after exploratory laparotomy in infancy: A case series

AbstractExploratory laparotomy in neonates is typically performed via a transverse laparotomy incision. However, this incision may be complicated by poor cosmesis and scar contracture. In three patients, primary gastroenterologists identified significant scar contractures that resulted in pain and limitations with physical activity, necessitating surgical referrals. All patients required subsequent surgical revision of their scar, which involved creation of skin flaps, repair of abdominal wall hernias if present, and reapproximation of the subcutaneous tissue. We describe this phenomenon and the resultant need for surgical management to raise awareness of these late complications and suggest subcutaneous tissue reapproximation should be performed when possible during abdominal wall closure.

Efficacy of Hydrogen Sulfide Baths in Complex Burn Rehabilitation: a Single-Center Observational Study

INTRODUCTION. The healing of burn wounds often leads to pathological scars and scar contractures, significantly deteriorating the quality of life for patients who have experienced burn trauma. In comprehensive anti-scar therapy, balneotherapy with sulfide (hydrogen sulfide) waters can be applied alongside primary methods. However, due to a lack of modern information on its effectiveness, this method is not frequently included in rehabilitation programs. AIM. To determine the significance of hydrogen sulfide baths in comprehensive rehabilitation and improve treatment outcomes for patients with hypertrophic post-burn scars. MATERIALS AND METHODS. In the years 2021–2022, 110 patients, including adults and children, participated in an observational study at the Matsesta Balneological Resort (Sochi, Russia) titled “Evaluation of the Effectiveness of Balneotherapy for Post-Burn Scars in Adults and Children”. All patients received a course of 10 hydrogen sulfide irrigations or baths at the Matsesta Balneological Resort. Before the start of the procedure and after completion, scar tissue assessment using the Vancouver Scar Scale and patient surveys were conducted by a physiotherapist. RESULTS AND DISCUSSION. Among the patients, there were 40 adults and 60 children. The age of patients ranged from 2 to 61 years, with an average of 19.8 years; 49 were male, and 51 were female. The burn area in patients ranged from 5 to 90 % (average 33.1 %) of the body surface. After the first course of sulfide irrigations, the scar tissue assessment on the Vancouver Scar Scale decreased by 2.1 points in children and 2.2 points in adults. After a repeat course of sulfide irrigations, scar tissue assessment decreased by 1.3 points in children and 1.8 points in adults. According to surveys based on the Dermatology Life Quality Index, before treatment, patients subjectively rated their condition on average at 3.45 points, and after treatment, at an average of 2.76 points. The decrease in scores was mainly due to the reduction or disappearance of symptoms such as dryness, burning, pain, and paresthesia in the scar. CONCLUSION. Balneotherapy with sulfide waters for patients with hypertrophic post-burn scars within the first 24 months after burn trauma is effective for both children and adults.

Revision Surgery Following Primary Reconstruction for Hand Syndactyly

Web creep and scar contracture are established complications of syndactyly reconstruction; however, few reports characterize risk factors for revision surgery. The purpose of this investigation was to examine the rate and risk factors of reoperation for congenital hand syndactyly. Patients undergoing syndactyly reconstruction from 2007 to 2021 at a single children's hospital were reviewed. Cases with less than 1 year of follow-up were excluded. Demographic, surgical, and outcomes data were recorded by each web space to account for mixed treatments. In total, 514 web spaces in 231 children were reviewed with a mean follow-up of 6.0 years after primary reconstruction; 66 (12.8%) web spaces in 51 (22.1%) children underwent revision. The most common procedures were web space deepening due to web creep (57.9% of cases) and digital scar contracture release (45.6%); these were augmented in a minority (17.5%) of cases by other aesthetic/functional procedures. Revisions occurred at a median of 1.7 years after primary reconstruction. First web spaces (thumb-index finger) were most frequently reoperated (33.3%). On multivariable analysis, first web space involvement, complete syndactyly, and complications after the primary reconstruction significantly increased odds of revision. Age at primary reconstruction was not a significant predictor. Following revision, 10.5% of cases had recurrent web creep, and 14.0% had recurrent scar contracture. Eight (1.6%) web spaces in seven (3.0%) children required multiple revisions. Approximately 13% of syndactyly reconstructions (22% of patients) require reoperation. Most revisions occur within 4 years of primary reconstruction. Complete syndactyly, complications after the primary reconstruction, and first web space involvement increase the risk of revision; age at primary reconstruction is not a risk factor. Revision outcomes mirror the index procedure, with 10% to 14% of revised web spaces experiencing recurrent web creep or contracture. Therapeutic IV.

A case-control study evaluating single and dual layer dermal matrix in treating scar contractures using the Vancouver and POSAS scar scales, and correlations with retraction and function in treating scar contractures

A case-control study evaluating single and dual layer dermal matrix in treating scar contractures using the Vancouver and POSAS scar scales, and correlations with retraction and function in treating scar contractures

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: a two years retrospective analysis

Treatment of burn injuries has developed over the past few years with the development of enzymatic debridement and new types of skin replacement materials beyond primary surgical therapy providing complex personalized therapy concepts with the goal of preserving and replacing the dermal layer of the skin.The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and to evaluate the outcome of an individualized combined treatment of mixed depth burn wounds with an enzymatic debridement and decellularized fish skin.A total of 18 Patient treated could be analyzed with a mean age of 34.8 years and a mean follow-up of 447,6 days. The mean total burn surface area was 12.3%. All patients received an enzymatic debridement and an average area of ​​247.2 square centimeters decellularized fish skin. Days until complete epithelization was 49,4 ± 25,79. No Patient developed a scar contracture or a keloid. The POSAS Observer Scale showed an overall impression average of 2,2 ± 0,83. The POSAS patient scale showed an overall impression average 2 ± 0,7. The Vancouver Scar Scale showed an average score of 1,89 ± 1,45. In conclusion, a combined treatment of enzymatic debridement and decellularized fish skin, polylactide membrane or split skin grafts allows a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result regarding the overall outcome of the developed scar tissue and could lead to a reduction of the area needed to be autologous transplanted.

A comparative study of the healing effects of sesame oil and TiO2 nanoparticles gel on second-degree burn

Burns, a severe form of soft tissue injury, can cause significant damage and, in extreme cases, be fatal. They also lead to considerable mental and emotional distress due to excessive scarring and skin contractures. Despite various treatment methods, burn care remains a challenging medical issue. In this study, titanium dioxide (TiO2) nanoparticles were synthesized and characterized using Field Emission Scanning Electron Microscopy (FE-SEM), revealing particle sizes ranging from 31.52 to 69.08 nanometers. The impact of biosynthetic nanomaterials and sesame seed oil on burn healing in laboratory rats was investigated. The study compared the effects of a 1% TiO2 solution and 20% sesame oil on burned skin with a control group of rats having natural skin. Fifteen rats were divided into three groups, each receiving daily treatment for 28 days. The results indicated that the TiO2 treatment significantly accelerated healing compared to the sesame seed oil group, which had a slower healing rate of 0.12 points per day. The TiO2 treatment demonstrated a marked improvement in healing speed and effectiveness.

Guidance for Circumflex Scapular Artery Flap Utilization in Pediatric Reconstruction.

The circumflex scapular artery (CSA) flap system, consisting of scapular, parascapular, and chimeric flaps, is useful for pediatric reconstruction in many anatomical locations. The objectives of this case series are to offer insights into our decision-making process for selecting the CSA flap in particular pediatric reconstructive cases and to establish a framework for choosing a scapular or parascapular skin paddle. We also aim to emphasize important technical considerations of CSA flap utilization in pediatric patients. Pediatric reconstruction with CSA flaps performed at our institution between 2006-2022 was retrospectively reviewed. Patient demographics, indications, flap characteristics, complications, and operative data were abstracted. Functional donor site morbidity was assessed through postoperative physical examinations. Unpaired t test analyzed scapular versus parascapular flap size. Eleven CSA flaps were successfully performed in 10 patients (6 scapular and 5 parascapular flaps). Patient ages ranged from 2 to 17 years. Scapular fasciocutaneous free flaps (n = 4) were performed in patients' ages 2-5 years for hand and forearm scar contractures. Two pedicled scapular flaps were performed for a single patient for bilateral axillary hidradenitis suppurativa. The 5 parascapular flaps were performed in patients' ages 2-14 years for calcaneus and forearm avulsion wounds and reconstruction after resection of hidradenitis suppurativa, nevus sebaceous, and Ewing sarcoma. In the sarcoma resection case, a chimeric flap with latissimus dorsi was employed. Average flap size was 101.6 ± 87.3 cm2 (range: 18-300 cm2). Parascapular flaps were significantly larger than scapular flaps (156.60 ± 105.84 cm2 vs 55.83 ± 26.97 cm2, P = 0.0495). Overall, 3 complications occurred (27.3% of cases) including venous congestion (n = 2) and wound dehiscence (n = 1). There were no reported cases of compromised shoulder function at 1.9 ± 2.5-year follow-up. The successful reconstruction rate for scapular, parascapular, and chimeric flaps was 100%. The CSA flap treated a wide variety of indications demonstrating the flap's attributes: large vessel caliber, wide arc of rotation, reliable vascular anatomy, minimal donor site morbidity, and ability to incorporate bone and muscle. Our cases also highlight important pediatric considerations such as vascular mismatch and limited scapular bone stock. We recommend selection of the parascapular over the scapular flap with reconstruction of larger, complex defects given its ability to be harvested with a large skin paddle.

The Dermatologist's Role in Rehabilitation: A Novel Multidisciplinary Treatment Approach Combining Ablative Fractional Laser Resurfacing and Physical Therapy in Managing a Patient with Scar Contracture of the Neck

Objective: To employ a multidisciplinary approach combining ablative fractional laser resurfacing concurrently with physical therapy to improve functional and cosmetic deficits associated with traumatic scarring status-post parotid cancer treatment. Methods: A 65-year-old female presented to dermatology with scar contracture of the right neck secondary to multiple surgeries and 36 rounds of adjuvant radiation therapy for stage III adenoid cystic carcinoma of the parotid gland. Severe scar-related complications included impaired physical strength, limited range of motion of the neck, and activity intolerance. The patient also reported difficulty with swallowing and limited ability to open her mouth, resulting in a 30-pound weight loss. Ablative fractional laser resurfacing treatments and laser-assisted delivery of triamcinolone in combination and in parallel with physical therapy sessions were initiated. Results: By month five of combination treatment, the patient had objectively decreased scar fibrosis and swelling, decreased facial swelling composite scores, increased range of motion of the neck, and increased right shoulder strength. Subjectively, the patient expressed increased satisfaction in scar appearance, decreased pain, and increased tolerance to activities such as lifting and reaching. Conclusion: Ablative fractional laser resurfacing is a promising adjunct to established interventions for improving functional and cosmetic deficits and quality of life in patients with scar contractures due to its safety profile and efficacy.

Airway management for patients with tracheal stenosis and severe scar contracture of the face and neck via bronchoscopy: a case report

Both anaesthesiologists and surgeons experience challenges in managing airway stenosis and scar contracture in the face and neck. Herein, we report the case of a 38-year-old woman (BMI 23.1 kg/m2, third-degree burns covering 40% of her body, an American Society of Anaesthesiologists physical status III) with an unusual case of airway constriction. This patient had a predictable difficult airway (mouth opening of 2 cm, bilateral nostril scar hyperplasia, Mallampatti score III, scarring of the head and neck, and severe tracheal stenosis). Tracheal stenosis measuring 5.5 mm in width as observed 8 cm below the glottis, and the bronchoscope could not pass through it. After two failed attempts at laryngeal mask insertion, we decided to instead insert a custom-made tracheal tube under the guidance of a fiberoptic bronchoscope. The operation was successful, and the patient was transferred to the intensive care unit (ICU).

Comparative analysis of length gain provided by five-flap z-plasty and double z-plasty techniques for correction of digital flexion contractures

Introduction: Persistent postburn flexion contractions of the digits present challenging deformities. The surgical goal is to lengthen the linear scar band on the flexion surface of a finger through local tissue rearrangement using different z-plasty techniques. This study aimed to analyse the length gain and compare outcomes between 5-flap z-plasty and double serial z-plasty techniques for correcting digital flexion contracture.Patients & method: This retrospective study was conducted from November 2022 to January 2024 on patients who presented with digital flexion contractures caused by volar linear scar contracture and who needed surgical intervention. All patients who underwent correction via the 5-flap z-plasty or double z-plasty technique were categorized into two groups.Results: A total of 12 patients were included in this study. All patients successfully achieved complete release of their digital contracture in both groups. While there was a significant increase in the length of the contracture band and extensor lag angle postoperatively in both groups, the mean increase in band length for patients treated with five-flap Z-plasty was significantly greater than that for patients treated with double z-plasty (63.667 ± 13.125% vs. 41.333 ± 12.1764%, respectively).Conclusion: The 5-flap Z-plasty technique could be a more favourable alternative to the frequently used double z-plasty method due to its ability to achieve a superior rate of elongation in the contracture band and restore finger function when treating linear digital flexion contractures.

Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome

IntroductionWhile there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla. MethodsA retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint. ResultsAll patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively. ConclusionThe square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

Frostbite injuries related to recreational nitrous oxide use: incidence, management, and complications in a Swedish case series

Background: Nitrous Oxide (N2O) use in the recreational setting has been increasing in Sweden and Europe and therefore also related injuries. We aimed to investigate incidence, management, and surgical outcomes of frostbite injury (FI) related to N2O use. Material and MethodAll patients in a 22-month period, 2021-2022 presenting with FI related to N2O abuse from two plastic surgery clinics (one national burn centre) were identified. Data regarding patient comorbidity, mechanism of injury, initial management, treatment, and follow up were investigated. Complications following surgery were categorized into minor (treated in outpatient setting), and major (requiring reoperation). Results: In total 9 patients were identified, and 5 patients gave consent and were included. Direct contact with gas canister was the most common injury mechanism (n=4). All but one patient contracted full thickness injuries, and these four patients later required surgical intervention. The medial thigh was the most common area of injury. Outpatient clinic visits were common (mean 4.8 visits/patient). Surgical complications were common, and all operated patients were diagnosed with a minor complication and half of them also with a major complication (wound dehiscence and scar contracture). Conclusion: Frostbite injuries arising from recreational N2O are complex and often requiring surgical intervention and leading to complications. With the increasing incidence of N2O abuse in Sweden, further research is crucial to address emerging public health concerns and optimize treatment strategies for these distinctive injuries.

Approaches to scarless burn wound healing: application of 3D printed skin substitutes with dual properties of anti-infection and balancing wound hydration levels

Severe burn wounds face two primary challenges: dysregulated cellular impairment functions following infection and an unbalanced wound hydration microenvironment leading to excessive inflammation and collagen deposition. These results in hypertrophic scar contraction, causing significant deformity and disability in survivors. A three-dimensional (3D) printed double-layer hydrogel (DLH) was designed and fabricated to address the problem of scar formation after burn injury. DLH was developed using methacrylated silk fibroin (SFMA) and gelatin methacryloyl (GelMA) for the upper layer, and GelMA and hyaluronic acid methacryloyl (HAMA) for the lower layer. To combat infection, copper-epigallocatechin gallate (Cu-EGCG) was incorporated into the lower layer bioink, collectively referred to as DLS. To balance wound hydration levels, HaCaT cells were additionally encapsulated in the upper layer, designed as DLS/c. DLH demonstrated suitable porosity, appropriate mechanical properties, and excellent biocompatibility. DLS exhibited potent antimicrobial properties, exerted anti-inflammatory effects by regulating macrophage polarisation, and may enhance angiogenesis through the HIF-1α/VEGF pathway. In the DLS/c group, animal studies showed significant improvements in epidermal formation, barrier function, and epidermal hydration, accompanied by reduced inflammation. In addition, Masson's trichrome and Sirius red staining revealed that the structure and ratio of dermal collagen in DLS/c resembled that of normal skin, indicating considerable potential for scarless wound healing. This biomimetic matrix shows promise in addressing the challenges of burn wounds and aiming for scarless repair, with benefits such as anti-infection, epidermal hydration, biological induction, and optimised topological properties. Shown in Acknowledgements.

Stomal Stenosis After Continent Urinary Diversion in Bladder Exstrophy: Risk Factors and Management

OBJECTIVETo identify risk factors for stenosis and compare management strategies for stenosis etiology and to examine the efficacy of each approach. Patients with classic bladder exstrophy (CBE), a rare genitourinary malformation, may require construction of a continent urinary stoma (CUS) if incontinence persists. Stomal stenosis is a challenging complication as it is common, progressive and recurrent. METHODSCBE patients who underwent CUS were retrospectively reviewed for risk factors for stenosis including stoma type, prior midline laparotomy number, and umbilicoplasty suture material. Stenosis etiology and management strategies were further reviewed. RESULTSA total of 260 CBE patients underwent CUS creation. Stenosis developed in 65 patients (25.0%) at a median interval of 1.9 years. Etiology included scar contracture (n=41), keloid (n=17), and hypertrophic scar (n=7). Multifilament suture was the only variable associated with an increased risk of stenosis compared to monofilament suture (p=0.009). Almost all patients required surgical intervention. Most scar contractures underwent stomal incision with success in 100%. Hypertrophic scars and keloids responded best to excision with local tissue rearrangement (66.7%). At last follow-up, all patients achieved success. CONCLUSIONStomal stenosis is common and challenging for the reconstructive surgeon. Strategies to prevent and effectively manage this are greatly desired. Use of multifilament suture for the umbilicoplasty increased stenosis perhaps from a greater inflammatory response and scarring, while monofilament suture may reduce its incidence. Stomal incision for treating scar contractures, and excision with local tissue rearrangement for hypertrophic scars and keloids may improve successful primary surgical intervention.

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction-A Systematic Review.

When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.

The effectiveness of botulinum toxin injection for reducing hypertrophic scar after cleft lip surgery

Introduction: The most frequent complication after cleft lip surgery is HTS. This condition leads to lip asymmetry as the scar contracts, leading to a shortened lip and nasal deformity on the affected side, impaired speech development, and psychological stress. Botulinum toxin injection is known as HTS treatment. Therefore, this systematic review aims to postoperatively establish the physical outcome of cleft lip scar in patients injected with botulinum toxin. Method : The systematic review was conducted based on the PRISMA guidelines and PICO criteria. The experimental group was patients given botulinum toxin injections, and the control group was a placebo group. The results were based on the physical effects. This study was assessed with Cochrane risk-of-bias assessment tools. Five studies met the criteria. Results: Physical outcomes were significantly improved using the Vancouver Scar Scale criteria, while two studies explained no significant difference in the scar scale. The consistent results were from the scar width measurement. The experimental group's scar was narrower than that of the control group. Two studies added a visual analog scale with better results in the experimental groups. Compared with standard saline injection, botulinum toxin injection has a better outcome. This result was aligned with the results found in several previous studies. Conclusions: Botulinum toxin can promote wound healing pre or postoperatively and has narrower effects than in control groups. This study showed that overall physical outcome improved in botulinum injection for the cleft lip’s surgical scars. However, there is still a need for broader-scale studies on this topic for more reliable results.

An Innovative Approach to Classifying and Treating Axillary Scar Contracture.

Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is imperative. In light of Ogawa's prior classification of axillary cicatricial contracture deformities, we have proposed a novel classification system and reconstruction principles based on a decade of treatment experience. Our proposed system offers a more comprehensive approach to correcting axillary cicatricial contracture deformities and aims to improve patient outcomes. Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II). For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees. We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.

Staged Periorbital Reconstruction for Cicatricial Lagophthalmos

Introduction: Eyelid trauma can present reconstructive challenges for facial surgeons. The authors postulated that treating cicatricial lagophthalmos with protective ptosis in the acute setting prior to definitive grafting could help limit scar contraction. Material and Methods: This is an observation of a patient who benefited from a staged approach to periorbital reconstruction after suffering extensive facial trauma. Informed consent was appropriately obtained from the patient. Results: After treating the periorbital injury in staged fashion, an aesthetically acceptable result was achieved and was well-tolerated by the patient. Discussion: Disruption of the periorbital region, particularly the eyelids, can have severe functional and aesthetic consequences. One such disruption is lagophthalmos. Neurotoxin-induced protective ptosis is a well-known strategy that can be used as the initial treatment in a staged approach to cicatricial lagophthalmos. Conclusion: Treating lagophthalmos with protective ptosis in the acute setting prior to definitive grafting is not only a means of avoiding tarsorrhaphy but also it can allow time for the wound to declare itself and limit scar contraction. In addition, the contralateral eyelid represents both a complimentary skin graft harvest site as well as an opportunity to create a symmetrical repair.

Graftless Syndactyly Release.

Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of "graftless" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear. In addition, the inevitable scarring from extra recruitment of local adjacent skin is perhaps underemphasized. In this article, we revisit the trilobed flap technique which serves to balance the amount of skin needed for resurfacing digits while minimizing local donor site scarring. The geometry and nuances of the flap inset are illustrated in detail to guide those embarking on this technique. The trilobed syndactyly release technique is a reproducible, safe, and reliable method for the release of simple syndactyly.