Trapeze-flap Plasty Research Articles

A systematic review of procedural treatments for burn scars in children: Evaluating efficacy, safety, standard protocols, average sessions and tolerability based on clinical studies.

Managing burn scars in children presents significant challenges. This study investigates effective treatment methods for burn scars, focusing on efficacy, safety, standard protocols and tolerability. Major databases such as PubMed, Scopus and Web of Science were thoroughly searched up to August 2024, emphasizing procedural treatments for burn scars in children. Key data collected included participant demographics, sample sizes, intervention methods, follow-up protocols, treatment effectiveness and reported adverse events. A total of 256 children were assessed, with all procedural treatments yielding satisfactory outcomes. Among the various methods, trapeze-flap plasty and percutaneous collagen induction showed improvements in all patients. In the laser treatment group, which included 161 children, the Vancouver Scar Scale (VSS) score reduction ranged from 55.55% to 76.31%, with outcomes rated as good (24.61%) to excellent (60%). Laser treatment using local anaesthesia proved to be well tolerated by children. Our findings indicate that various methods-including trapeze-flap plasty, percutaneous collagen induction, phototherapy and fractional CO2 laser-demonstrate a relatively good response and an acceptable safety profile. Notably, light-based therapies/lasers may serve as safe, effective and tolerable options for scar treatment in this age group, often eliminating the need for general anaesthesia.

Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach.

One of the dramatic consequences of burns is scar contracture and deformities of the neck. Cervical contracture in children is especially dangerous, leading to face disfigurement and kyphosis; therefore, early reconstruction is indicated. Despite the existence of many various surgical techniques, the successful neck contracture treatment in pediatric patients remains a challenge for surgeons. Eleven children (aged 5 to 14 years) with postburn neck anterior contractures were studied to develop a new approach for reconstruction that would employ the use of local scar-fascial flaps. The new approach and technique for postburn pediatric contracture treatment was developed which is especially effective in the treatment of children who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration. The technique consists of two trapezoid scar-fascial flaps mobilization which includes all the anterior neck surfaces and consists of scars, fat layer, platysma, and deep cervical fascia. Counter transposition of flaps with tension elongated neck anterior surface was 100 to 200%. The contracture was fully eliminated, and neck contours, mentocervical angle, and head movement were restored. In case of severe contracture, residual wound in submandibular region and above clavicles were skin-grafted. The full range of head motion (functional results) was achieved in all the 11 patients. The flaps continued to grow and the skin grafts shrinkage was moderate. Local trapeze-flap plasty allows neck contracture elimination in children in the cases when a more complex technique is impossible or undesirable to use. Early surgical intervention prevents secondary complications, allotting enough time for patients to mature and be ready for more complex procedures.

Both Ankles Severe Postburn Edge Dorsiflexion Contracture in Pediatric Patient: Anatomy and Treatment with Trapeze-Flap Plasty-A Case Report and Literature Review

Postburn severe edge ankle dorsiflexion contractures are the result of deep burn of the lateral joint surface. The contracture affects the foot motions, impairs the lower extremity function and slows down its development in pediatric patients; scars and tissue defects cause severe deformities. Therefore, early reconstruction is needed. Review of literature shows that ankle scar contractures are the least researched among big joints contractures when it comes to surgical treatment, and little attention is given to this problem. The most common curative technique is a contracture release with contracted scar incision and skin grafting (1). Rarely distally based sural or free flaps are used (2). Severe ankle contractures are treated using Ilizarov fixator. (3). The rate of contracture recurrence is high (see Discussion). It is no clear why local tissues (scars and healthy skin) cannot be used for ankle contracture treatment.There is no anatomic classification of the ankle scar contractures. Our experience (personally operated 55 patients with ankle scar contractures) allowed us to divide all dorsiflexion scar contractures into three types and propose appropriate surgical local-flap techniques for each type (4). It was also noted that mild and moderate edge and medial dorsiflexion contractures can be successfully eliminated with trapeze-flap plasty using local adiposecutaneous and adipose-scar trapezoid flaps. New approach allowed escape skin grafts and regional pedicled flaps. Previous publications did not cover the severe ankle dorsiflexion contracture. In this paper we add to research and literature by analyzing the anatomy and treatment of one child, 5-years of age, with severe both ankles edge contractures. The paper aims to demonstrate that the trapeze-flap plasty in combination with skin grafting are able to solve a very complex problem and achieve excellent functional and good cosmetic outcomes.

Postburn Knee Flexions Contractures: Anatomy and Methods of Their Treatment

Background: Postburn knee flexion contractures cause functional limitations of all lower extremity, not allowing the patient to walk normally, creating serious cosmetic defects, and, therefore, requiring surgical reconstruction. The anatomic features of knee flexion contractures and their treatment have been covered in literature far less than large joints of the upper extremities, and their treatment is still a challenge for many surgeons. Methods: Anatomy of postburn knee flexion contractures in 58 patients was studied and contractures were surgically eliminated by using new approaches and techniques. Follow-up results were observed from 6 months to 12 years. Results: Knee postburn flexion contractures were divided into three anatomic types: edge, medial, and total. Edge contractures were caused by scars located on the lateral or medial knee surface and were characterized by the presence of the fold along the popliteal fossa edge. The lateral sheet of the fold was scarred and k ulcerous scars should be excised. The study is the original research of the 1st level of evidence. Conclusion: Three anatomic types of knee scar flexion contractures were identified: edge, medial, and total. An anatomically justified technique for edge and medial contractures was trapeze-flap plasty. Total and most medial contractures were efficiently eliminated with scar excision and skin grafting; rarely was external distractor needed.

Postburn dorsal and palmar interdigital commissural contractures: Anatomy and treatment—A new approach

Background: Postburn dorsal and palmar interdigital commissural contracture is one of the most common complications of hand burns which restricts finger motion and presents a serious cosmetic defect. Many techniques and flaps have been suggested, and research continues for more effective techniques as the problem has not been solved. Methods: Anatomy of scar interdigital commissural contractures was studied in 760 operated patients aiming to develop a new, more effective surgical technique. Results: There are two anatomic types of scar commissural contractures: edge and total. Dorsal and palmar commissural contractures are identified as the edge type and are caused by the fold located along interdigital fossa’s edge. In the fold, the lateral sheet is scars, and the medial sheet and adjacent interdigital fossa are healthy skin. Total commissural contracture is characterized by interdigital fossa obliteration and phalanges’ fusion. Scar sheets have a trapeze-shaped surface deficiency (contracture cause), which spreads from the fold’s crest to metacarpophalangeal joints. The surgical technique consists of scar surface deficiency compensation and commissural groove and slant restoration which can be optimally achieved with the trapezoid adipose-cutaneous flap. The best donor site is interdigital fossa. The small skin grafts on the lateral surface of proximal phalanges did not present a cosmetic defect. Conclusion: Dorsal and palmar interdigital commissural contractures are of an edge type and can be successfully reconstructed with trapeze-flap plasty.

The Elimination of Postburn Nasal Contracture in Children With Trapeze-Flap Plasty

The Elimination of Postburn Nasal Contracture in Children With Trapeze-Flap Plasty

Postburn shoulder medial-adduction contracture: Anatomy and treatment with trapeze-flap plasty

BackgroundShoulder-adduction contractures after burn, most frequent among big joints, cause functional deficiency of the upper limb and, therefore, benefits from surgical correction. Many reconstructive techniques and flaps have been suggested for contracture treatment, but the problem in choosing an adequate reconstructive technique based on the anatomy of the contracture remains. Shoulder-adduction contracture has been given less emphasis in research than any other type and its surgical reconstructive technique remains of concern. MethodsAnatomic features of scar shoulder-adduction contractures were studied in 346 patients, personally operated upon. This allowed us to classify all contractures into three types: edge, medial and total. New surgical techniques specifically for medial contractures were developed. ResultsEighty percent of patients had edge contractures in which the axillary fossa was spared. In 20% of patients, axilla, including the hairy dome, was involved. These cases were anatomically classified into two types: medial, making up 30% of the cases, when contracted scars involved only axilla, and total caused by scars, tightly surrounding the shoulder joint. The scars, causing medial contracture, form a crescent-shaped fold along the medial axillary line. The fold's sheets are scars in which there is skin surface surplus in width, which allows the contracture release with local tissues. Surface deficiency in length has a trapezoid form. Medial contracture can be successfully treated with opposite transposition of trapezoid adipose-scar flaps prepared from both sheets of the fold. ConclusionMedial shoulder-adduction contracture is a newly described type with specific anatomic features. Contracture can be successfully treated with local tissues using trapeze-flap plasty.

Ankle dorsiflexion postburn scar contractures: Anatomy and reconstructive techniques

BackgroundPostburn ankle scar contractures cause functional limitations of all lower extremities and create a serious cosmetic defect, not allowing patients to use normal foot wear, and, therefore, needing surgical reconstruction. The anatomic features of ankle dorsiflexion contractures and their treatment have been covered in the literature far less than other joint contractures, and their treatment is still a challenge for many surgeons. A common treatment method is incisional release of the contracture and defect resurfacing with skin graft. Rarely, distally based sural or free flaps and Ilizarov fixator are used. MethodsAnatomy of postburn ankle scar contractures in 55 patients was studied and contractures were surgically treated using a specific approach and technique. Follow-up results were observed from 6months to 16years. ResultsAccording to the anatomic features, dorsiflexion scar contractures were divided into three types: edge, medial, and total. Edge contractures were caused by burns and scars located on the lateral or medial ankle surface and were characterized by the presence of the fold along the anterior edge ankle; the skin of the anterior ankle surface was not injured. Medial contractures were caused by scars located on the anterior ankle surface and were characterized by the presence of the fold along the medial ankle line. Total contractures were caused by scars tightly surrounding the ankle. In fold's sheets of edge and medial contractures there is a trapeze-shaped surface deficit in length (cause of contracture) and a surface surplus in width which allows contracture release with local trapezoid flaps. For total contractures, wide scar excision and skin grafting were indicated. ConclusionThree anatomic types of ankle dorsiflexion scar contractures were identified: edge, medial, and total. An anatomically justified technique for edge and medial contractures is trapeze-flap plasty; total contractures are effectively eliminated with scar excision and skin grafting.

Postburn Edge Shoulder Adduction Contracture

Postburn scar shoulder adduction contracture is the most common among big joints' contractures. As the contracture impedes all upper limb function, surgical reconstruction is indicated as early as the contracture is formed. Many flaps and techniques have been suggested, yet the problem is not resolved completely. Three hundred forty-six edge scar shoulder adduction contractures were eliminated personally in 277 patients. Contracture anatomy was studied before and during surgery. Effectiveness of the existing and newly developed techniques was evaluated. Edge shoulder scar adduction contracture is caused by scars located on anterior and/or posterior shoulder joint surface and is characterized by the presence of the fold along the axillary fossa edge. Crest of the fold is the edge of scars. The fold's lateral sheet is scars (causes contracture); medial sheet and axillary fossa skin stay uninjured. Lateral scar sheets have surface deficit in length; the deficit spreads from the fold's crest to the shoulder joint rotation axis and has a trapezoid form. The conclusion was made that the adequate technique should consist of sheet surface deficit compensation with the flap of the same (trapezoid) shape. The medial fold sheet and axillary fossa served as an excellent donor site for the flap. Depending on contracture severity, several variants of the trapeze-flap plasty were developed: trapeze-flaps alone or in combination with skin grafts. In all cases, contractures were eliminated completely with trapeze-flap plasty without serious complications. No flap loss and contracture recurrence took place. The proposed techniques are based on the anatomy of the contracture. They are easy to plan and perform, allow complete restoration of the upper limb's function, and improve shoulder joint region appearance in general. The author believes that the trapeze-flap plasty procedure is a preferred technique for adult and pediatric patients with edge scar shoulder adduction contracture.

In Response: Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia

The Journal of Burn Care and Research recently published an article titled “Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia” by Lykoudis et al.1 In conclusion the authors stated, “... the combined use of tissue expansion and latissimus dorsi transfer may prove to be a very good option in the treatment of complex postburn axillary contractures.” The statement can mislead the reader, implying that the suggested excessively complex and traumatic technique should be used to solve relatively simple surgical problems. The reviewed article deals with an edge shoulder posterior adduction contracture that is caused by scars on the posterior shoulder joint, trunk, and shoulder surfaces. These contractures can be eliminated using a shorter, easier, less traumatic, single-stage, safe, and effective reconstructive technique: trapeze-flap plasty.2 Edge shoulder posterior adduction contracture is caused by the fold located along posterior axillary fossa's edge. Lateral fold sheet (according to axilla) is scars; medial fold sheet and axillary fossa are healthy skin; and the crest of the fold is the edge of scars. Contracture is caused only by the lateral scar sheet, having scar surface deficiency in length. The deficiency spreads from the fold's crest to the joint rotation axis and has a trapezoid form which can be seen clearly after contracted sheet's dissection with a Y-shaped incision. Therefore, contracture elimination should use a flap of a similar (trapezoid) shape to compensate scar surface deficiency.

The Elimination of Postburn Nasal Contracture in Children With Trapeze-Flap Plasty

One consequence of a facial burn is nasal contracture. In pediatric patients, scar tension presents a particular problem because of facial growth. The forehead and nasal scar contraction deform the nose dorsum, especially between the eyes. The nasofrontal angle becomes smoothened, wide, and flat; the scar edges cover the inner canthus. The dorsum nose scar stretching delays nasal development, pulls the nose up, making it shorter, and causes nasal ectropion. Secondary deformity of the nose's solid structures develops as a consequence of scar contracture, and its reconstruction poses a major problem. At the same time, it is suggested that nasal reconstruction in the pediatric patients should be planned as a staged procedure. Therefore, scar contracture release should be performed early, at the first stage of pediatric nasal reconstruction, to create conditions for normal nasal development. In this author's opinion, the most suitable procedure is trapeze-flap plasty. The scar tissue surplus in the nasofrontal angle allows contracture release with local tissues. Reconstruction with local trapezoid flaps releases the scar tension and elongates the nasal dorsum surface by approximately 1.5 cm; the epicanthus is eliminated, and the nasofrontal angle (nasal root) is restored. Eight children were operated. Good results were observed in all patients for the duration of 3 years.

Post-burn microstomia: Anatomy and elimination with trapeze-flap plasty

Perioral contractures after burn (microstomia) is a common consequence of facial burns. A small oral opening creates a problem for oral hygiene, food intake and intubation. Therefore, contracture treatment is beneficial once severe limitation of function is realised. Traditionally, this type of contracture is released and the defect is closed with Y–V or Z-plasty. A commonly used technique consists of scar excision in the zone of the commissural apex down to the mucosal lining; the mobilised mucosal flaps are rotated up and down to cover the defect. Anatomical studies and surgical treatment experience for scar microstomia (345 patients) showed that a microstomia contracture could be described as an ‘edge’ contracture and is caused by a fold located at the oral angle. The lateral (exterior) sheet of the fold the scar causing the contracture; the medial sheet is the mucosa. The scar-surface deficit exists in the exterior sheet of the fold and the angle zone. Therefore, additional excision of scar deforms the oral angle. The contracture release, with a Y-shaped incision, and wound coverage (scar-surface-deficit compensation) with the single mucosal flap allows complete microstomia release and oral angle restoration. After the incisional contracture release, the wound, as a rule, accepts a trapezoid form. The defect (wound) is closed with a similar-shaped mucosal advancement flap. Good functional and cosmetic results were achieved in all cases. The commissural angle accepted a normal shape; the mucosal flap was invisible when the mouth was closed; the mouth had a normal appearance when the mouth orifice was open. After an adequate correction, no recurrence of contractures took place. Thus, scar dissection and wound coverage with the trapeze-flap plasty becomes a preferred reconstructive technique for microstomia release after burn.

Trapezoid Adipose Scar Local Flap: Postburn Lateral Truncal Contracture Elimination With Trapeze-Flap Plasty

Trunk burns result in various complications, deformities, and contractures. Contracture of the lateral surface of the trunk is one of the serious complications that limits movements of the spine; children experience structural changes in the form of scoliosis. Therefore, the lateral truncal contracture should be the subject of early surgical treatment. The currently used method has been the stage-by-stage incisions on the contracture scars and skin grafting or Z-plasty. Skin grafts have a tendency to shrink; thus, compression garments are recommended for an extended period of time after surgery. Triangular flaps are small to complete contracture elimination. The need for development of a more effective surgical technique is apparent. Lateral truncal contracture is caused by a crescent-shaped fold; both sheets of the fold are scars. The sheets have a trapeze-shaped surface deficit in length, which causes the contracture and creates the skin surplus in width. The contracture is of medial type; therefore, it is subject to treatment with local tissues using trapeze-flap plasty. The fold and the adjacent contracted scars are converted into trapezoid flaps by radial incisions. The distance among incisions ranges from 4 to 5 cm, which determines the width of the flap's top. One or several trapezoid flap pairs are planned. The scar flaps are elevated with the subcutaneous fat layer and transposed one toward another with tension, so that the end of one flap reaches the base of the counter flap. As a result, the zone of the plasty is elongated by 100 to 150%. Twelve patients with lateral truncal contractures were operated using trapeze-flap plasty. Good immediate and late results have been achieved. It is the author's belief that trapeze-flap plasty is the most effective technique in light of today's proposed methodology.

First web space post-burn contracture types: Contracture elimination methods

First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Effective hand reconstruction usually considers anatomy as its foundation. Based on the experience of over 500 web space contracture elimination cases, three anatomical types of thumb adduction contractures were identified: edge, medial and total. Edge contractures (80% of all thumb adduction contractures) are caused by a fold in which only one sheet is scarred, either the palmar or dorsal surface. The contraction is caused by a trapeze-shaped length deficiency of the scar sheet, which has a surface surplus in width. Reconstruction consists of surface deficiency compensation with trapezoid flap prepared from the non-scarred side and skin–fat tissues of the web space. In most cases, the small scar–fat trapezoid flaps should be prepared from the non-scarred side to cover the donor wounds on both sides of the main flap. Medial contractures (10% of thumb adduction contractures) are caused by the fold, both sheets of which are scarred and have trapeze-shaped surface deficiency in length and surplus in width. Both fold sheets are converted into one or several pairs of trapezoid scar–fat flaps by radial incisions. The oppositely located flaps are transposed towards each other. As a result of the counter flaps transposition, the contracture is eliminated; the web space's shape and depth are restored by the use of flaps alone or in combination with skin grafting. The trapeze-flap plasty is very simple and effective with the length gain of up to 100–200%. Neither flap loss nor re-contracture occurs. Total contractures (about 10% of all) have no fold. Reconstruction consists of the creation of the central zone of the first web space depth with the rectangular subdermal pedicle flap; the wounds on both sides of the flap are skin grafted. The flap sustains normal web depth and prevents the contracture recurrence and skin graft shrinkage.

Flexion contractures of fingers: Contracture elimination with trapeze-flap plasty

Scar flexion contracture of fingers is one of the most serious consequences of hand burns and patient disability after burn. Many kinds of reconstructive techniques are currently used and new procedures are being investigated. The author presents a new method of finger contracture reconstruction developed in the process of burn reconstructive operations on hands of over a thousand patients. Finger flexion contractures are caused by a semilunar fold, both sheets of which are scars. The sheets have a surface deficiency in length, which causes a contracture, and excess of skin in width, which allows contracture elimination with local flaps. The length deficiency extends from the crest of the fold to the joint rotation axis and has a trapezoid form. To compensate for skin deficiency and to address the contracture, it is necessary to convert both fold sheets into trapezoid flaps by radial incisions. Because the fold is of semilunar (crescent) shape, the flaps accept a trapezoid form. One or several pairs of the flaps are mobilized with the split fat layer from the fold's crest to the joint rotation axis level. The oppositely transposed flaps fully or partially cover the wound in the proximal interphalangeal (PIP) zone first. The remaining smaller wounds are covered with full-thickness skin grafts. The flaps have a reliable blood circulation; partial flap loss is an exception. The flap's surface does not decrease, the skin grafts shrink insufficiently, and the distant results, as a rule, are good. Two hundred and seventy-five patients were operated upon. Scar contractures were satisfactorily addressed in all patients. Incomplete extension was found in 46 patients; this was caused by interphalangeal joint injuries (ligaments, capsule, cartilage), ankylosis or boutonniere deformity.

Postburn Hand Border Contractures and Eliminating Them With Trapeze-Flap Plasty

The hand burns can be complicated with the scar contracture of the ulnar or radial hand border. The contracture restricts the mobility of adjacent joints (fifth interphalangeal, wrist joints), causing deviation of the small finger and the whole hand. The contracture and deviation are caused by semilunar fold sheets of which are scars (medial contracture). The fold sheets have the trapeze-shaped surface deficiency in length and surface surplus in width. Thus, the local tissue flaps should have the corresponding form (trapeze-shaped flaps) for surface deficiency compensation. The sheets are transformed into trapezoid flaps along the total length of the semilunar fold with radial incisions until the full tension release is achieved. The incision's ends are split to complete the scar tension release. The distance between radial incisions at the fold's top is approximately 2 to 3 cm, which matches the width of the flap's end. The flaps are mobilized with the full fatty layer and transposed toward each other until the end of one flap reaches the base of the opposite flap. As a result, the skin surface lengthens by two to three times, which allows complete contracture elimination. The contractures were liquidated in all 16 patients without complications. The trapeze-flap plasty is recommended for a wide use in treatment of hand boarder contractures.

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

Trapeze-flap plasty: Effective method for postburn neck contracture elimination

The new method for postburn neck contracture management is presented. The method is found to be most effective when using the local flap procedures on patients who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration (children, elderly patients, patients with inadequate donor sites, and patients with cosmetically acceptable scar appearance). The method consists of the opposite transposition of trapezoid scar-fascial flaps which are prepared one on each antero-lateral neck surface. Both flaps include scars, fat, platysma and deep cervical fascia. As a result of the trapeze-flap plasty, the anterior surface of the neck is lengthened approximately by 100–200%, the contracture is eliminated and mentocervical angle and head movement are restored. The flaps have reliable blood circulation through the superficial cervical artery perforators, therefore flap loss is rare. The functional results were good in 24 out of 26 patients. The flaps surface does not decrease; therefore, the mild contracture becomes an exception.

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

A medial flexion elbow contracture is characterized by the presence of a fold which has a semi-lunar shape, the sheets of which are scars. The shortage in skin length and the excess in width occurs in the sheets. To estimate the size and form of length deficiency in the fold is the section from the top of the fold to the rotation axis of the joint. As a rule, the wound receives a trapeze form. To convert the sheets of the fold into trapeze-shaped flaps, several radial cross-sections from the tops of the fold to joint rotation axis are used. The flaps are mobilized with the full fat layer, and then transposed toward one another causing tension, therefore, covering the wound on the flexion surface of the joint. Flaps and the adjacent skin, displaced forward from lateral and back surfaces of the joint, participate in wound coverage. Trapezoid flaps have a wide end, stable blood circulation; they do not undergo rotation, therefore, do not undergo necrosis. Contractures are eliminated in full without relapse. As a rule, in all 35 patients the functional outcome was perfect.