A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAOYashan , ZANTao , LIHaizhou ,  LIQingfeng

Department of Plastic Surgery, the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200011, P. R. China;

Corresponding author：

LIQingfeng, Email: dr.liqingfeng@yahoo.com

Keywords：

Pre-expanded flap; Skin graft; Scar contracture

DOI：

10.7507/1002-1892.20150244

Video：

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Objective To study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. Methods A total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and preexpanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. Results The patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). Conclusion Pre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

Citation： GAOYashan, ZANTao, LIHaizhou, LIQingfeng. A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1124-1128. doi: 10.7507/1002-1892.20150244 Copy

1.	Li Q, Zan T, Gu B, et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery, 2009, 29(7):515-523.
2.	Cheng C, Zheng D, Xie Y, et al. Lipotransfer:the potential from bench to bedside. Ann Plast Surg, 2015, 74(2):269-270.
3.	Xie F, Li H, Li Q, et al. Application of the expanded lateral thoracic pedicle flap in face and neck reconstruction. Burns, 2013, 39(6): 1257-1262.
4.	Xie F, Wang J, Li Q, et al. Resurfacing large skin defects of the face and neck with expanded subclavicular flaps pedicled by the thoracic branch of the supraclavicular artery. Burns, 2012, 38(6):924-930.
5.	Zan T, Li H, Gu B, et al. Surgical treatment of facial soft-tissue deformities in postburn patients:a proposed classification based on a retrospective study. Plast Reconstr Surg, 2013, 132(6):1001e-1014e.
6.	Iwuagwu FC, Wilson D, Bailie F. The use of skin grafts in postburn contracture release:a 10-year review. Plast Reconstr Surg, 1999, 103(4):1198-1204.
7.	Kansy K, Mueller AA, Mücke T, et al. Microsurgical reconstruction of the head and neck region-current concepts of maxillofacial surgery units worldwide. J Craniomaxillofac Surg, 2014, 42(8):1610-1613.
8.	Atiyeh B, Janom HH. Physical rehabilitation of pediatric burns. Ann Burns Fire Disasters, 2014, 27(1):37-43.
9.	Lee JY, Kim JM, Kwon H, et al. Freestyle local perforator flaps for facial reconstruction. Biomed Res Int, 2015, 2015:707065.
10.	Hudson DA, Arasteh E. Serial tissue expansion for reconstruction of burns of the head and neck. Burns, 2001, 27(5):481-487.
11.	Hou CL, Chang SM, Lin J, et al. A Brief History of Perforator Flaps// Surgical Atlas of Perforator Flaps. Netherlands:Springer, 2015:1-4.
12.	Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck:a 10-year experience. Plast Reconstr Surg, 1999, 103(3):808-820.
13.	Dotan L, Icekson M, Yanko-Arzi R, et al. Pediatric tissue expansion: our experience with 103 expanded flap reconstructive procedures in41 children. Isr Med Assoc J, 2009, 11(8):474-479.
14.	Di Mascio D, Castagnetti F, Mazzeo F, et al. Overexpansion technique in burn scar management. Burns, 2006, 32(4):490-498.
15.	Li Q, Zan T, Li H, et al. Flap prefabrication and stem cell-assisted tissue expansion:how we acquire a monoblock flap for full face resurfacing. J Craniofac Surg, 2014, 25(1):21-25.
16.	Haughey BH, Wilson E, Kluwe L, et al. Free flap reconstruction of the head and neck:analysis of 241 cases. Otolaryngol Head Neck Surg, 2001, 125(1):10-17.

1. Li Q, Zan T, Gu B, et al. Face resurfacing using a cervicothoracic skin flap prefabricated by lateral thigh fascial flap and tissue expander. Microsurgery, 2009, 29(7):515-523.
2. Cheng C, Zheng D, Xie Y, et al. Lipotransfer:the potential from bench to bedside. Ann Plast Surg, 2015, 74(2):269-270.
3. Xie F, Li H, Li Q, et al. Application of the expanded lateral thoracic pedicle flap in face and neck reconstruction. Burns, 2013, 39(6): 1257-1262.
4. Xie F, Wang J, Li Q, et al. Resurfacing large skin defects of the face and neck with expanded subclavicular flaps pedicled by the thoracic branch of the supraclavicular artery. Burns, 2012, 38(6):924-930.
5. Zan T, Li H, Gu B, et al. Surgical treatment of facial soft-tissue deformities in postburn patients:a proposed classification based on a retrospective study. Plast Reconstr Surg, 2013, 132(6):1001e-1014e.
6. Iwuagwu FC, Wilson D, Bailie F. The use of skin grafts in postburn contracture release:a 10-year review. Plast Reconstr Surg, 1999, 103(4):1198-1204.
7. Kansy K, Mueller AA, Mücke T, et al. Microsurgical reconstruction of the head and neck region-current concepts of maxillofacial surgery units worldwide. J Craniomaxillofac Surg, 2014, 42(8):1610-1613.
8. Atiyeh B, Janom HH. Physical rehabilitation of pediatric burns. Ann Burns Fire Disasters, 2014, 27(1):37-43.
9. Lee JY, Kim JM, Kwon H, et al. Freestyle local perforator flaps for facial reconstruction. Biomed Res Int, 2015, 2015:707065.
10. Hudson DA, Arasteh E. Serial tissue expansion for reconstruction of burns of the head and neck. Burns, 2001, 27(5):481-487.
11. Hou CL, Chang SM, Lin J, et al. A Brief History of Perforator Flaps// Surgical Atlas of Perforator Flaps. Netherlands:Springer, 2015:1-4.
12. Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck:a 10-year experience. Plast Reconstr Surg, 1999, 103(3):808-820.
13. Dotan L, Icekson M, Yanko-Arzi R, et al. Pediatric tissue expansion: our experience with 103 expanded flap reconstructive procedures in41 children. Isr Med Assoc J, 2009, 11(8):474-479.
14. Di Mascio D, Castagnetti F, Mazzeo F, et al. Overexpansion technique in burn scar management. Burns, 2006, 32(4):490-498.
15. Li Q, Zan T, Li H, et al. Flap prefabrication and stem cell-assisted tissue expansion:how we acquire a monoblock flap for full face resurfacing. J Craniofac Surg, 2014, 25(1):21-25.
16. Haughey BH, Wilson E, Kluwe L, et al. Free flap reconstruction of the head and neck:analysis of 241 cases. Otolaryngol Head Neck Surg, 2001, 125(1):10-17.

Chinese Journal of Reparative and Reconstructive Surgery

A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS

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