55 The Advantages of Fasciocutaneous Free Tissue Transfers for the Management of Post-Burn Scar Contractures
Notice bibliographique
Résumé
Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries placing a greater emphasis on reconstruction to improve long-term outcomes of scar deformities. Burn scar contractures are common deformities which limit range of motion, complicate airway management and create significant cosmetic deformities which are difficult to treat. Traditional methods such as partial and full-thickness skin grafts, Z-plasties, local flaps, tissue expanders and skin substitutes have been used to release contractures and improve function but are subject to variable graft take, residual tightness and suboptimal cosmetic appearances, especially in highly visual regions of the face and neck. In the past, microvascular free tissue transfer is a more technical, time consuming and risky approach. In our experience, modern fasciocutaneous free tissue transfers for release of contractors have been reliable, safe, and high quality long term solutions for many difficult burn scar deformities with improved results over previous approaches employed in the past. Between 2005 and 2018, 18 free flaps were performed on burn patients aged 7–63 yr, 10 males and 8 females with TBSA 20–70% who developed contractures of the neck, breast and extremities. Anterlateral thigh flaps (n=11), radial forearm flaps (n=3), deep inferior epigastric (n=3) and ulnar artery (n=1) flaps were used. All 18 flaps survived without tissue loss despite 2 re-explorations for venous thrombosis. In the neck, fasciocutaneous flaps improved range of motion significantly (p<0.05), reduced intubation difficulty based on Malampati scores and improved cosmetic results with smooth contour, adequate colour match and contour, and thin coverage. Overall patient satisfaction was very good despite the need for secondary defatting in 70% of cases. Superior cosmetic and functional results were achieved also for breast and extremity deformities. Post-burn scar contractors compromise the cosmetic appearance and function of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Free flaps are now considered an important and reliable method for burn scar contracture deformity reconstruction following burn injury. This research seeks to recognize the limitation fo traditional treatment of scar contractures secondary to burn injuries and to understand the advantages for free tissue transfer for their reconstruction.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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