55 The Advantages of Fasciocutaneous Free Tissue Transfers for the Management of Post-Burn Scar Contractures
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".