Application of continuous Z-flaps combined with scar debulking in the clinical treatment of hyperplastic scar contracture deformity of children’s hand
10.3760/cma.j.cn114453-20191120-00348
- VernacularTitle:连续Z形皮瓣联合瘢痕减容在儿童手部增生性瘢痕挛缩畸形治疗中的应用
- Author:
Zhengfu YU
1
;
Weimin SHEN
;
Jie CUI
;
Jianbing CHEN
;
Tao HAN
;
Jun YAN
;
Jijun ZOU
Author Information
1. 南京医科大学附属儿童医院烧伤整形科 210008
- Keywords:
Cicatrix, hypertrophic;
Contracture;
Hand;
Child;
Z-plasty;
Scar debulking
- From:
Chinese Journal of Plastic Surgery
2020;36(10):1095-1099
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of continuous Z-flaps combined with scar debulking in correcting hyperplastic scar contracture deformity of children′s hand.Methods:From January 2016 to December 2018, 27 cases of children with scar contracture deformity after hand burn or scald were admitted to the Department of Burn and Plastic Surgery of Children′s Hospital of Nanjing Medical University, involving a total of 36 joint parts. 12 male patients and 15 female patients aged 10 months to 12.5 years were divided into mild, moderate and severe types according to the contracture angle of metacarpophalangeal joints and interphalangeal joints, so as to make the treatment plan. The transposition of flaps for wound closure was designed for both mild and moderate cases after continuous Z-flaps to release contracture deformity with scar debulking. For severe deformity, the transposition of flaps should be conducted to cover the wound after the complete release by continuous Z-flaps and scar debulking, and the residual wound was covered by free skin grafts. The hand function and appearance were followed up after operation.Results:In this study, 12 of the 36 joints were mildly deformed, 15 were moderately deformed, and 9 were severely deformed. No skin grafting was performed for mild and moderate deformities, and the amount of skin grafting was selectively reduced for severe deformities. All contracture joint deformities were completely corrected, with the follow-up period of 0.8-2.0 years, and no contracture deformities were found again. The hand joint function, skin flap color, texture of mild and moderate types were close to the surrounding normal skin. Severe type had only a small degree of pigmentation at the skin graft site. One 12.5-year-old child received second procedure 2 years later because of the poor elasticity of the skin graft and the tensions. The tension resolved after operation, with satisfactory results.Conclusions:Continuous Z-flaps combined with scar debulking could maximize the retention of skin of the scar surface and reduce the amount of skin grafts, providing an excellent method for the treatment of hand contracture deformities in children, with stable long-term postoperative effects.
