Surgical Management of Burn Sequelae of the Popliteal Fossa: Retrospective Analysis and Development of a Management Algorithm.

Abstract

Burn sequelae of the popliteal fossa cause significant functional impairment, with aesthetic and psychological consequences. Flexion contractures are the most frequent, and several therapeutic classifications exist; however, the clinical heterogeneity of these sequelae makes it difficult to establish a consensus. A retrospective study (January 2014 to January 2022) included 20 patients who underwent surgical treatment for major burn sequelae of the popliteal fossa. Functional outcomes were assessed using the Ogawa and Pribaz, and Baux and Mimoun classifications. The median age was 15.5 years, with a male predominance (sex ratio=1.5). Sixty percent of patients were from rural areas, and 55% received initial non-specialized management. Skin contractures were present in 90% of cases, with a severe knee extension deficit in 89%. Reconstruction involved local techniques such as Z-plasties (40%) and locoregional flaps (pedicled transposition or perforator flaps; 45%). These two categories were analyzed separately due to their distinct anatomical and technical considerations. Final functional outcomes were considered good to excellent in 80% of cases after a median follow-up of 1.15 years. Children are particularly susceptible to popliteal fossa burn sequelae, with a risk of recurrence. The quality of initial management influences the severity of sequelae. Surgical intervention is indicated in the presence of ulceration or significant functional impairment. Local flaps demonstrated good results with fewer recurrences. The main limitations of this study include the small sample size, its retrospective nature, and limited follow-up. A management algorithm for retractile sequelae has been proposed and requires prospective validation.