方形皮瓣法与五瓣Z成形术矫正烧伤后腋窝挛缩的临床对比研究：长度增加分析和功能效果评估

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-08-17 DOI:10.1016/j.burns.2024.08.012

Mahmoud A. Hifny , Ahmed Gaber Abdelmegeed

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引用次数: 0

摘要

虽然对于烧伤后腋窝挛缩的最佳手术方法还没有达成共识，但关键是要考虑疤痕轴线的拉长率，这是确定最佳手术方法的有用测量指标。方形皮瓣和五瓣z成形术是解决腋窝瘢痕挛缩的常用瘢痕延长术。这些方法成功地破坏了线性疤痕，在减少横向张力的同时显著拉长了疤痕。我们的研究旨在比较这两种方法在治疗烧伤后腋窝挛缩时所增加的瘢痕带长度和功能效果。我们利用 34 位轻度至中度带状挛缩（位于腋窝前线或后线）患者的数据进行了一项回顾性研究，这些患者通过方形皮瓣技术或五瓣 Z 形成形术接受了手术矫正。手术方法的有效性通过两个客观指标进行评估：挛缩带长度的改善和肩关节外展角度的改善。所有患者都完全解除了挛缩。两组患者术后外展程度的改善在统计学上没有明显差异。虽然两组患者术后挛缩带的长度都有明显增加，但使用方形皮瓣治疗的病例的平均长度增加幅度明显大于使用五瓣 Z 形成形术的病例（分别为 87.7381 ± 44.8192 % 对 38.80 ± 11.119 %）。与常用的五瓣Z成形术相比，方形皮瓣技术被认为是一种更好的替代方法，因为在处理腋窝单线性带状挛缩时，方形皮瓣技术可以实现挛缩带的更高伸长率，恢复关节功能，并创造最佳形状。

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Clinical comparison study of square flap method and five-flap Z-plasty technique for correction of post-burn axillary contractures: Analysis of length gain and evaluation of functional outcome

Introduction

While there is no consensus on the best surgical procedure for post-burn axillary contractures, it is crucial to consider the elongation rate along the scar axis as a useful measurement index for determining the optimal surgical approach. The square flap and five flap z-plasty techniques are commonly employed scar lengthening procedures to address scar contractures in the axilla. These approaches successfully disrupt the linear scar, leading to significant elongation while reducing transverse tension. Our study aims to compare the increase in band length and functional results of these two approaches for treating post-burn contractures in the axilla.

Methods

A retrospective study was carried out utilizing data from 34 patients with mild-to-moderate band-like contractures located on the anterior or posterior axillary lines who underwent surgical correction through either the square flap method or five-flap z-plasty technique. The effectiveness of surgical methods was evaluated using two objective indices: improvement in contracture band length and improvement in abduction angle at the shoulder joint.

Results

All patients achieved complete contracture release. There is no statistically significant difference between the two groups regarding the improvement in the degree of abduction postoperatively. Although there was a significant increase in the length of the contracture band postoperatively in both groups, the average increase in length for cases treated with a square flap was significantly greater than those managed with a five-flap Z-plasty (87.7 ± 44.8 % vs. 38.80 ± 11.119 %,) respectively.

Conclusion

The square flap technique is considered a better alternative to the commonly used 5-flap Z-plasty method because it can achieve higher elongation in the contracture band, restore joint function, and create optimal shape when dealing with single linear band contractures over the axilla.

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.