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Clinical experience in treatment of peri-anal scar contracture in children
E Ye1
1Department of Burns and Plastic Surgery, She-kou People's Hospital, Shenzhen People's Republic of China.
Insights
Local Z or Y-V plasty effectively treats peri-anal scar contracture in children, offering a simple, less traumatic, and highly successful surgical option with reduced recurrence rates.
Area of Science:
- Pediatric Surgery
- Burn Reconstruction
- Dermatology
Background:
- Peri-anal scar contracture is a debilitating complication following burn injuries in children.
- Previous treatments like skin grafting have shown poor outcomes due to graft complications.
- Surgical intervention is necessary to restore function and prevent long-term issues.
Purpose of the Study:
- To evaluate the efficacy of different surgical techniques for treating peri-anal scar contracture in pediatric burn patients.
- To identify the most successful and least traumatic surgical approach for this condition.
- To compare the outcomes of local plasty versus skin grafting and flap transposition.
Main Methods:
- Retrospective analysis of 39 pediatric patients treated for peri-anal scar contracture since 1987.
- Surgical interventions included local excision with full-thickness skin grafting (4 patients), scar lysis with flap transposition (3 patients), and local Z or Y-V plasty (32 patients).
- Outcomes were assessed based on success rate, graft survival, infection, necrosis, and recurrence of contracture.
Main Results:
- Local excision with skin grafting resulted in poor outcomes, including graft movement, infection, and necrosis.
- Scar lysis with flap transposition yielded satisfactory results in 3 patients.
- Local Z or Y-V plasty demonstrated high success rates with minimal recurrence in 32 patients, proving to be the most effective method.
Conclusions:
- Local Z or Y-V plasty is the recommended treatment of choice for pediatric peri-anal scar contracture due to its simplicity, low trauma, and high success rate.
- This technique significantly reduces the tendency for contracture recurrence.
- Adequate pre- and post-operative care, including bowel preparation and local wound management, is crucial for optimal surgical outcomes in these patients.
Abstract:
Thirty-nine children suffering from peri-anal scar contracture as a result of burn injury have been treated since 1987. Among them, 25 were boys and 14 girls. Their age ranged from 6 months to 7 years, mean age 3.5 years. In 4 patients, local excision of scar followed by full-thickness skin grafting was done. The result was poor because of movement of the graft, infection and finally necrosis of the graft. In 3 patients, lysis of the scar followed by a transposition of flap, and in 32 local "Z" or "Y-V" plasty were performed with satisfactory results. In our opinion the latter technique should be the treatment of choice, as it is simple, less traumatic, and resulting to high success rate with less tendency to recurrence of contracture. For patients with chronic intestinal obstruction, adequate pre-operative bowel preparation, meticulous post-operative local care are essential. General supportive treatment should not be neglected to ensure a satisfactory operative result.
