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Perforator-based interposition flaps for sustainable scar contracture release: a versatile, practical, and safe
Pauline D H M Verhaegen1, Carlijn M Stekelenburg, Antoine J M van Trier
1Beverwijk and Amsterdam, The Netherlands From the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive, and Hand Surgery, the Burn Centre, and the Department of Radiology, Red Cross Hospital; and the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center Amsterdam.
Perforator-based interposition flaps offer a reliable method for releasing broad scar contractures, with flaps expanding significantly post-surgery. This versatile technique allows for intraoperative adjustments, including islanding flaps when needed.
Area of Science:
- Plastic Surgery
- Regenerative Medicine
- Wound Healing
Background:
- Extensive wounds, particularly burns, often result in problematic scar contractures.
- Perforator-based interposition flaps are explored as a surgical technique for scar contracture release.
Purpose of the Study:
- To evaluate the applicability of islanded and non-islanded perforator-based interposition flaps for scar contracture release.
- To assess the reliability and versatility of this flap technique in managing broad scar contractures.
Main Methods:
- Patients undergoing scar contracture release surgery were included.
- Perforator identification using color Doppler sonography and flap design tailored to perforator location.
- Flap measurements taken intraoperatively and during follow-up, with supple scar tissue incorporation for extensive burns.
Main Results:
- Twenty-two flaps were performed; four were converted to island flaps.
- All flaps survived, with four cases experiencing tip necrosis.
- Flap width and surface area increased by 123% and 116% respectively after a mean 7.8-month follow-up.
Conclusions:
- Perforator-based interposition flaps are a reliable and versatile technique for broad scar contractures.
- The technique allows for intraoperative tailoring, including islanding the flap base when necessary.
- While effective, additional venous outflow considerations and potential time savings by keeping the flap base intact are noted.
