The Square-Plus Flap: A Modification to Release Long Postburn Scar Contractures

Area of Science:

• Plastic Surgery
• Burn Reconstruction
• Scar Management

Background:

• The square flap method is established for releasing contracture bands.
• Long contracture bands may require more extensive surgical techniques than the traditional square flap alone.
• Postburn contractures, particularly web-like bands, present a significant reconstructive challenge.

Purpose of the Study:

• To introduce and evaluate a modified surgical technique, the square-plus flap, for releasing long contracture bands.
• To demonstrate the efficacy of the square-plus flap in a clinical case of postburn axillary contracture.
• To provide plastic surgeons with an enhanced armamentarium for managing complex contractures.

Main Methods:

• A novel square-plus flap technique was developed, extending the traditional square flap design.
• The technique involves incorporating Z-plasties adjacent to the central square flap.
• A case study of a pediatric patient with a postburn axillary contracture band illustrates the application of the modified technique.

Main Results:

• The square-plus flap technique allowed for complete relaxation of a long, web-like postburn contracture band in the axilla.
• Only one of the two Z-plasties required transposition, simplifying the procedure.
• The modified technique proved efficient in releasing the extensive contracture.

Conclusions:

• The square-plus flap is an effective modification for releasing long postburn contracture bands.
• This technique offers a valuable addition to surgical options for complex scar contractures.
• The square-plus flap demonstrates potential for improved outcomes in reconstructive surgery for burn survivors.