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The management of perineal contractures in children with burns
G P Pisarski1, D G Greenhalgh, G D Warden
1Shriners Burns Institute, Cincinnati, OH 45229.
Insights
Perineal scar contracture release surgery outcomes varied by technique. Local flaps were simpler but had higher recurrence rates, while split-thickness skin grafting (STSG) was better for severe cases.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Burn Scar Management
Background:
- Perineal scar contractures can significantly impact quality of life.
- Surgical reconstruction is necessary for severe cases.
- Understanding surgical principles is crucial for effective treatment.
Purpose of the Study:
- To review surgical principles for perineal contracture release.
- To evaluate outcomes of different reconstructive techniques.
- To identify factors influencing recurrence and recovery.
Main Methods:
- Retrospective review of 18 patients undergoing perineal contracture release (1980-1991).
- Analysis of surgical techniques: local flap, incisional release with split-thickness skin grafting (STSG), primary closure, and combinations.
- Comparison of recurrence rates and recovery times across techniques.
Main Results:
- Local flaps were used in 56% of cases, STSG in 28%, and combinations in 11%.
- Recurrence rates were 40% for local flaps, 20% for STSG, and 50% for combinations.
- Local flaps offered simpler procedures and shorter recovery despite higher recurrence.
Conclusions:
- STSG is recommended for large, bilateral contractures and recurrences, especially when flap tissue is unavailable.
- Close follow-up is essential for pediatric burn patients with contractures due to growth variables.
- Surgical technique choice depends on contracture severity and available tissue.
Abstract:
A retrospective review of patients undergoing reconstruction for perineal scar contracture between 1980 and 1991 was performed to determine the surgical principles involved in perineal contracture release. Of the 5280 reconstructive admissions, 18 (0.34%) were for perineal contracture release. Fifty-six percent of patients received a local flap as an initial release, 28% underwent incisional release with split-thickness skin grafting (STSG), 5% had primary release and closure, and 11% had a combination of these techniques. Recurrences developed in 40% of the local flap group, 20% of the STSG group, and 50% of the combination group, with no statistical differences between groups. Although there was a higher rate of recurrence in the flap group, the procedure was much simpler to perform and recovery time was shorter. The use of STSG should be reserved for large bilateral contractures and recurrences, especially if normal skin for a flap is not available. Growth is an important variable in the development of perineal contractures in children with burns; thus these patients should be followed up closely during rapid-growth periods.