Maximizing Gain of Advancement Expanded Flaps by Both Vertical and Horizontal Back Cuts in Cases of Post Burn Deformities | ||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||
| Article 3, Volume 43, Issue 2, July 2019, Pages 171-176 PDF (10.52 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejprs.2019.64899 | ||
| Authors | ||
| Nahed Samir* ; Sherine M Aboulfoutouh | ||
| The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| Abstract | ||
| Background: Tissue expansion can be considered one of the fundamental steps in reconstruction ladder. It is a technique that can provide similar tissues to the defect without sacrificing other tissues. Tissue expansion offers lots of benefits, it provides tissue similar in texture and colour for coverage of defects especially post burn deformities. The high percent of complications and need of multiple stages has always been an obstacle to this technique. However in limited donor areas application of large expanders is very difficult and the gain of small expanders is limited with need of repeated sessions with its high complications and risks. In this study, we use rectangular expanded flaps which yields tissues more than other circular or crescent expanders and backcuts are added in order to increase both length and width of the flap. Aim of Work: To study the value of both vertical and horizontal back-cuts added to expanded advancement flaps in reconstruction of post burn deformities in safe and effective way. Patients and Methods: • Twenty expanders were used for 16 patients as two expanders were applied in 4 cases. The expanders were implanted in the scalp (n=10), neck (n=3), chest and abdomen (n=3) and shoulders (n=4). Rectangular expanders were used in all cases. The capacity of the expanders employed varied from 250 to 750ml. • Cases were divided into two groups. In group A; we did two horizontal back cuts located at the base of expanded flap at the time of expander delivery while in group B; a third vertical backcut was added on the distal limb of the flap. • The measurement of length of expanded flap is measured before doing any back cut and after the two horizontal backcuts in group A. It is also measured before and after all back cuts in group B. • Results during 3 years period from 2015-2017, 16 cases were subjected to application of 20 rectangular expanders for reconstruction of post burn scarinng of different parts of the body, cases were divided into two groups complications included infection, port exposure, and superficial flap necrosis of the edges. In group A measurement of the length of expanded skin was done before and after horizontal back cuts for both vertical limbs AC, BD. In group B measurement was taken for the same limbs before and after all the 3 backcuts. The average increase in length in group; A=3.12± cm, while the average increase in group; B=4.35cm. 171 Conclusion: Using both vertical and horizontal back cuts added to both length and width of expanded flap gain, enabled us to remove more scarred tissue bilaterally. It also preserved normal tissues infront of the scarred tissue from being discarred. | ||
| Keywords | ||
| Expanded flaps – Back cuts – Post Burn; deformities | ||
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