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Perforator-Based Interposition Flaps for Sustainable Scar Contracture Release: A Versatile, Practical, and Safe Technique

Verhaegen, Pauline D. H. M. M.D.; Stekelenburg, Carlijn M. M.D.; van Trier, Antoine J. M. M.D.; Schade, Frank B. M.D.; van Zuijlen, Paul P. M. M.D., Ph.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e318208d1fb
Reconstructive: Head and Neck: Original Articles
Abstract

Background: Problematic scar contractures are frequently observed following extensive (burn) wounds. In this study, the authors investigated the applicability of islanded and nonislanded perforator-based interposition flaps as a technique for release of scar contracture.

Methods: Patients requiring surgery for scar contracture release were included. Preoperatively, a suitable perforator was identified by color Doppler sonography. The flap design was tailored according to the localization of this perforator and the anticipated defect. Flap measurements were obtained intraoperatively and at follow-up. Supple scar tissue was included in the flap design when necessary, to increase the applicability of this concept in extensively burned patients. Flaps were converted into island flaps on indication to circumvent significant kinking of the flap base and compromised tissue perfusion.

Results: Twenty-two flaps were performed, of which four were converted into island flaps. All flaps survived, but in four cases necrosis of the tip was observed. After a mean follow-up of 7.8 months, the width and surface area of the flaps had expanded to 123 percent (range, 40 to 311 percent) and 116 percent (range, 60 to 246 percent), respectively. One flap was converted into a full-thickness graft during the initial operation.

Conclusions: This concept of perforator-based interposition flaps was found to be a reliable and versatile technique for broad scar contractures. Moreover, it allows intraoperative tailoring, as the flap base can be islanded when indicated. Nevertheless, additional venous outflow is warranted and operative time is saved if the flap base remains intact.

Author Information

Beverwijk 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.

Received for publication June 15, 2010; accepted October 1, 2010.

Presented in part at the 13th European Burns Association Congress, in Lausanne, Switzerland, September 2 through 5, 2009; at the 13th European Conference of Scientists and Plastic Surgeons, in Rotterdam, The Netherlands, September 18 and 19, 2009; and at the 15th Congress of the International Society for Burn Injuries, in Istanbul, Turkey, June 21 through 25, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Paul P. M. van Zuijlen, M.D., Ph.D., Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital Beverwijk, Vondellaan 13, 1942 LE Beverwijk, The Netherlands, paul.van.zuijlen@planet.nl

©2011American Society of Plastic Surgeons