Reconstructive and Plastic Surgery

doi: 10.25005/2074-0581-2017-19-4-506-512
OPTIMIZATION OF SURGICAL TREATMENT OF POST-BURNING TIGHTENING SCARS OF FRONT SURFACE OF THE NECK AND THE CHEST

U.A. Kurbanov1, I.S. Saidov1,2, A.A. Davlatov1,3, S.M. Dzhanobilova1,3

1Khatlon State Medical University, Dangara, Tajikistan
2Department of Surgical Diseases № 2, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
3Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Tajikistan

Objective: Evaluation the results of surgical treatment of post-burn cicatricial deformities and contractures of the front surface of the neck and thorax.

Methods: The results of surgical treatment of 80 patients with post-burn scars on the anterior surface of the neck and thorax analyzed. The age of the patients ranged from four to 40 years and averaged 19.2±6.5 years. There were 13 men (16.3%) and 67 women (83.7%). Patients arrived at the time from 1 year to 36 years after receiving the burn. Four clinical groups identified: isolated constrictive scars of the anterior surface of the neck – 38 (47.5%) patients; extensive contracting scars of the anterior thoracic surface – 16 (20%); combined constrictive scars of the anterior surface of the neck and thorax with deformity of the mammary gland – 8 (10.0%), and post-burn scars of the anterior thoracic surface, extending to the anterior surface of the shoulder joint – 18 (22.5%) patients. Surgical tactics depended on the severity and extent of the scarring process.

Results: In the immediate postoperative period, 96.3% (77 cases) in patients noted primary healing implantation grafts and flaps engraftment. Complications noted in 3 (3.7%) cases in the form of marginal necrosis of the skin (2) and venous thrombosis of the vascular pedicle of the flap with necrosis of the graft. Long-term results studied in 75 (93.7%) patients in the period from 6 months to 16 years after the operation. Good results were noted in 67 (89.3%) patients, satisfactory – in 5 (6.6%), unsatisfactory – in 3 (4%) patients.

Conclusions: Post-burn cicatricial deformities of the anterior surface of the neck and thorax are a complex and multifaceted problem in reconstructive and plastic surgery; in order to obtain optimal long-term results, the choice of the method of surgical treatment should be differentiated.

Keywords: Burn, scars, post-burn tightening scars on neck and thorax, pedicled parascapular flap.

Download file:


References
  1. Mody NB, Bankar SS, Patil A. Post burn contracture neck: Clinical profile and management. J Clin Diagn Res. 2014; 8(10):NC12-7. Available from: http:// dx.doi/10.7860/JCDR/2014/10187.5004.
  2. Sarkar A, Raghavendra S, Naiyer JMG, Bhattacharya D, Dutta G, Bain J, Asha J. Free thin anterolateral thigh flap for post-burn neck contractures – a functional and aesthetic solution. Ann Burns Fire Disasters. 2014;27(4):209- 14.
  3. Saaiq M, Zaib S, Ahmad S. The menace of post-burn contractures: A developing country’s perspective. Ann Burns Fire Disasters. 2012;25(3):152- 8.
  4. Kurbanov UA, Davlatov AA, Dzhanobilova SM, Dzhononov DD, Kholov ShI. Khirurgicheskoe lechenie posleozhogovoy kontraktury shei [Surgical treatment of post-burn scar contracture of the neck]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;1:7-18.
  5. Vathulya M, Shukla S, Shukla N. Primary management of post-burn contracture neck with tracheostomy: A surgeon and an anaesthetist’s perspective. Indian J Plast Surg. 2017; 50(1):117-9. Available from: http:// dx.doi/10.4103/ijps.IJPS_154_15.
  6. Mathur R, Jain PK, Chakotiya PS, Rathore P. Anaesthetic and airway management of a post-burn contracture neck patient with microstomia and distorted nasal anatomy. Indian J Anaesth. 2014; 58(2):210-3. Available from: http://dx.doi/10.4103/0019-5049.130834.
  7. Sharobaro VI, Moroz VYu, Yudenich AA, Vaganova NA, Grechishnikov MI , Vaganov NV. Plasticheskie operatsii na litse i shee posle ozhogov [Plastic operations for the face and neck after burns]. Klinicheskaya praktika. 2013; 4(16):17-21.
  8. Madazimov MM, Teshaboev MG, Arystanova DR, Askhanov ZP, Ketmonov AG. Ustranenie rubtsovykh deformatsiy i kontraktur shei s pomoshch’yu predvaritel’no rastyanutykh tkaney [Removal of scar deformities and contractures of the neck with pre-expended tissues]. Voprosy travmatologii i ortopedii. 2013; 1(6):32-5.
  9. Orgill DP, Ogawa R. Current methods of burn reconstruction. Plast Reconstr Surg. 2013; 131(5):827e-36e. Available from: http://dx.doi/10.1097/ PRS.0b013e31828e2138.
  10. Wang C, Zhang J, Yang S, Hyakusoku H, Song P, Pu LL. The clinical application of preexpanded and prefabricated super-thin skin perforator flap for reconstruction of post-burn neck contracture. Ann Plast Surg. 2016;77Suppl 1:S49-52. Available from: http://dx.doi/10.1097/SAP.0000000000000711.
  11. Zhernov AA, Zhernov AnA. Lechenie posleozhogovoy deformatsii i kontraktury shei s ispol’zovaniem rastyanutykh loskutov s osevym tipom krovosnabzheniya [The treatment of a post-burn deformity and contracture of the neck, using extended flaps with axial type of blood supply]. Klinichna Khirurgiya. 2012; 3(828):47-51.
  12. Ismail H, Elshobaky A. Supraclavicular artery perforator flap in management of post-burn neck reconstruction: Clinical experience. Ann Burns Fire Disasters. 2016;29(3):209-14.
  13. Albarah A, Kishk T, Megahed M, Elsakka D, Ghareeb F. Pre-expanded extended island parascapular flap for reconstruction of post-burn neck contracture. Ann Burns Fire Disasters. 2010;23(1):28-32.
  14. Yang Z, Hu C, Li Y, Tang Y, Zhao M, Chen W, et al. Pre-expanded cervicoacromial fasciocutaneous flap based on the supraclavicular artery for resurfacing post-burn neck scar contractures. Ann Plast Surg. 2014; 73 Suppl 1: S92-8. Available from: http://dx.doi/10.1097/SAP.0000000000000245.
  15. Kurbanov UA, Davlatov AA, Dzhanobilova SM, Dzhononov DD. Novyy sposob khirurgicheskogo lecheniya posleozhogovykh rubtsovykh deformatsiy i kontraktur shei [New method of surgical treatment of postburn scar deformities and contracture of the neck]. Vestnik Avitsenny [Avicenna Bulletin]. 2011;3:7-15.
  16. Agbenorku P, Fugar S, Akpaloo J, Hoyte-Williams PE, Alhassan Z, Agyei F. Management of severe burn injuries with topical heparin: The first evidencebased study in Ghana. Int J Burns Trauma. 2013;3(1):30-6.
  17. Grishkevich VM, Grishkevich M, Menzul V. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps: a new approach. J Burn Care Res. 2015; 36(3):e.112-9. Available from: http://dx.doi/10.1097/ BCR.0000000000000118.

Authors informations:

Kurbanov Ubaidullo Abduloevich, Corresponding Member of AS RT, Doctor of Medical Sciences, Full Professor, Rector of Khatlon State Medical University

Saidov Iskandar Saidzhafarovich, Full-time Postgraduate Student of the Department of Surgical Diseases № 2, Avicenna Tajik State Medical University

Davlatov Abdumalik Abdulkhakovich, Candidate of Medical Sciences, Head of the Department of Reconstructive and Plastic Microsurgery of the Republican Scientific Center for Cardiovascular Surgery

Dzhanobilova Sitora Murodilloevna, Candidate of Medical Sciences, Attending Physician of the Department of Reconstructive and Plastic Microsurgery of the Republican Scientific Center for Cardiovascular Surgery

Address for correspondence:

Saidov Iskandar Saidzhafarovich

Full-time Post-graduate Student of the Surgical Diseases № 2, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: (+992) 918 273398

E-mail: mediskandar29m@mail.ru

Materials on the topic: