For the Medical Practitioners
doi: 10.25005/2074-0581-2022-24-2-244-253
SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES

E.K. Ibragimov1,2, A.A. Davlatov2,3, M.KH. Malikov3, M.R. Khaydarov3, N.KH. Khamidov2, N.A. Makhmadkulova1

1Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
3Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To study surgical management of post-burn scar extension contractures of the toes.

Methods: The treatment outcomes of 72 children with post-burn scar extension contractures of the toes between the ages of 3-15 were analysed. There were 38 boys (52.8%), girls – 34 (47.2%). In 14 (19.4%) children, both feet were affected, with a total of 86 feet with extension contracture. In most cases (n=53, 73.6%) of children (62 feet), retracting scars extending proximally also caused extension contracture of the ankle joint.

Results: In all cases, a modified Z-plasty (butterfly flap) technique, according to Hirshowitz, was used to correct scar contracture of the anterior ankle. In 89.5% of patients (77 feet) after reconstruction using a local flap, soft tissue defects (range, 6-30 cm2) remained. The defects were covered with full-thickness autologous skin grafts. In this case, in 32.6% (28 feet), the exposed tendons and cutaneous nerves were preliminarily covered by the surrounding subcutaneous tissue and fascia used as a blood-supplying source. Local flap surgery helped reconstruct mild scar contracture in 16 (18.6%) feet. In 21 (24.4%) cases, tendon-articular structures were reconstructed. Complications in the early postoperative period were observed in 7 out of 86 operated feet, which amounted to 8.1%. In all cases, complications included marginal necrosis of local flaps and transplanted full-thickness skin grafts observed in 4 feet (4.6%) and 3 (3.5%) feet, respectively. In all cases, engrafting of a full-thickness skin graft was noted; and there was no complete recurrence of contracture. Due to the somatic growth of children in 8 cases (9.3%) in the late postoperative period (after 6-10 years), repeated corrective surgical procedures were required.

Conclusion: In children, burn contractures of the toes require surgical intervention on the skin and soft tissue. Unfortunately, the pathological process is almost always accompanied by a lack of skin and soft tissue, requiring skin grafts. In the long term, there is a need for repeated corrective surgical interventions.

Keywords: Post-burn contracture, skin autografts, foot contracture, local flap surgery.

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References
  1. Shakirov BM. Evaluation of different surgical techniques used for correction of post-burn contracture of foot and ankle. Ann Burns Fire Disasters. 2010;23(3):137-43.
  2. Williams KL, Garza LA. Garza diverse cellular players orchestrate regeneration after wounding. Exp Dermatol. 2021;30(4):605-12. Available from: https://doi. org/10.1111/exd.14248
  3. Emsen IM. A new method in the treatment of postburn and post-traumatic scar contractures: Double-opposing Z- and V- (K-M-N) plasty. Can J Plast Surg. 2010;18(2):e20-e26
  4. Fillipova OV, Afonichev KA. Osobennosti reabilitatsii detey s posleozhogovymi rubtsami distal'nykh otdelov nizhnikh konechnostey [Features of the rehabilitation of children with post-burn scars of the distal lower parts]. RMZH. Mat' i ditya. 2021;2:168-72. Available from: https://doi.org/10.32364/2618-8430- 2021-4-2-168-172
  5. Mirzoev NM, Khodzhamuradov GM, Shaymonov AH, Ziyozoda SS, Odinaev BA, Shamsov NKh. Rezul'taty primeneniya dvukhetapnoy plastiki pri tyazhyolykh posledstviyakh ozhogov verkhney konechnosti [Results of two-stage plasty in severe consequences of burns of the upper extremity]. Zdravookhranenie Tadzhikistana. 2021;(4):48-55. Available from: https://doi.org/10.52888/0514- 2515-2021-351-4-48-55
  6. Lee SH, An SJ, Kim NR, Kim UJ, Kim JI. Reconstruction of postburn contracture of the forefoot using the anterolateral thigh flap. Clin Orthop Surg. 2016;8(4):444-51. Available from: https://doi.org/10.4055/cios.2016.8.4.444
  7. Toyoshima Y, Maeda T, Kijima T, Namiki O, Nemoto T, Inagaki K. Therapeutic failure an d eventual solution for skin necrosis and exposed tendon of the dorsum of the foot: A case report. Clin Case Rep. 2018;6(8):1600-3. Available from: https://doi.org/10.1002/ccr3.1697
  8. Afonichev KA, Nikitin MS, Kuptsova OA. Lechenie posleozhogovoy vtorichnoy deformatsii stopy [Treatment of post-burn secondary deformity of the foot]. Ortopediya, travmatologiya i vosstanovitel'naya khirurgiya detskogo vozrasta. 2015;3(2):52-5.
  9. Bandurashvili AG, Afonichev KA, Fillipova OV. Posleozhogovye rubtsovye deformatsii stop: osobennosti kliniki, lecheniya [Post-burn cicatricial deformities of the feet: Features of the clinic, treatment]. Ortopediya, travmatologiya i vosstanovitel'naya khirurgiya detskogo vozrasta. 2014;2(1):18-26.
  10. Shakirov BM. Surgical treatment of post burn bent contractures of the foot in children. Clin Res Foot Ankle. 2015;3:166. Available from: https://doi. org/10.4172/2329-910X.1000166
  11. Afonichev KA, Nikitin MS, Proshchenko YaN. K voprosu svobodnoy kozhnoy plastiki v rekonstruktivnoy khirurgii ozhogov u detey [On the issue of free skin grafting in reconstructive surgery for burns in children]. Ortopediya, travmatologiya i vosstanovitel'naya khirurgiya detskogo vozrasta. 2017;5(1):39-44.
  12. Jerome T, Sabtharishi V, Sk T. Supraclavicular flap for severe post-burn neck contracture in children. Cureus. 2021;13(1):e12910. Available from: https:// doi.org/10.7759/cureus.12910
  13. Lewinson RT, Capozzi LC, Johnson K, Harrop AR, Fraulin FOG, Nickerson DA. Review of perforator flaps for burn scar contractures of joints. Plast Surg (Oakv). 2019;27(1):66-77. Available from: https://doi. org/10.1177/2292550318767433
  14. Stekelenburg CM, Marck RE, Verhaegen PDHM, Marck KW, Zuijlen PPM. Perforator- based flaps for the treatment of burn scar contractures: A review. Burns Trauma. 2017;27(5):5. Available from: https://doi.org/10.1186/s41038-017- 0071-2
  15. Kim JH, Choi JM, Chung CM, Park MC. Reconstruction of postburn scar contracture of the sole using the medialis pedis free flap. J Korean Burn Soc. 2021;24:74-6.
  16. Vijayaragavan M, Chittoria RK, Thomas N, Kerakada N, Reddy SD, Kumar MS. Role of low-level laser therapy as an adjuvant in functional rehabilitation of patients with joint stiffness in post-burn contracture. Radiol Open J. 2022;6(1):1- 3. Available from: https://doi.org/10.17140/ROJ-6-135
  17. Chapman P, Banerjee A, Campbell RC. Extended use of the Mustardé dancing man procedure. Br J Plast Surg. 1987;40(4):432-5. Available from: https://doi. org/10.1016/0007-1226(87)90050-6

Authors' information:

Ibragimov Erkindzhon Karimdzhonovich
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AFN-2726-2022
ORCID ID: 0000-0003-1375-1973
E-mail: erkinjon05@mail.ru

Davlatov Abdumalik Abdulkhakovich
Candidate of Medical Sciences, Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery; Assistant of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAF-6440-2022
Scopus ID: 21933830600
ORCID ID: 0000-0003-2776-074X
SPIN: 3766-9641
Author ID: 998715
E-mail: davlatov.abdumalik@mail.ru

Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-7816-5521
E-mail: mmirzobadal@mail.ru

Khaydarov Mekhroj Rakhmatulloevich
Postgraduate Student of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-1993-8285
E-mail: mehroj.doctor92@mail.ru

Khamidov Nisoriddin Khoshimovich
Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0002-4278-9164
E-mail: drnisoriddin@gmail.com

Makhmadkulova Nigora Akhtamovna
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Ibragimov Erkindzhon Karimdzhonovich
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Hospital Resident of the Department of Reconstructive and Plastic Microsurgery, Republican Scientific Center for Cardiovascular Surgery

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

Tel.: +992 (907) 701456

E-mail: erkinjon05@mail.ru

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