Features of free skin grafting to correct post-burn neck deformities in children

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Abstract

BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results.

AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures.

MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery.

Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture.

RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III — 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%).

Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs.

Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results.

CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures.

Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.

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About the authors

Olga V. Filippova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: olgafil-@mail.ru
ORCID iD: 0000-0002-1002-0959
SPIN-code: 8055-4840
http://www.rosturner.ru/kl7.htm

MD, PhD, D.Sc.

Russian Federation, 64-68 Parkovaya str., Pushkin, 196603, Saint Petersburg

Konstantin A. Afonichev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: afonichev@list.ru
ORCID iD: 0000-0002-6460-2567
SPIN-code: 5965-6506

MD, PhD, D.Sc.

Russian Federation, 64-68 Parkovaya str., Pushkin, 196603, Saint Petersburg

References

  1. Gnipov PA, Baindurashvili AG, Brazol’ MA, et al. Preimushchestva rannego hirurgicheskogo lecheniya glubokih ozhogov shei u detej. Ortopediya, travmatologiya I vosstanovitel’naya hirurgiya detskogo vozrasta. 2020;8(1):25–34. doi: 10.17816/PTORS16298. (In Russ.)
  2. Saaiq M, Zaib S, Ahmad S. The menace of post-burn contractures: a developing country’s perspective. Ann Burns Fire Disasters. 2012;25(3):152–158.
  3. Mody NB, Bankar SS, Patil A. Post burn contracture neck: clinical profile and management. J Clin Diagn Res. 2014;8(10):NC12-7. doi: 10.7860/JCDR/2014/10187.5004
  4. Kurbanov UA, Davlatov AA, Dzhanobilova SM, Holov ShI. Hirurgicheskoe lechenie posleozhogovyh rubcov lica s kontrakturoj perioral'noj oblasti. Vestnik Avicenny. 2015;(3):7–15. (In Russ.)
  5. Vaganova NA. Novye hirurgicheskie sposoby lecheniya deformacij volosistoj chasti golovy, lica i shei s primeneniem ballonnogo rastyazheniya tkanej [dissertation]. Moscow; 2006. (In Russ.)
  6. Akita S, Hayashida K, Takaki S, et al. The neck burn scar contracture: a concept of effective treatment. Burns Trauma. 2017;5:22. doi: 10.1186/s41038-017-0086-8
  7. Seo D-K, Kym D, Hur J. Management of neck contractures by single-stage dermal substitutes and skin grafting in extensive burn patients. Ann Surg Treat Res. 2014;87(5):253–259. doi: 10.4174/astr.2014.87.5.253
  8. Povstyanoj NE. Vosstanovitel’naya hirurgiya ozhogov. Moscow: Meditsina; 1973. (In Russ.)
  9. Karvayal KF, Parks DK. Ozhogi u detey. Moscow: Meditsina; 1990. (In Russ.)
  10. Paramonov BA, Porembskiy BA, Yablonskiy VG. Ozhogi. Rukovodstvodlyavrachey. Saint Petersburg: SpecLit; 2000. (In Russ.)
  11. DiVincenti FC, Curreri PW, Pruitt BA Jr. Use of mesh skin autografts in the burned patient. Plast Reconstr Surg. 1969;44(5):464–467.
  12. Raff T, Hartmann B, Wagner H Germann G. Experience with the modified. Meek technique. Acta ChirPlast. 1996;38(4):142–146.
  13. Lattari V, Jones LM, Varcelotti JR, et al. The use of a permanent dermal allograft in full-thickness burns of the hand and foot: a report of three cases. J Burn Care Rehabil. 1997;18(2):147–155. doi: 10.1097/00004630-199703000-00010
  14. DeBruler DM, Blackstone BN, McFarland KL, et al. Effect of skin graft thickness on scar development in a porcine burn model. Burns. 2018;44(4):917–930. doi: 10.1016/j.burns.2017.11.011

Supplementary files

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2. Fig. 1. Patient K (11 years old); 2 years after the burn and grafting of granulating wounds with sieve skin autograft. Grade III cicatricial flexion contracture of the neck: a, pronounced retraction and pigmentation of the skin autograft; b, restriction of neck extension, smoothness of the cervicogenian angle, and opening of the mouth when extending the neck; c, the closest result of stage 1 neck flexion contracture grafting, complete engraftment of the skin autograft, and tension in the lower lip area was eliminated; d, the cervicogenian angle was formed; e, compression half mask for prevention of scar tissue hypertrophy; f, fixation of the neck with a cervical collar to counteract the process of skin autograft retraction; g, long-term result of stage 1 grafting of neck flexion contracture (after 6 months); the skin autograft was straightened; h, the cervicogenian angle was formed; cicatricial tension was preserved in the lower parts of the neck; i, the closest result of stage 2 grafting of the flexion contracture of the neck (14 days after surgery) with complete engraftment of the skin autograft, and the extension amplitude was restored; j, the neck contours were restored

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3. Fig. 2. Patient R (15 years old); 9 years after grafting of burn wounds with sieve skin autografts and 2 years after reconstructive surgery to eliminate neck contracture using a continuous full-thickness skin autograft in another clinic. Neck flexion contracture of degree II: a, pronounced retraction of the skin autograft and limitation of extension; b, smoothness of the cervicogenian angle and impairment of the neck contour; c, free skin autograft fixed to the wound bed; d, measures aimed at preventing retraction of the skin autograft and preserving the surgical results, compression half mask, and fixation of the neck in the cervical collar; e, long-term result of elimination of flexion contracture of the neck 1 year after plastic surgery, the skin autograft was straightened, and extension was fully restored; f, restored cervicogenian angle and neck contours

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4. Fig. 3. Patient Y (16 years old); 10 years after the burn and 6 years after reconstructive surgery to eliminate neck contracture in another clinic. Neck flexion contracture of degree II: a, hypertrophic cicatricial cords at the border of skin autografts and intact skin; b, retraction of skin autografts, limiting the amplitude of neck extension; c, the closest result of elimination of neck contracture using free skin grafting, the autografts were engrafted completely, and the neck extension amplitude was restored; d, the cervicomandibular angle was restored, and hypertrophic cicatricial cords were eliminated; e, fixation of the cervicogenian angle and prevention of scar hypertrophy using a compression half mask; f, long-term result of the elimination of neck contracture using free skin grafting, the amplitude of neck extension was preserved, and there was no scar tissue hypertrophy; g, the neck contour was restored

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5. Fig. 4. Patient S (10 years old); 2 years after grafting of a granulating neck wound with a sieve skin autograft. Degree IV of flexion cicatricial contracture of the neck with deformity of the neck and shoulder girdle: a, neck contour deformity and shoulder girdle displacement; b, sharp limitation of neck extension; c, long-term result (after 2 years) of stage 1 of surgical elimination of neck scarring, engrafted skin autograft in the lower part of the neck, and deformity of the shoulder girdle was eliminated; d, the amplitude of neck extension was increased; e, the closest result of stage 2 of surgical elimination of neck contracture, engrafted skin autografts, restoration of the contours of the neck and cervicogenian angle, and stabilization of the result in a compression mask; f, complete engraftment of skin autografts and an increase in the amplitude of neck extension; g, restoration of the contour of the neck and the cervicogenian angle

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Copyright (c) 2021 Filippova O.V., Afonochev K.A.

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