Burn wounds, like many other mechanical injuries of the human body, often heal with the formation of coarse scar tissue. If the damaged area is easily hidden by clothing, and the resulting scar does not cause significant discomfort to the patient – scar removal is optional. But in most cases, modern methods of plastic surgery help to get rid of such skin defects. By creating defects in appearance, post-burn deformities can largely affect various areas of human life. Skin plasty is the main method for eliminating post-burn deformities and contractures. Read about the methods of surgical rehabilitation of patients with the consequences of burns on estet-portal.com.
Treatment of post-burn scars with skin grafting
The method of skin grafting is selected individually in each individual case, depending on the severity of the deformities, the degree of contracture, the condition of the surrounding tissues, location, age, gender of the patient, and some other factors. Local plasty is the most reliable, simple and effective way to eliminate defects after burn injuries. It includes several types of surgical interventions: plasty with counter triangular, trapezoidal, & nbsp; rotational, V- and U-shaped flaps. Local plasty is possible with mild contractures of the 1st-2nd degree and soft scars. In other cases, some other types of skin grafting are the method of choice.
Skinplasty:
- combined skin plasty to eliminate post-burn scars;
- skin grafting using pedicled flaps;
- free grafting of complex flaps with microvascular anastomoses.
Combined skin grafting to eliminate post-burn scars
The use of combined skin grafting allows you to expand the scope of surgical intervention for severe deformities and contractures. With combined skin plastic surgery, functional and cosmetic results are improved, as well as the number of surgical interventions is reduced, and the treatment time is reduced. To achieve maximum results, the following principles of combined plastic surgery should be followed:
- functionally important areas, such as exposed bones, tendons, joints, nerve and vascular formations, should be covered with skin-fat flaps;
- the rest of the wound surface is closed with thick split or, if possible, full-thickness grafts;
- flaps from local tissues can be triangular, trapezoidal, U-shaped or other shape;
- when cutting out and moving the flaps, it is necessary to maintain their adequate blood supply.
Skin grafting with pedicled flaps
Currently, there are many modifications of skin grafting using pedicled flaps, which are used for gross deformities and pronounced contractures, when joints, bones and tendons are involved in the pathological process, which could not be closed with local tissues. The most reliable are flaps with an axial type of blood supply: skin-subcutaneous, skin-muscular and skin-fascial. With sufficient knowledge of the topography and areas of adequate blood supply to the supply vessel, the doctor can form large-area flaps, the length of which may be several times greater than the width. The undoubted advantage of muscle flaps is the possibility of their use not only in reconstructive surgery, but also in acute burns, as well as the resistance of such flaps to infection.
Free grafting of complex flaps with microvascular anastomoses
Free grafting of complex flaps with microvascular anastomoses It is used for skin grafting in cases where there is damage to bones, tendons, joints and other deep structures, but there is no possibility of cutting out flaps from surrounding tissues. With the help of free transplantation of skin flaps, it is possible to simultaneously transfer skin-subcutaneous, skin-fascial, skin-muscular and skin-muscular-bone tissue complexes from distant parts of the body to the affected surface, while improving its blood supply, maintaining the viability of deep structures and reducing the rehabilitation period. patient. The disadvantages of microsurgical transplantation are the duration of the operation, the complexity of postoperative management of the patient, as well as possible complications that can lead to unsatisfactory results.<
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