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Review
. 2019 Feb;27(1):66-77.
doi: 10.1177/2292550318767433. Epub 2018 Apr 19.

A Review of Perforator Flaps for Burn Scar Contractures of Joints

Ryan T Lewinson  1 , Lauren C Capozzi  1 , Kody Johnson  2 , Alan Robertson Harrop  2   3 , Frankie O G Fraulin  2   3 , Duncan Nickerson  2
Affiliations
Review

A Review of Perforator Flaps for Burn Scar Contractures of Joints

Ryan T Lewinson et al. Plast Surg (Oakv). 2019 Feb.

Abstract
in English, French

Objective: Perforator flaps are one possible surgical treatment for burn scar contractures; however, a review of evidence on this topic is lacking.

Methods: MEDLINE was searched for articles related to perforator flaps for burn contractures. Following title and abstract screen, full texts were searched to identify articles describing perforator flaps for burn scar joint contractures. Data were extracted and summarized descriptively. Only articles that contained ≥10 patients with burn scar contracture were considered.

Results: Two hundred forty-eight articles were identified, of which 17 met criteria for review. Of these, 16 were low-quality case series, while 1 was an open randomized controlled trial. In total, perforator flaps were performed on 339 patients (age range: 3-75 years), with the most common contracture locations being cervical (n = 218) and knee (n = 41). Nine of the 17 articles described a rehabilitation strategy. In general, functional outcomes were excellent, with the majority of patients experiencing return of normal joint range of motion and no recontracture. Compared to full-thickness skin grafts, perforator flaps showed greater improvements in joint range of motion. Cosmetically, perforator flaps were shown to have good color match with surrounding tissue, good contour around anatomical landmarks, and improved overall patient appearance. The most common complications were marginal flap necrosis (n = 26 patients) and venous congestion (n = 17 patients).

Conclusions: Preliminary evidence from low-quality case series and 1 high-quality trial suggests perforator flaps may be successful for resurfacing released burn scar contractures; however, there is a need for additional trials comparing perforator flaps to other approaches.

Objectif: Les lambeaux perforateurs font partie des traitements chirurgicaux des contractures des cicatrices de brûlure, mais il n’y a pas d’analyse des données probantes sur le sujet.

Méthodologie: Les chercheurs ont effectué une recherche dans MEDLINE pour extraire les articles liés aux lambeaux perforateurs pour les contractures causées par des brûlures. Après un filtrage en fonction des titres et des résumés, ils ont fouillé les textes intégraux et retenu les articles décrivant les lambeaux perforateurs pour corriger les contractures causées par des cicatrices de brûlure. Ils ont extrait les données et procédé à un résumé descriptif. Ils n’ont évalué que les articles portant sur au moins dix patients ayant des contractures causées par des cicatrices de brûlure.

Résultats: Les chercheurs ont extrait 248 articles, dont 17 respectaient les critères d’analyse. De ce nombre, 16 étaient des séries de cas de faible qualité et un, un essai aléatoire et contrôlé ouvert. Au total, 339 patients (de trois à 75 ans) ont reçu des lambeaux perforateurs, et les contractures étaient surtout situées dans la région du cou (n = 218) et du genou (n = 41). Neuf des 17 articles décrivaient une stratégie de réadaptation. En général, les résultats fonctionnels étaient excellents, car la majorité des patients retrouvaient une amplitude de mouvements normale et n’avaient plus de contractures. Par rapport aux greffes cutanées pleine épaisseur, les lambeaux perforateurs assuraient une plus grande amélioration de l’amplitude du mouvement articulaire. Sur le plan esthétique, les lambeaux perforateurs assuraient un bel appariement de couleur par rapport aux tissus avoisinants, un beau contour des repères anatomiques et une amélioration globale de l’apparence. Les principales complications étaient une nécrose du lambeau marginal (n = 26 patients) et une congestion veineuse (n = 17 patients).

Conclusions: D’après les données probantes préliminaires de séries de cas de faible qualité et d’un essai de haute qualité, les lambeaux perforateurs peuvent être utiles pour le resurfaçage de contractures causées par des cicatrices de brûlure. D’autres études devront être réalisées pour comparer les lambeaux perforateurs à d’autres approches.

Keywords: burn; cosmetics; flap; mobility; plastic surgery; rehabilitation; skin.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Process flowchart for selecting articles for review. Some articles contained patients with burn contracture and other surgical indications. In these cases, the article was only retained for review if outcomes specific to the burn contracture patients were reported.
Figure 2.
Figure 2.
Definitions for method of flap elevation used in this review. A, Pedicled flap, where a bridge of healthy tissue remains intact with a known cutaneous perforator supplying the elevated flap. B, Island flap, where a perforator is dissected but left intact. C, Free flap, where the perforator is dissected and then transected with the intent of anastomosing the vessel at a distant site. In each, the red lines represent the perforator source to the flap. (A) and (B) may be referred to as local flaps, as their use is restricted by the length and/or maneuverability of the tissue or vascular pedicle.
See this image and copyright information in PMC

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