Saffet ULUTAŞ, Serdar KARA, Mustafa Nihat KOÇ, Berat ÇİĞDEM

Use of Subcutaneous Pedicled Rhomboid Flap Technique for Surgical Treatment of Burn Contractures

Objective: Release of contractures mainly due to burn scars mandates reconstruction with a well-vascularized tissue and an aesthetically acceptable result. Many techniques of the reconstructive ladder have been applied. Local flaps are the first choice. In thisstudy, we present a superior local flap alternative, the diamond flap (subcutaneous pedicled rhomboid flap), for the reconstructionof contractures.Methods: In a 1-year period, 23 patients underwent contracture release using a diamond flap. The elongation of the distancebetween two reference points on the contracture line was measured.Results: A total of 23 contractures due to burn scars were released via a diamond flap in 23 patients. No flap loss was seen. Patientswere followed up for an average of 18 months, and no recurrence of contractures was seen. Elongation of the contracture lineswas measured as the distance between two reference points preoperatively marked. We observed 60%–200% elongation of thecontracture line during early postoperative measurement and 30%–125% elongation during late postoperative measurementdepending on the anatomical site and original length of the contracture.Conclusion: Diamond flap should be kept in mind as an alternative for contracture release, especially in cases of wide, long, multiple adjacent contractures located in poorly vascularized areas.

PDF

___

Ertas NM, Kücükcelebi A, Bozdogan N, Özdil K, Celebioglu S. Treatment of recontracture with the subcutaneous pedicle rhomboid flap. Plast Reconstr Surg 2006; 117: 1590.
Suzuki S, Isshik N, Ishileawa K, Ogriwa Y. The use of subcutaneouspedicle flaps in the treatment of postburn scar contractures. Plast Reconstr Surg 1987; 80: 792–8.
Uzunismail A, Kahveci R, Özdemir A, Bozdogan N, Yüksel F. Therhomboid release: a new approach to the management of digital burncontractures. Ann Mediterran Burns Club 1994; 8: 94–7.
Askar I. Double reverse V–Y-plasty in postburn scar contractures: anew modification of V–Y-plasty. Burns 2003; 29: 721–5.
Bozdogan N, Ertas NM, Gündeslioglu O, Celebioglu S. Release of first web space contractures using rhomboid flap. Turk J Plast Reconstr Aesthetic Surg 2002; 10: 94.
Ertas NM, Bozdogan N, Uscetin I , Kücücelebi A, Celebioglu S. The use of subcutaneous pedicle rhomboid flapin the treatment of postburn scar contractures. Ann Plast Surg 2004; 53: 235.
Ertas, NM, Kücükcelebi A, Bozdogan N, Celebioglu S. The use of subcutaneous pedicle multiple rhomboid flapsin the treatment of long postburn scar contractures. Burns 2004; 30: 594.
Iwnagwu FC, Wilson D, Bulre F. The use of skin grafts in postburn contracture release: a 10 year review. Plast Reconstr Surg 1999; 103: 1198–204.
Furnas DW. The four fundamental functions of the Zplasty. Arch Surg 1968; 96: 458.
Hyakusoku H, Yamamaoto T, Fumirn M. The propeller flap method. Br J Plast Surg 1991; 44: 53–4.
Serkan Y, Gulden A, Mithat A, Misirlioglu A, Akoz T. Antrelateralthigh flap in the treatment of postburn contractures of the knee. Plast Reconstr Surg 2003; 111: 1630–7.
Prakash V. A new concept for the management of post burncontracture. Plast Reconstr Surg 2000; 106: 217-37.
Hudson DA. Some thoughts on choosing a Z-plasty: the Z madesimple. Plast Reconstr Surg 2000; 106: 665-71.
Cooper MACS. The multiple Y–V plasty in linear burn scar contracturerelease. Br J Plast Surg 1990; 43: 145-9.
Suliman MT. Experience with the 7 flap-plasty for the release of burnscontractures. Burns 2004; 30: 374–9.
Goodacre T. Surgical techniques: the V to Y plasty. Repair Reconstr 2001; 2: 13.
Hashem AM. Use of the 5-flap Z plasty in digital flexioncontractures. Ann Plast Surg 2009; 63: 503–6.
Pegahmehr M, Hafezi F, Naghibzadeh B, Nouhi A. MultipleV–Y advancement flaps: a new method for axillary burncontracture release. Plast Reconstr Surg 2008; 122: 44–5.
Ertas NM, Kücükcelebi A, Erbas O, Bozdoğan N, Celebioglu S. Comparison of Elongation Provided by Subcutaneous Pedicle Rhomboid Flap and Z-Plasty in Rat Inguinal Skin Plast Reconstr Surg 2006; 117: 486.
Ertas NM, Kücükcelebi A, Bozdogan N, Erbas E, Celebioglu S. Rate of elongation provided by multiple subcutaneouspedicle rhomboid flaps: An experimental study inthe rat inguinal skin. Burns 2004; 30: 467.
Hirshowitz B, Karev A, Rousso M. Combined double Z-plasty and Y-Vadvancement for thumb web contracture. Hand 1975; 7: 291–3.
Szymanowski J. Operations on the surface of the human body. Kiev: I and A Davidenko; 1856.
Szymanowski J. Handbuch der Operativen Chirurgie.Braunschweig: Von Friedrich Vieweg; 1870.
Shaw DT, Li CS. Multiple Y-V plasty. Ann Plast Surg1979; 2: 436–40.
Bier A, Braun H, Kummell H. Chirurgische Operationslehre, vol. I. Leipzig: Johann Ambronius Barth; 1922.