Elsevier

Burns

Volume 31, Issue 7, November 2005, Pages 894-900
Burns

Treatment of axillary burn scar contracture using opposite running Y–V-plasty

https://doi.org/10.1016/j.burns.2005.04.028Get rights and content

Abstract

Burn scar contractures are frequently observed following full-thickness burns of the axillary area. Such contractures are traditionally reconstructed sometime within the first year after injury with therapeutic methods including skin grafting, Z-plasty, local/regional flap, island flap, perforator flap, free flap or combination thereof. Flap methods have many advantages over split skin grafting, including less likelihood of recurrence of contracture as well as making prolonged splinting unnecessary. However these flaps are cumbersome, unattractive, and apparently distort the axillary hair. Moreover, they have a risk of flap necrosis or marginal vascular compromise. A new opposite running Y–V-plasty presented here is designed to overcome those dilemmas. This procedure was performed in eight cases with good functional recovery and cosmetic appearance. It is also a simple, adaptable, and reliable method. The range of motion of shoulder joint was also satisfactorily achieved since axillary contracture scars were almost completely released. Most of all the procedure can be repeated if the release is not enough. In short, the opposite running Y–V-plasty is a good alternative method when we consider the reconstruction of axillary burn contracture.

Introduction

Axillary burn scar contractures constitute one of the most complicated challenges to all burn patients and surgeons. Some authors have advocated that the best therapy for the burned axilla is split-thickness skin grafting as soon as possible after injury [1], [2]. However this is followed immediately by immobilization of the shoulder in an abduction splint with constant pressure therapy over the axillary wound. Although variable splints have been devised for the comfort, applicability, and durability, this is in itself a difficult task [3], [4], [5]. Skin grafting tends to contract in spite of splint, massage, and rehabilitation. Several alternatives have been proposed, including Z-plasty, local flaps, regional flaps, transposition flaps, rotating flaps, axial flaps, perforator flaps, and free flaps [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], but these flaps still have some disadvantages such as a bulky, unattractive appearance, the distortion of axillary hair with possible vascular disturbance, and brachial plexus injury [19].

Early in 1975, Hirshowitz et al. combined double Z-plasty and Y–V advancement for thumb web contracture [20]. Four years later, King used the multiple Y–V-plasty to treat Dupuytren's contracture by extensive fasciectomy [21]. The same year, Shaw and Li resurfaced with multiple Y–V advancement flaps to release broad scar contracture following burn [22]. Later, “continuous Y–V-plasty” was presented by Olbrisch for cord-like scar release and the technique has superseded the Z-plasty in the treatment of contracted burn scars [23]. The term “running Y–V plasty” was first clinically used by Xu in 1988 [24]. Olbrisch and Lai et al. subsequently reported the use of running Y–V-plasty for lengthening cord-like burn scar without the complication of tips of transposed skin flaps necrosis from Z-plasty in 1991 and 1995, respectively [25], [26].

Running Y–V-plasty, in the literature, has been defined as keeping the stems of the Ys keeping on the same side of the tip in each V flap at about 1/3–1/2 length of the Vs’ arm or modified in a ‘cut-as-you-go’ manner [25], [26]. What we present here is different from the traditional running Y–V-plasty in that the stems of the Ys are located alternately in opposite tip of V flap to get more advancement and lengthening. We carried out a total eight cases of axillary burn scar contracture using this “Opposite Running Y–V-Plasty (ORYVP)” technique and we report here on the results.

Section snippets

Patients and methods

The demography of these eight cases is summarized in Table 1.

Results

A total of eleven ORYVP procedures (six in anterior and five in posterior axilla) were performed in eight cases (three in right and five in left side) (Table 1). There were six male and two female patients and their mean age was 18.8 years old (range from 4 to 43 years old). The cause of accident was evenly distributed between scald (four cases) and flame burns (four cases). The average period from burn injury to ORYVP procedures was 64.5 months. The mean range of motion in shoulder abduction

Discussion

Traditional running Y–V-plasty could lengthen quite well to release the burn scar and apply in many clinical conditions [24], [25], [26]. The question, though, is why the opposite running Y–V-plasty (ORYVP) may lengthen more than traditional running Y–V-plasty. The reason is that ORYVP can advance in two directions but running Y–V plasty only advances to one side.

Theoretically, we assume that the angle of preoperative zigzag Vs is 90° and the stem of each of Ys equals the arm of the Vs. For

Acknowledgements

We are deeply indebted to Hui-Lan Lin SN and An-Pei Kao MPH for their diligent and careful collection of the data in this study. We also acknowledge Miss Chii-Shur Chiou and Miss Jing-Yi Tian for their kind help in the preparation of this manuscript.

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