PLASTIC SURGICAL TECHNIQUES FOR THE TREATMENT OF BURN ABNORMAL SCARS IN PEDIATRIC PATIENTS
Post-burn scars have a major impact on the quality of life of pediatric patients, both from a psychological and functional point of view. Pediatric patients with post-burn scars usually have difficulties integrating into the collective due to the low self-esteem determined by the poor aesthetic outcome of the deep or large burns. From a functional standpoint, burn contractures are a significant cause of disability in burn survivors worldwide, as they can affect the tendons and muscles or impair joint mobility. The statistical information that results from this study plays a role in improving the therapeutic protocol. The reconstruction methods of post-burn abnormal scars can be used in order to prevent or to treat the psychological consequences and the functional disability of the affected segment. Material and methods: The study includes a group of 147 patients aged between 1-24 years, male and female, admitted through the emergency or outpatient service in the Department of Plastic Surgery and Reconstructive Microsurgery in the “Sf. Maria” Emergency Children Hospital Iasi. Results: From the total number of pediatric patients with post-burn scarring sequelae (n=147), 32.65% (n=48) were treated by local triangular skin flaps plasty, 18.36% (n=27) by full-thickness skin graft plasty, 12.92% (n=19 ) by scar excision and suture, 11.56% (n=17) by tissue expander implant, 7.48% (n=11) by employing the Z-plasty technique, 5.44% (n=8) by associating a local triangular skin flap with a full-thickness skin graft, 5.44% (n=8) by combining Z-plasty with a full-thickness skin graft, 2.04% (n=3) benefited from plasty with synthetic dermis (Integra®), 1.36% (n=2) were treated by degranulation, 1.36% (n=2) by Triamcinolone injection, less than 1% (n=1) of patients received dermabrasion or hair transplantation. Conclusions: Skin flaps represent the most effective and frequently utilized method of treatment of post-burn scar sequelae.
2. D'Souza AL, Nelson NG, McKenzie LB: Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics 2009; 124: 1424-1430
3. Kevin C. Chung, Grabb and Smith’s Plastic Surgery, Wolters Kluwer, 2020, 684-700.
4. Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds: chronic wound care and management. J Am Acad Dermatol 2016; 74: 607-625.
5. Prema Dhanraj, Plastic Surgery Made Easy.New Delhi: Jaypee Brothers Medical Publishers, 2006, 102-112.
6. Prohaska J, Cook C, Skin grafting. Stat Pearls, US National Library of Medicine, 2019.
7. Geoffrey C, Gurtner Peter C, Neligan D, Liu Z. Plastic Surgery, Fourth Edition, Elsevier, 2018, 214-314.
8. Martha F, Deepak MK, Khawaja GR. Tissue expansion reconstruction of head and neck burn injuries in pediatric patients-A systematic review. J PRAS Open 2018; 18: 78-97.
9. Bozkurt A, Groger A, O'Dey D, Vogeler F, Piatkowski A, Fuchs P. Retrospective analysis of tissue expansion in reconstructive burn surgery: evaluation of complication rates. Burns 2008; 34(8): 1113-1118.
10. Monroy MFDLC, Kalaskar DM, Rauf KG. Tissue expansion reconstruction of head and neck burn injuries in pediatric patients-a systematic review. JPRAS 2018; 18: 78-97.
11. Kavita SS, Ralston D, Giblin V, MacNeil S. Engineering of Accepted Skin-Equivalent Tissue for Tissue Repair: Current State and Perspectives. Encyclopedia of Tissue Engineering and Regenerative Medicine 2019, 285-298.
12. Stiefel D, Schiestl C, Meuli M. Integra Artificial Skin® for burn scar revision in adolescents and children. Burns 2010; 36(1): 114-120.
13. Pereima MJL, Feijó R, da Gama FO, de Oliveira Boccardi R. Treatment of burned children using dermal regeneration template with or without negative pressure. Burns 2019; 45(5): 1075-1080.
14. Shehab J, Quentin F, El-Muttardiab N, Dziewulskiab P. A systematic review of the applications of free tissue transfer in burns. Burns 2014; 40(6): 1059-1070.
15. Hur GY, Seo DK, Lee JW. Contracture of skin graft in human burns: effect of artificial dermis. Burns 2014; 40(8): 1497-1503.
16. Yamamoto Y, Fujihara H, Kirita M, Soejima K. Micronized dermal grafts (Rigenera™) and split-thickness skin grafts alone or in combination for deep dermal burn wounds. Burns Open 2022; 6(4): 212-217.
17. Nguyen DQ, Potokar TS, Price P. An objective long-term evaluation of Integra (a dermal skin sub-stitute) and split-thickness skin grafts, in acute burns and reconstructive surgery. Burns 2010; 36(1): 23-28.
18. Theddeus OH, Prasetyono, Patricia M. Sadikin, Debby KASaputra, The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review. Burns 2015; 41(5): 890-906.
19. Chinmaya Chiranjibi Samal, Suvashis Dash, Karoon Agrawal, Raman Tandon, Comparative evalua-tion of three methods of skin graft fixation for split-thickness skin graft after release of post burn contracture of the neck. Burns 2019; 45(3): 691-698.
20. Zheng XP, Chen J, Chen TS, et al. Preliminary effect observation on the application of micro-negative pressure in children with small-area deep partial-thickness burn. Chinese Journal of Burns 2019; 35(10): 720-725.
21. Yoshino Y, Kubomura K, Ueda H, Tsuge T, Ogawa R. Extension of flaps associated with burn scar reconstruction: a key difference between island and skin-pedicled flaps. Burns 2018; 44(3): 683-691.
22. Anthonissen M, Daly D, Janssens T, Van den Kerckhove E. The effects of conservative treatments on burn scars: a systematic review. Burns 2016; 42(3): 508-518.
23. Issler-Fisher AC. The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars-a narrative review with illustrative cases. Burns 2023; 49(3): 707-771.
24. Schiefer JL, Rath R, Ahrens E, et al. Evaluation of scar quality after treatment of superficial burns of the hands and face with Dressilk or Biobrane-An intra-individual comparison. Burns 2018; 44(2): 305-317.
25. Vana LPM, Battlehner CN, Ferreira MA, Caldini EG, Gemperli R, Alonso N. Comparative long-term study between two dermal regeneration templates for the reconstruction of burn scar contractures in humans: Clinical and histological results. Burns 2020; 46(3): 596-608.
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