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Investigation of the “Surgical Cuts CO₂ Laser Therapy Technique” to Treat Minor Burn Scar Contractures in Children

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Eur. Burn J. 2023, 4(3), 293-302; https://doi.org/10.3390/ebj4030027 - 19 Jul 2023

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Abstract

Fractional carbon dioxide (CO₂) laser therapy has been shown to improve scar contractures following burns. However, the benefits of using other CO₂ laser techniques to treat burn scar contractures are relatively unknown. This pilot study investigated a CO₂ laser [...] Read more.

Fractional carbon dioxide (CO₂) laser therapy has been shown to improve scar contractures following burns. However, the benefits of using other CO₂ laser techniques to treat burn scar contractures are relatively unknown. This pilot study investigated a CO₂ laser technique in which a series of perpendicular “surgical cuts” were created along the contracture. The aim of this study was to evaluate the effectiveness of using the “surgical cuts CO₂ laser technique” in pediatric patients. This study included 12 participants with minor hand burn scar contractures that received one CO₂ laser treatment using the surgical cuts technique. Trained assessors measured contractures pre- and post-laser therapy by assessing range of motion (ROM), digit length, and/or hand-span. All contractures were secondary to contact burns with the mean participant age equal to 5.5 years (SD 3.9). For all participants, at least one of the measured characteristics (ROM, hand-span, and digit length) improved after treatment. This pilot study demonstrated the benefit of using the surgical cuts CO₂ laser technique to treat minor burn scar contractures. Future investigations are needed to further evaluate its effectiveness in comparison to the fractional CO₂ laser therapy technique. Full article

(This article belongs to the Special Issue Reconstruction after Burn Injury: An Integrative Approach)

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Open AccessCommunication

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

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Geneviève Ferland-Caron

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Peter O. Kwan

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Edward E. Tredget

Eur. Burn J. 2023, 4(2), 248-258; https://doi.org/10.3390/ebj4020022 - 09 Jun 2023

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Abstract

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they [...] Read more.

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries. Full article

(This article belongs to the Special Issue Reconstruction after Burn Injury: An Integrative Approach)

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Open AccessBrief Report

The Two Facing Square Flaps Method for Release of Anterior and Posterior Axillary Line Burn Contractures

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Whitney Laurel Quong

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Rei Ogawa

Eur. Burn J. 2023, 4(4), 529-536; https://doi.org/10.3390/ebj4040034 - 04 Oct 2023

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Abstract

With improved burn outcomes and survival rates, the focus of management in large burns has shifted from merely survival towards optimizing form and function for the burn survivor. Due to its unique structural features and functional demands however, the axilla is prone to [...] Read more.

With improved burn outcomes and survival rates, the focus of management in large burns has shifted from merely survival towards optimizing form and function for the burn survivor. Due to its unique structural features and functional demands however, the axilla is prone to contracture formation, and remains complex to reconstruct. Where contractures involve both the posterior and anterior axillary lines, the two facing square flaps method is a suitable choice for a wide range of patients. The flap design is flexible, and is relatively safe with a sufficient blood supply. Superior lengthening of approximately 3–4 times can be achieved, and is maintainable. In this surgical technique paper, we describe the strategy of the two facing square flaps, and present two patterns of its application, with representative cases of the local flap method. Full article

(This article belongs to the Special Issue Reconstruction after Burn Injury: An Integrative Approach)

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