ObjectiveTo study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. MethodsA total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and preexpanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. ResultsThe patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). ConclusionPre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.
Objective To explore the feasibility and effectiveness of sideburn reconstruction using the expanded island scalp flap based on the parietal branch of the superficial temporal vessel. Methods Between February 2012 and April 2015, 7 patients underwent sideburn reconstruction. There were 3 males and 4 females with an average age of 15 years (range, 4-44 years). The etiologies included burn injury in 3 cases, trauma in 1 case, radiation therapy in 1 case, and congenital melanocytic nevus in 2 cases. The size of the sideburn defects ranged from 5.0 cm×3.5 cm to 16.0 cm×10.0 cm. At the first-stage, according to the sideburn defect, a tissue expander of the appropriate size was inserted beneath the superficial temporal fascia which containing the parietal branch of the superficial temporal vessel. Postoperatively, regular saline injection was commenced. After 3-6 months of the first-stage surgery, the expander was adequately inflated. While the second-stage surgery was performed, the lesion was excised and the tissue expander removed. The expanded island scalp flap based on the parietal branch of the superficial temporal vessel was harvested and advanced towards the defect of the sideburn according to the contralateral normal one, and the size of flap ranged from 8 cm×3 cm to 17 cm×11 cm. The donor site was closed primarily. Results All flaps survived and the wound and donor sites were healed primarily without any complication. All patients were followed up 1-36 months (mean, 9.8 months). The profile, hair density, and hair direction of the new sideburn were similar to the contralateral sideburn. In 1 patient, the reconstructed sideburn was a little larger than the contralateral normal one. After laser hair removal, the patient was satisfied with the appearance. Conclusion The expanded island scalp flap based on the parietal branch of the superficial temporal vessel provides an effective option for the sideburn reconstruction, which presents with the similar appearance to the contralateral one.