Clinical experience and analysis of length gain with the use of seven-flap plasty in burn contractures.
BACKGROUND
The seven-flap plasty despite its excellent surgical properties in the release of burn contractures is not widely adopted by surgeons. It is likely that the surgeons may have misgivings about its reliability, its ability to release a contracture and the length gain that can be obtained.


METHODS
A sponge model is described to determine the gain in length obtained from the seven-flap plasty. It also helps to understand the physical mechanics. Our clinical series of 55 release procedures with the use of seven-flap plasty is described. The anatomical regions include the neck, axilla, cubital fossa, hand, perineum, popliteal fossa and the foot. Forty-nine procedures were assessed for the immediate gain in length obtained post-release.


RESULTS
The sponge model demonstrated a length gain of 80%. The length of the contractures to be released ranged from 1 to 14 cm. The immediate length gain obtained in the clinical series ranged from 60 to 233% (average=105%).


CONCLUSIONS
The theoretical length gain in z-plasty is of little clinical significance. A host of factors such as lateral laxity, number of flaps, angle at the tips, the anatomic region, and the cause of the contracture determine the actual clinical length gain obtained following a seven-flap plasty release procedure.
Daya
M
M
Department of Plastic and Reconstructive Surgery, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa. dayam@iafrica.com
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing