title: Perforator-based interposition flaps for sustainable scar contracture release: a versatile, practical, and safe technique.
abstract: BACKGROUND
  Problematic scar contractures are frequently observed following extensive (burn) wounds. In this study, the authors investigated the applicability of islanded and nonislanded perforator-based interposition flaps as a technique for release of scar contracture.
  
  
  METHODS
  Patients requiring surgery for scar contracture release were included. Preoperatively, a suitable perforator was identified by color Doppler sonography. The flap design was tailored according to the localization of this perforator and the anticipated defect. Flap measurements were obtained intraoperatively and at follow-up. Supple scar tissue was included in the flap design when necessary, to increase the applicability of this concept in extensively burned patients. Flaps were converted into island flaps on indication to circumvent significant kinking of the flap base and compromised tissue perfusion.
  
  
  RESULTS
  Twenty-two flaps were performed, of which four were converted into island flaps. All flaps survived, but in four cases necrosis of the tip was observed. After a mean follow-up of 7.8 months, the width and surface area of the flaps had expanded to 123 percent (range, 40 to 311 percent) and 116 percent (range, 60 to 246 percent), respectively. One flap was converted into a full-thickness graft during the initial operation.
  
  
  CONCLUSIONS
  This concept of perforator-based interposition flaps was found to be a reliable and versatile technique for broad scar contractures. Moreover, it allows intraoperative tailoring, as the flap base can be islanded when indicated. Nevertheless, additional venous outflow is warranted and operative time is saved if the flap base remains intact.
authors: Beverwijk and Amsterdam, The Netherlands From the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive, and Hand Surgery, the Burn Centre, and the Department of Radiology, Red Cross Hospital; and the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center Amsterdam.
authors: Pauline D H M
authors: PDHM
authors: Verhaegen
authors: Carlijn M
authors: CM
authors: Stekelenburg
authors: Antoine J M
authors: AJM
authors: van Trier
authors: Frank B
authors: FB
authors: Schade
authors: Paul P M
authors: PPM
authors: van Zuijlen
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D019115:Fasciitis, Necrotizing / Q000150:complications; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D055815:Young Adult