title: Perforator-based flaps for the treatment of burn scar contractures: a review.
abstract: Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.
authors.affiliation: Burn Center and Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Stekelenburg
authors.affiliation: Burn Center and Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, Academical Medical Center, Amsterdam, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Marck
authors.affiliation: Burn Center and Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, Isala, Zwolle, The Netherlands.
authors.forename: P D H M
authors.initials: PDHM
authors.lastname: Verhaegen
authors.affiliation: Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: K W
authors.initials: KW
authors.lastname: Marck
authors.affiliation: Burn Center and Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands.|Department of Plastic, Reconstructive, and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: P P M
authors.initials: PPM
authors.lastname: van Zuijlen
keywords: Burn; Contracture; Perforator flap; Scar