Postburn dyspigmented scar contractures of the upper extremity often require aesthetic improvement. The ideal reconstruction of this deformity remains a challenge because the various available skin grafts and flaps result in skin colour mismatches, prominent marginal scars and donor morbidity. Postburn scar contractures and dyspigmented areas of the upper extremity can be improved by a combination of dermabrasion and Alloderm(®) graft over scar-releasing defect. Their raw surfaces are subsequently re-surfaced with thin split-thickness skin graft (0.005-0007 inches thick). Twenty-seven patients with wide dyspigmented scar contractures of the upper extremity underwent the combined techniques described by us. The median patient age at burn incidents was 3 years and at operation was 24 years. Median thin skin graft area was 180cm(2), and the median AlloDerm(®) graft area was 40cm(2). Thin skin and AlloDerm(®) grafts took root completely in all patients without re-grafting. Follow-up periods ranged from 30 to 67 months (average 47.6 months). Re-pigmentation was achieved in all cases and all scar contractures were adequately released and treated with an AlloDerm(®) graft. Paired differences between preoperative and postoperative parameters as determined by the Vancouver Scar Scale (VSS) were significant. Focal hypertrophic scar and reddish-coloured graft sites gradually improved over 3-4 years postoperatively. Graft margin and donor scars were inconspicuous. Our described combined technique was found to treat these deformities effectively. We suggest that the use of Alloderm(®) and thin skin grafting be considered in patients concerned about this type of cosmetic disfigurement.

译文

烧伤后上肢的疤痕挛缩通常需要改善美学。这种畸形的理想重建仍然是一个挑战,因为各种可用的皮肤移植物和皮瓣会导致皮肤颜色不匹配,明显的边缘疤痕和供体发病率。烧伤后的疤痕挛缩和上肢的呼吸困难区域可以通过磨皮和异种动物的组合来改善 (®) 移植超过瘢痕释放缺损。它们的原始表面随后用薄的裂厚皮肤移植物 (0.005-0007英寸厚) 重新表面。27例上肢广泛的疤痕挛缩患者接受了我们描述的联合技术。烧伤事件的中位患者年龄为3岁,手术年龄为24岁。中位值为180厘米 (2),中位值为同种异体 (®) 移植面积为40厘米 (2。皮肤薄、皮肤薄 (®) 移植物在所有患者中完全生根,无需重新移植。随访期为30至67个月 (平均47.6个月)。在所有情况下均实现了色素沉着,并且所有疤痕挛缩均得到充分释放并用异种动物治疗 (®) 嫁接。由温哥华疤痕量表 (VSS) 确定的术前和术后参数之间的配对差异显着。术后3-4年,局灶性肥厚性瘢痕和红色移植物部位逐渐改善。移植物边缘和供体疤痕不明显。我们所描述的组合技术被发现可以有效地治疗这些畸形。我们建议使用Alloderm (®),对于这种类型的化妆品毁容的患者,应考虑进行薄皮肤移植。

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