Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 442 - файл
.pdf
32 How toSurgically Reconstruct Acute andChronic Burn Wounds inLow- andMiddle-Income Countries
https://t.me/medicina_free
421
Figs. 32.71–32.74 Release of upper arm /chest contracture. Arm pit reconstruction with fasciocutaneous transposition ap from upper arm. Wounds covered with meshed STSG.Before/after shown here
422
https://t.me/medicina_free
Figs. 32.75 and 32.76 Linear scar crossing the elbow joint. Thick scar proximal of upper forearm.Release of linear
scar with Z-plasty. Thick scar release, covered with STSG
E. Eriksen
Figs. 32.77–32.82 A 24-year-old student with history of
ame burn injury 5years back. Post burn contracture of
right hand with luxation of the IP joint of the thumb, wrist
contracture, and moderate syndactyly between the ulnar
ngers. Contracture release/excision of scar tissue of
wrist and thumb. IP joint of thumb reduced and transxed
with a K-wire. FTSG applied to the wrist, thumb, and
radial part of the dorsum of the hand, and release of ulnar
syndactyly with FTSG
32 How toSurgically Reconstruct Acute andChronic Burn Wounds inLow- andMiddle-Income Countries
https://t.me/medicina_free
423
Figs. 32.83–32.87 Case Presentation: The patient had a third degree contact burn both palms from hot oven.
Contracture release with FTSG
424
https://t.me/medicina_free
Groin andLower Limb
E. Eriksen
Figs. 32.88–32.91 A patient with a chronicabdominal
and groinwoundrequiring wide excision. FTSG applied
to both groins. Remaining wound covered with meshed
STSG.The splint is practical in keeping the legs far apart,
also helpful during dressing change
32 How toSurgically Reconstruct Acute andChronic Burn Wounds inLow- andMiddle-Income Countries
https://t.me/medicina_free
425
Knee Joint
1. Burn contractures of the knee joints are common and disabling. There are several important points to remember when planning knee
joint contracture release.
2. The common peroneal nerve may easily be
overstretched during the release procedure as
it winds around the neck of the bula.
3. The posterior joint capsule has most likely
become tight.
4. The rst step is to excise all scar tissue. This
will certainly enable the joint to be carefully
extended. No force should be applied to
extend the joint. The joint should be stabilized
either with an external xator, or wooden
bars. Continue with daily dressing.
5. Further extension of the joint may be done
2–3 times per week under sedation. No force
to be applied. The joint will often reach full
extension in a couple of weeks.
6. Once the joint is fully extended, the popliteal
area should be covered with a FTSG. Remaining
wounds with meshed STSG. Keep the external
xator until grafts have healed well. POP splints
may be used for another 4–6weeks, depending
on the initial severity of the contracture.
7. In longstanding cases, the cartilage might
have disintegrated, making the extended joint
painful. The only solution would be arthrodesis to avoid a painful unstable joint.
8. One might argue that fasciocutaneous aps
may give a better solution to the popliteal
joint compared to FTSG. This may certainly
be the case, under favorable conditions, slim
individuals, limited burns with ample healthy
skin for a transposition ap. One must be sure
the ap would reach the opposite side. In case
of a bulky ap due to the amount of subcutaneous tissue, the situation is different.
9. The main advantages of using a FTSG are
avoiding bulky aps besides the advantage of
harvesting the required size for the defect.
The recipient wound bed must be very well
prepared with no scar tissue for the FTSG to
be successful (Figs.32.92, 32.93, and 32.94).
Figs. 32.92–32.94 An18-year-old girl (3months pregnant) with post burn bilateral knee contractures of
3months duration. Notice incisions reach mid-lateral line
of knee joints to prevent post-op contracture lines. FTSG
should always cover the popliteal areas as seen here.
Remaining woundscovered with meshed STSG.Post-op
POP splintswere applied for 4–6weeks
426
https://t.me/medicina_free
E. Eriksen
Figs. 32.95–32.98 A 21-year-old woman sustained a
burn at the age of 6months. She had never walked on two
legs until she was admitted and underwent reconstruc-
tion in 2011. Contracture released, external xation
applied, wounds covered with meshed STSG.Arthrodesis
of knee joint due to destroyed cartilage
32 How toSurgically Reconstruct Acute andChronic Burn Wounds inLow- andMiddle-Income Countries
https://t.me/medicina_free
427
Figs. 32.99–32.102 A 14-year-old burned when stepping into burning trash while playing football 7years previously. Note 90 degrees hyperextension of toes.
Contractionrelease and pinning with K-wires, coverage
withthick STSGs, 7weeks in hospital
428
https://t.me/medicina_free
E. Eriksen
Figs. 32.103–32.106 Severely twisted/contracted ankle
joints in a 4-year-old boy following stepping into burning
trash. Ankle joints completely locked with no movement
at all due to contracting scar tissue. Both knees exed
slightly so that heels would touch ground while walking.
Even then, keeping balance was nearly impossible.
Careful dissection under tourniquet to avoid exposure of
tendon sheets, nerves, and joints.Toes dissected free and
transxed with K-wires.FTSG applied across the anterior
ankle joint. The other areas covered with sheets of
STSG.1year post-op visit, ankle close to normal range of
movement
32 How toSurgically Reconstruct Acute andChronic Burn Wounds inLow- andMiddle-Income Countries
https://t.me/medicina_free
429
Heel Reconstruction
Heel reconstruction is a rather rare procedure.
Surgeons will come across cases where heel
reconstruction is necessary, either from trafc
accidents, burns, or other casualties and tumors
(Fig.32.107).
Once the heel pad is missing, a skin graft –
STSG or FTSG – may not yield a satisfactory
result in the long run as pain will inevitably
become a headache for the patient.
The sural reverse fasciocutaneous ap is fre-
quently used in reconstruction of heel defects.
In this section, another reliable and easy to
perform pedicle ap will be described through
specic case examples: the tensor fascia lata
(TFL)cross-leg ap. The distal part of the TFL
muscle consists of a thick fascia that is included
in the ap. Figure32.108 shows the ap as it is
raised from the lateral distal part of the right
thigh. This ap produces predictably good results
(Figs.32.109 and 32.110).
430
https://t.me/medicina_free
E. Eriksen
Figs. 32.107–32.110 Deep burn to left sole and heel on
a 16-year-old boy. Excision of the necrosis reveals a huge
defect. Left foot is brought across to the contralateral
thigh where the TFL ap has been raised to be applied to
the defect of the left heel. The remaining wound on the
sole as well as the donor area on right thigh are covered
with meshed STSG.Pedicle released 3weeks post-op. No
complaint of pain on follow-up
Соседние файлы в папке @xirurgi_2025