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Article in Chinese | WPRIM | ID: wpr-1009108


OBJECTIVE@#To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic.@*METHODS@#A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll's hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation.@*RESULTS@#The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll's hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively.@*CONCLUSION@#Congenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.

Humans , Male , Female , Forearm/surgery , Contracture/surgery , Muscle, Skeletal , Tendons/surgery , Ulna/surgery , Range of Motion, Articular
Chinese Medical Journal ; (24): 1478-1484, 2023.
Article in English | WPRIM | ID: wpr-980926


BACKGROUND@#Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.@*METHODS@#We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients' overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.@*RESULTS@#Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients' patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.@*CONCLUSIONS@#TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.

Humans , Arthroplasty, Replacement, Knee/methods , Hemophilia A/surgery , Follow-Up Studies , Retrospective Studies , Treatment Outcome , Knee Joint/surgery , Range of Motion, Articular , Arthritis/complications , Pain , Contracture/surgery , Surgeons , Knee Prosthesis
Article in Chinese | WPRIM | ID: wpr-981658


OBJECTIVE@#To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.@*METHODS@#Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly.@*RESULTS@#All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases.@*CONCLUSION@#The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.

Adult , Female , Humans , Male , Middle Aged , Aged , Cicatrix/surgery , Contracture/surgery , Crush Injuries/surgery , Finger Injuries/surgery , Plastic Surgery Procedures , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-981613


OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Male , Female , Humans , Forearm/surgery , Contracture/surgery , Ischemic Contracture/surgery , Fingers/surgery , Muscle, Skeletal/surgery
Article in English | WPRIM | ID: wpr-970976


Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

Humans , Child, Preschool , Surgical Flaps/surgery , Upper Extremity , Plastic Surgery Procedures , Skin Transplantation , Contracture/surgery
Article in English | WPRIM | ID: wpr-928481


Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.

Adult , Humans , Male , Anesthesia, General , Anesthesia, Local , Brain Neoplasms , Contracture/surgery , Dissection , External Fixators , Fracture Fixation , Wakefulness
Chinese Journal of Burns ; (6): 454-461, 2022.
Article in Chinese | WPRIM | ID: wpr-936032


Objective: To explore the effects of expanded frontal-parietal pedicled flap in reconstructing cervical scar contracture deformity in children after burns. Methods: A retrospective observational study was conducted. From January 2015 to December 2020, 18 male children with cervical scar contracture deformity after burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 4 to 12 years, including 10 cases with degree Ⅱ cervical scar contracture deformity and 8 cases with degree Ⅲ scar contracture deformity, and were all reconstructed with expanded frontal-parietal pedicled flap. The surgery was performed in 3 stages. In the first stage, a cylindrical skin and soft tissue expander (hereinafter referred to as expander) with rated capacity of 300 to 500 mL was placed in the frontal-parietal region. The expansion time was 4 to 6 months with the total normal saline injection volume being 2.1 to 3.0 times of the rated capacity of expander. In the second stage, expander removal, scar excision, contracture release, and flap transfer were performed, with the flap areas of 18 cm×9 cm to 23 cm×13 cm and the secondary wound areas of 16 cm×8 cm to 21 cm×11 cm after scar excision and contracture release. After 3 to 4 weeks, in the third stage, the flap pedicle was cut off and restored. The rated volume of placed expander, total normal saline injection volume, type of vascular pedicle of flap, survival of flap and reconstruction of scar after the second stage surgery were recorded. The neck range of motion and cervico-mental angle were measured before surgery and one-year after surgery. The appearance of neck, occurrence of common complications in the donor and recipient sites of children, and satisfaction of children's families for treatment effects were followed up. Data were statistically analyzed with paired sample t test. Results: All the patients successfully completed the three stages of operation. The rated volume of implanted expander was 300 mL in 6 children, 400 mL in 9 children, and 500 mL in 3 children, with the volume of normal saline injection being 630 to 1 500 mL. The type of vascular pedicle of flap was double pedicle in 13 cases and was single pedicle in 5 cases. All the flaps in 17 children survived well, and the secondary wounds after neck scar excision and contracture release were all reconstructed in one procedure. In one case, the distal blood supply of the single pedicled flap was poor after the second stage surgery, with necrosis of about 2.5 cm in length. The distal necrotic tissue was removed on 10 days after the operation, and the wound was completely closed after the flap was repositioned. In the follow-up of 6 months to 3 years post operation, the cervical scar contracture deformity in 18 children was corrected without recurrence. The flap was not bloated, the texture was soft, and the appearances of chin and neck were good. The range of motion of cervical pre-buckling, extension, left flexion, and right flexion, and cervico-mental angle in one year after operation were improved compared with those before operation (with t values of 43.10, 22.64, 27.96, 20.59, and 88.42, respectively, P<0.01). The incision in the frontal donor site was located in the hairline, the scar was slight and concealed. No complication such as cranial depression was observed in expander placement site, and the children's families were satisfied with the result of reconstruction. Conclusions: Application of expanded frontal-parietal pedicled flap in reconstructing the cervical scar contracture deformity in children after burns can obviously improve the appearance and function of neck, with unlikely recurrence of postoperative scar contractures, thus it is an ideal method of reconstruction.

Child , Humans , Male , Burns/surgery , Cicatrix/surgery , Contracture/surgery , Perforator Flap , Plastic Surgery Procedures/methods , Saline Solution , Skin Transplantation , Treatment Outcome
Chinese Journal of Burns ; (6): 328-334, 2022.
Article in Chinese | WPRIM | ID: wpr-936014


Objective: To explore the clinical effects of free transplantation of expanded thoracodorsal artery perforator flaps in reconstructing cervical cicatrix contracture deformity after burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 11 patients with cervical cicatrix contracture deformity after burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 3 males and 8 females, aged 5 to 46 years, with a course of cervical cicatrix contracture deformity of 5 months to 8 years. The degree of cervical cicatrix contracture deformity was degree Ⅰ in one patient, degree Ⅱ in nine patients, and degree Ⅲ in one patient. In the first stage, according to the sizes of neck scars, one rectangular skin and soft tissue expander (hereinafter referred to as expander) with rated capacity of 200 to 600 mL was placed in the back. The expansion time was 4 to 12 months with the total normal saline injection volume being 3.0 to 3.5 times of the rated capacity of expander. In the second stage, free expanded thoracodorsal artery perforator flaps with areas of 10 cm×7 cm to 24 cm×13 cm were cut out to repair the wounds with areas of 9 cm×6 cm to 23 cm×12 cm which was formed after cervical cicatectomy. The main trunk of thoracodorsal artery and vein were selected for end-to-end anastomosis with facial artery and vein, and the donor sites were directly closed. The survival of flaps and healing of flap donor sites were observed on the 14th day post surgery. The appearances and cicatrix contracture deformity of the flaps, recovery of cervical function, and scar hyperplasia of donor sites were followed up. Results: On the 14th day post surgery, the flaps of ten patients survived, while ecchymosis and epidermal necrosis occurred in the center of flap of one patient and healed 2 weeks after dressing change. On the 14th day post surgery, the flap donor sites of 11 patients all healed well. During the follow-up of 6-12 months post surgery, the flaps of ten patients were similar to the skin around the recipient site in texture and color, while the flap of one patient was slightly swollen. All of the 11 patients had good recovery of cervical function and no obvious scar hyperplasia nor contracture in the flaps or at the donor sites. Conclusions: Application of expanded thoracodorsal artery perforator flaps can restore the appearance and function of the neck, and cause little damage to the donor site in reconstructing the cervical cicatrix contracture deformity after burns, which is worthy of clinical reference and application.

Female , Humans , Male , Arteries , Burns/surgery , Cicatrix/surgery , Contracture/surgery , Hyperplasia , Perforator Flap , Plastic Surgery Procedures , Skin Transplantation , Soft Tissue Injuries/surgery , Treatment Outcome
Chinese Journal of Burns ; (6): 321-327, 2022.
Article in Chinese | WPRIM | ID: wpr-936013


Objective: To investigate the clinical effects of free transplantation of expanded ilioinguinal flaps in the reconstruction of severe scar contracture after extensive burns. Methods: A retrospective observational study was conducted. From August 2017 to October 2021, 7 patients with severe scar contracture deformity caused by extensive burns were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 5 males and 2 females, aged 26-65 years, with scar area of 20 cm×4 cm-34 cm×14 cm. In the first stage, the rectangular skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 500-600 mL were embedded above the inguinal ligament, and then normal saline was injected after stitch removal for expansion to meet the needs of repair surgery. In the second stage, the scar was removed by surgical excision to correct the deformity and release the adhesion and contracture; after the removal of the expanders, the expanded ilioinguinal free flaps were harvested. When a larger flap was needed, the paraumbilical perforator flap was harvested at the same time, and the flaps were transplanted to the secondary wound after scar resection. The number of embedded expanders, the total amount of injected normal saline, the expansion time, the complications of skin and soft tissue expansion, the number, area, thickness, and anastomotic vascular pedicles of the expanded ilioinguinal flaps being resected, the type of flaps used, the repair method of flap donor sites, and the survival of flaps after operation were observed and recorded. The long-term repair effect and donor site condition were followed up. At the last follow-up, the patients' satisfaction with the curative effect of each surgical site was investigated according to the grade 5 score of Likert scale. Results: A total of 10 expanders were embedded in 7 patients, of which 4 patients had 1 each and 3 patients had 2 each. The total volume of normal saline injected was 800-1 800 (1 342±385) mL, and the expansion time was 4-24 (11±5) months. One patient had the expander exposed due to infection after the expander being inserted, while the other patients had no complications of skin and soft tissue expansion. Totally 10 expanded ilioinguinal flaps with the area of 22 cm×6 cm-36 cm×16 cm ((326±132) cm2) and the thickness of 0.6-1.1 (0.77±0.16) cm were harvested. Among the 10 expanded ilioinguinal flaps, 5 were pedicled with the superficial circumflex iliac artery, 3 with the superficial abdominal artery with relatively large caliber, 1 with the common trunk of the superficial circumflex iliac artery and the superficial abdominal artery, and 1 flap was anastomosed with the superficial circumflex iliac artery and bridged the superficial abdominal artery for intra-arterial supercharge. Unilateral expanded ilioinguinal flap combined with ipsilateral paraumbilical perforator flap were harvested in 4 cases, bilateral expanded ilioinguinal flaps were harvested in 1 case, and unilateral expanded ilioinguinal flap was harvested in 2 cases. Except for 1 case being transplanted with autologous split-thickness scalp to repair the flap donor site after combined resection of bilateral expanded ilioinguinal flaps, the donor sites of the other patients were sutured directly. All the flaps survived after operation without tip necrosis or wound residue. Follow-up for 3-30 (15±10) months showed that the flap was soft and not bloated, the function and appearance of the recipient area were significantly improved compared with those before operation, and the appearance of the donor sites was good. At the last follow-up, the patients' satisfaction with the treatment effect of the surgical site scored 4-5 (4.5±0.4). Conclusions: The expanded ilioinguinal flap can be obtained in a large area. It has the advantages of rich blood supply, less damage to the donor site, concealed location, and being convenient to be resected and transplanted in combination with the paraumbilical perforator flap. It is suitable for the clinical reconstruction and treatment of severe scar contracture deformity after extensive burns.

Female , Humans , Male , Burns/surgery , Cicatrix/surgery , Contracture/surgery , Perforator Flap , Plastic Surgery Procedures/methods , Saline Solution , Skin Transplantation , Soft Tissue Injuries/surgery , Treatment Outcome
Chinese Journal of Burns ; (6): 306-312, 2022.
Article in Chinese | WPRIM | ID: wpr-936011


Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

Female , Humans , Male , Chin/surgery , Cicatrix/surgery , Contracture/surgery , Free Tissue Flaps , Perforator Flap , Plastic Surgery Procedures , Skin Transplantation , Surgical Wound , Treatment Outcome
Rev. bras. cir. plást ; 32(2): 241-244, 2017. ilus
Article in English, Portuguese | LILACS | ID: biblio-847375


Introdução: São apresentados dois casos de retração em região axilar após queimadura em que a correção cirúrgica foi realizada empregando-se zetaplastias múltiplas. Apresentamos uma tática de marcação que visa facilitar o aprendizado desse procedimento pelos residentes de Cirurgia Plástica. Métodos: Dois pacientes com retrações axilares e de membros superiores após queimadura com líquido aquecido foram submetidos à correção cirúrgica empregando-se a zetaplastia múltipla. A tática de planejamento proposta nesse estudo preconiza primeiro a marcação do retalho triangular localizado no ponto médio da retração axilar, o qual irá avançar e cruzar o eixo da cicatriz, e a partir daí o desenho dos retalhos subsequentes com ângulo de 60° entre si. Acreditamos que essa sistematização da marcação facilita o planejamento e aprendizado da plástica em Z. Resultados: Os pacientes apresentaram adequadas amplitude de movimento e recuperação funcional do membro acometido no pós-operatório. Não houve necrose das extremidades dos retalhos, que preconizamos serem cuidadosamente trabalhadas e um pouco arredondadas; e a execução do procedimento foi simples devido à tática de marcação que aplicamos. Conclusão: A tática de marcação que apresentamos é reprodutível e de fácil aprendizado. A zetaplastia múltipla foi eficaz em restabelecer a amplitude de movimento das áreas com sequela de queimadura tratadas com esse método.

Introduction: Herein, we present two cases of post-burn retraction of the axillary region, which were subsequently surgically corrected using multiple Z-plasties. We present a marking strategy to facilitate the learning of this procedure by plastic surgery residents. Methods: Two patients with axillary and upper limb retractions due to burns with hot liquids were surgically treated using multiple Z-plasties. The strategy proposed in this study recommends the marking of the triangular flap located at the midpoint of the axillary retraction, which then advances and crosses the axis of the scar. Then, subsequent flaps are made at an angle of 60° to each other. We believe that this systematization of marking facilitates the planning and learning of Z-plasty. Results: The study patients achieved an adequate range of motion and functional recovery of the affected limb postoperatively. We observed no cases of necrosis of the flap ends, which should be carefully worked and slightly rounded. The execution of the procedure was simple using the suggested marking strategy. Conclusion: The presented marking strategy was reproducible and easy to learn. Multiple Z-plasties were effective in restoring the range of motion of the areas affected by burns that were treated using this method.

Humans , Male , Female , Adult , History, 21st Century , Axilla , Surgical Procedures, Operative , Surgery, Plastic , Surgical Flaps , Teaching , Burns, Chemical , Cicatrix , Contracture , Axilla/surgery , Axilla/injuries , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/rehabilitation , Surgery, Plastic/rehabilitation , Surgical Flaps/surgery , Teaching/education , Burns, Chemical/surgery , Burns, Chemical/therapy , Cicatrix/surgery , Cicatrix/rehabilitation , Contracture/surgery , Contracture/therapy
Rev. bras. cir. plást ; 31(3): 328-338, 2016. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-2296


INTRODUÇÃO: Aumentos mamários exigem planejamento com critérios objetivos e rigorosos, que foram padronizados pelo sistema High Five, de Tebbetts. Existe um grande número de combinações possíveis, entre via de acesso, plano e tipo de implante, o que permite proporcionar o melhor resultado para cada paciente. MÉTODO: 100 pacientes operadas, 30 com implantes anatômicos e 70 com redondos, por via retromuscular ou subglandular, com a realização de roundblock ou não. Todos os casos foram operados pela via periareolar. A avaliação pré-operatória foi realizada conforme a sistematização High Five. RESULTADOS: Roundblock foi mais utilizado no grupo de implantes anatômicos, representando 43% da amostra neste caso. O plano subglandular foi o mais utilizado, representando 76,6% da amostra total. Com relação ao implante anatômico, 86,7% dos implantes foram colocados no plano subglandular. Dos anatômicos, 71,4% foram colocados no plano subglandular. Ocorreram quatro casos de contratura capsular graus III e IV, mais comum com o uso de implante redondo. O índice de rotação do implante anatômico foi de 10%, com três casos no total. CONCLUSÃO: Ocorreu baixo índice de complicações, em conformidade com a incidência da literatura. O acesso periareolar proporcionou bons resultados em todos os casos. O paciente deve ser informado sobre a possibilidade da rotação do implante anatômico.

INTRODUCTION: Breast augmentation requires planning with objective and rigorous criteria, which were standardized by the High Five system of Tebbetts. There are a many possible combinations based on access route, implant plane, and type of implant, enabling the best outcome for each patient. METHOD: Of 100 patients studied, 30 received anatomic implants and 70 received round implants in the retromuscular or subglandular position, with or without round block technique. All cases used periareolar access. Preoperative evaluation was performed according to the High Five system. RESULTS: The round block technique was used more often with anatomic implants (43%). The subglandular plane was most commonly used (76.6%). Of 30 anatomic implants, 86.7% were placed in the subglandular plane. Of 70 round implants, 71.4% were placed in the subglandular plane. There were 4 cases of grade III and IV capsular contracture, which is more common with the use of round implants. The rate of rotation among anatomic implants was 10%, with 3 cases. CONCLUSION: There was a low complication rate, in accordance with published data. Periareolar access provided good results in all cases. The patient should be informed about the possibility of rotation with use of anatomic implants.

Humans , Female , Adult , Middle Aged , Aged , History, 21st Century , Breast , Contracture , Breast Implantation , Implant Capsular Contracture , Breast/anatomy & histology , Breast/surgery , Anthropometry , Anthropometry/methods , Contracture/surgery , Contracture/therapy , Breast Implantation/methods , Implant Capsular Contracture/complications , Musculoskeletal System , Musculoskeletal System/anatomy & histology , Musculoskeletal System/surgery
Rev. bras. cir. plást ; 30(1): 123-128, 2015. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-873


INTRODUÇÃO: A contratura capsular é uma das principais complicações em cirurgias envolvendo implantes mamários. A classificação mais usada para avaliar o grau de contratura é a de Baker, que a divide em graus I, II, III e IV, sendo as de grau III e IV consideradas significativas. Apesar de existirem diversas teorias, a etiologia da contratura capsular permanece incerta. O tratamento convencional para os casos de contratura é a abordagem cirúrgica com realização de capsulotomia ou capsulectomia. Estes procedimentos, no entanto, não estão isentos de morbidades, com complicações como deiscências, hematomas, seromas, pneumotórax, assimetrias e recidiva da contratura. Este estudo faz uma revisão sobre as alternativas ao tratamento cirúrgico convencional, descritas na literatura. MÉTODOS: Foi realizada pesquisa nas bibliotecas da Pubmed e da Cochrane, utilizando-se os termos: 'capsular contracture', 'capsular contracture treatment' e 'capsular contracture breast treatment'. Foram identificados 991 artigos e selecionados os que discutiam opções medicamentosas para o tratamento de contratura, diferentes de capsulectomia e capsulotomia. RESULTADOS: Foram encontrados vårios estudos utilizando drogas com o fim de reduzir a contratura capsular, das quais o Zafirlucaste é apresentado em maior número de trabalhos. CONCLUSÃO: Dentre as várias drogas utilizadas, o Zafirlucaste apresentou boa eficácia, com baixos índices de complicação; a Triancinolona parece ser também uma boa opção, no entanto precisa de profissional habilitado para realizar as infiltrações. As demais drogas necessitam de maiores estudos.

INTRODUCTION: Capsular contracture is among the main complications of surgeries involving breast implants. The most commonly used classification to assess the degree of contracture is the Baker grading system, which divides contractures into grades I, II, III, and IV. Of these, grade III and IV contractures are considered significant. Although several causes have been postulated, the etiology of capsular contracture remains uncertain. Conventional treatment for contracture is based on a surgical approach, specifically capsulotomy or capsulectomy. These procedures, however, are not exempt from morbidity, and patients may develop complications such as dehiscence, hematoma, seroma, pneumothorax, asymmetry, and contracture recurrence. This study provides a review of alternatives to conventional surgery described in the literature. METHODS: We researched the PubMed and Cochrane Library databases using the following keywords: "capsular contracture", "capsular contracture treatment", and "capsular contracture breast treatment". We identified 991 articles from which we selected those discussing medication options for contracture treatment other than capsulectomy and capsulotomy. RESULTS: We identified several studies in which drugs, most commonly zafirlukast, were used to reduce capsular contracture. CONCLUSION: Among the various reported drugs, zafirlukast exhibited good efficacy and a low rate of complication. Triamcinolone also appears to be a good option, although professional assistance would be needed for drug administration via infiltration. The other drugs described would require further investigation.

Humans , History, 21st Century , Comparative Study , Review Literature as Topic , Pharmaceutical Preparations , Prospective Studies , Contracture , Breast Implantation , Evaluation Study , Implant Capsular Contracture , Clinical Study , Pharmaceutical Preparations/standards , Contracture/surgery , Contracture/complications , Contracture/etiology , Contracture/pathology , Contracture/drug therapy , Breast Implantation/adverse effects , Implant Capsular Contracture/surgery , Implant Capsular Contracture/complications , Implant Capsular Contracture/pathology , Implant Capsular Contracture/drug therapy
Einstein (Säo Paulo) ; 12(4): 502-504, Oct-Dec/2014. graf
Article in Portuguese | LILACS | ID: lil-732464


O câncer de bexiga é um importante problema de saúde mundial, tanto pelas elevadas taxas de prevalência, quanto pelos custos relacionados ao tratamento. Desde a introdução da imunoterapia intravesical adjuvante com bacilo Calmette-Guérin, vem sendo observada diminuição na taxa de recorrência. As principais complicações são de pequeno porte e simples resolução a partir de medidas locais e orientações. A bexiga contraída, uma complicação local rara e grave, mas incapacitante em alguns casos, é observada principalmente em doentes com um programa de manutenção. Relatamos aqui o caso de um paciente masculino submetido a ressecção transuretral da bexiga por um carcinoma urotelial T1 de alto grau, que desenvolveu tal complicação durante tratamento com bacilo Calmette-Guérin, sendo portanto submetido à cistoprostatectomia com realização de neobexiga ortotópica ileal.

Bladder cancer is an important health problem worldwide due to high prevalence rates and costs related to treatment. A reduction in recurrence rates has been observed since the introduction of adjuvant intravesical immunotherapy with bacillus Calmette-Guerin. There are mild complications that are easily solved by local measures and orientations. Bladder contracture, a rare and severe local complication, in some cases leading to disability, is observed primarily in patients in a maintenance program. In this article we reported the case of a male patient who underwent transurethral resection of the bladder because of a high-grade T1 urothelial carcinoma and developed this complication during treatment with bacillus Calmette-Guerin. For this reason he was submitted to cystoprostatectomy with orthotopic ileal neobladder reconstruction.

Humans , Male , Middle Aged , Adjuvants, Immunologic/adverse effects , BCG Vaccine/adverse effects , Carcinoma/therapy , Contracture/surgery , Cystectomy/methods , Urinary Bladder , Urinary Bladder Diseases/surgery , Urinary Bladder Neoplasms/therapy , Administration, Intravesical , Carcinoma/complications , Chemotherapy, Adjuvant/adverse effects , Contracture/etiology , Cystitis/surgery , Ileum/surgery , Treatment Outcome , Urinary Bladder Diseases/etiology , Urinary Bladder Neoplasms/complications , Urinary Diversion/methods
Rev. bras. cir. plást ; 27(3): 369-373, jul.-set. 2012. ilus
Article in English, Portuguese | LILACS | ID: lil-668133


INTRODUÇÃO: O aperfeiçoamento no tratamento inicial do paciente queimado, por meio da reposição volêmica e, principalmente, com excisão e enxertia precoce das lesões, resultou em profundo impacto na evolução dos indivíduos queimados, ocorrendo aumento da taxa de sobrevida. Com a maior sobrevida desses pacientes surgiu um novo desafio para a cirurgia reparadora, o tratamento das sequelas de queimaduras, principalmente compostas pelas contraturas. O objetivo deste estudo é demonstrar o uso da matriz dérmica artificial associado a terapia por pressão negativa no tratamento de sequelas de queimaduras. MÉTODO: Foram selecionados 10 pacientes com contratura por queimadura. Os pacientes selecionados foram submetidos a liberação da contratura cicatricial e colocação de matriz dérmica artificial (Integra®), conforme técnica padrão, e curativo por pressão negativa para cobertura. A cada 5 dias, foram realizadas trocas do curativo até completar período de 3 semanas a 4 semanas. Após esse período, o leito foi submetido a enxertia de pele. Os pacientes foram questionados, no pré e pós-operatório, quanto a sua satisfação com os aspectos estético e funcional da região abordada. RESULTADOS: Houve integração de cerca de 98% da matriz de regeneração dérmica na área em que a contratura foi ressecada. Também ocorreu integração de aproximadamente 85% dos enxertos utilizados. Todos os pacientes abordados referiram significativa melhora estética e, principalmente, funcional da região abordada. CONCLUSÕES: O uso da matriz de regeneração dérmica associado a terapia por pressão negativa promove maior taxa de sucesso na abordagem da contratura cicatricial, proporcionando melhor resultado tanto funcional como estético nos pacientes com sequelas graves de queimadura.

BACKGROUND: Burn patients are initially treated with volume replacement and, importantly, subsequent excision and early grafting of their injuries. These first aid measures improve the progress and survival rates of burned individuals. However, this treatment creates a new challenge in reparative surgery with regard to the management of burn sequelae, which mainly include contractures. In this study, we aimed to assess the effect of artificial dermal matrix application and negative pressure therapy on the treatment of burn sequelae. METHODS: Ten patients with burn contractures were selected for this study and underwent scar contracture release, wound coverage with an artificial dermal matrix (Integra®), and negative pressure dressing according to the standard procedures. Dressing changes were performed every 5 days for 3-4 weeks. A skin graft was then laid on the wound bed. In the pre- and postoperative period, the patients were asked to rate their satisfaction with the aesthetic and functional aspects of the treated region. RESULTS: In the areas in which the contractures were resected, integration of almost 98% of the dermal regeneration matrix was observed. Also integration was observed in 85% of the grafts used. All the patients reported a significant aesthetic and, in particular, functional improvement of the treated region. CONCLUSIONS: The use of dermal regeneration matrix and negative pressure therapy for the treatment of scar contractures improves the success rate and the aesthetic and functional outcomes of patients with severe burn sequelae.

Humans , History, 21st Century , Postoperative Complications , Wounds and Injuries , Burns , Skin Transplantation , Contracture , Plastic Surgery Procedures , Intraoperative Complications , Postoperative Complications/surgery , Postoperative Complications/therapy , Wounds and Injuries/surgery , Wounds and Injuries/therapy , Burns/surgery , Burns/rehabilitation , Skin Transplantation/methods , Skin Transplantation/rehabilitation , Contracture/surgery , Contracture/therapy , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/rehabilitation , Intraoperative Complications/surgery , Intraoperative Complications/therapy
Rev. bras. ortop ; 47(3): 325-329, 2012. ilus
Article in Portuguese | LILACS | ID: lil-649668


OBJETIVO: Avaliar pacientes submetidos à artroscopia para liberação do cotovelo rígido, discutindo a técnica, possíveis dificuldades e riscos. MÉTODOS: Foram realizadas 24 artroscopias de cotovelos. Todos os pacientes foram avaliados usando goniometria pré e seis meses pós-cirurgia e pontuados com o escore de cotovelo Mayo. RESULTADOS: Operados 15 homens e nove mulheres, 14 cotovelos direitos e 10 esquerdos, média de idade de 34,58 anos e de tempo de seguimento de 38,41 meses. A média do ganho do arco de movimento foi de 43,3º e MES de 85,4. CONCLUSÃO: A liberação artroscópica pode viabilizar melhor visualização e aumento das opções de mudança de estratégia durante a cirurgia, diminuição do trauma cirúrgico e possibilidade de reabilitação precoce, podendo atingir resultados similares ou melhores que os da cirurgia aberta. Contra a artroscopia há a grande curva de aprendizado e o maior custo do procedimento. Ambas as técnicas relatam complicações neurovasculares. Para evitar tais problemas, o protocolo para realização dos portais deve ser rigorosamente seguido. A liberação artroscópica mostrou ser opção segura e eficaz no ganho da ADM no cotovelo rígido pós-traumático.

To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. METHODS: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months after wards and were rated using the Mayo elbow performance score (MEPS). RESULTS: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3º and of MEPS, 85.4. CONCLUSION: Arthroscopic liberation might enable better intrarticular visualization and enhance options to change strategy during surgery, reduction of surgical trauma and possibility of early rehabilitation, and this technique can reach similar or better results than open surgery. Disadvantages of arthroscopy are lack of ability of surgeons and higher cost of procedure. Both techniques report neurovascular complications, to avoid such problems the arthroscopic portals protocols must be rigorously followed. Arthroscopic release of the stiff elbow can enable range of motion gain, and also promotes high level of satisfaction by the decrease of pain and good cosmetic appearance. Some cases might demand adjuvant treatments. When correctly indicated, arthroscopy may be a safe surgical option with satisfactory outcomes.

Humans , Male , Female , Adult , Middle Aged , Elbow Joint/injuries , Contracture/surgery , Elbow/injuries
Acta cir. bras ; 26(4): 320-324, July-Aug. 2011. tab
Article in English | LILACS | ID: lil-594354


PURPOSE: To compare vitamin levels, inflammatory and oxidative stress markers before and after skin autograft surgery to correct burn scar areas. METHODS: This prospective study was conducted with 8 patients with a median age of 28 years (range, 16 to 40 years) that had burn sequelae and were admitted to a Burn Unit for correction of small burn scar areas [3.3 (1.0-5.0) percent of the corporal surface]. The volunteers were evaluated before and 48 hours after excision of scar tissue and skin autograft. Routine laboratory data, along with a food questionnaire and anthropometry were collected in the preoperative period. Serum vitamin A, C, E, B12 and folic acid levels, inflammatory markers (C-protein reactive, alpha-1-acid glycoprotein, ferritin) and oxidative stress markers (reduced glutathione - GSH and Thiobarbituric Acid Reactive Substances - TBARS) were determined at preoperative and postoperative phases. Data were analyzed with two-sample Wilcoxon test. RESULTS: All volunteers were clinically stable and had adequate nutritional status at admission. After surgery, C-reactive protein serum levels increased [0.4 (0.01-1.0) vs. 2.5 (0.6-4.7) mg/dL, p=0.01] and vitamin A levels decreased [3.4 (2.1-4.2) vs. 2.4 (1.6-4.1) µmol/L, p=0.01]. No changes occurred in other vitamins, ferrritin, alpha-1-acid glycoprotein, GSH and TBARS levels. CONCLUSION: Minimal metabolic changes were produced after skin autograft in small areas of well-nourished patients without active infection or inflammation.

OBJETIVO: Comparar os níveis séricos de vitaminas e dos marcadores de estresse oxidativo e inflamatório antes e após enxerto cutâneo para correção de pequenas áreas de cicatrizes hipertróficas de queimaduras. MÉTODOS: O estudo prospectivo foi conduzido com oito pacientes com mediana de idade de 28 anos (variação de 16 a 40 anos) que apresentavam cicatrizes fibróticas decorrentes de queimaduras. Todos os pacientes foram admitidos em Unidade de Queimados para serem submetidos a enxertos autólogos [3,3 (1,0 a 5,0) por cento da superfície corporal]. Os voluntários foram avaliados antes e 48 horas após a excisão do tecido cicatricial e do enxerto autólogo. Exames laboratoriais de rotina, além do questionário alimentar e da antropometria foram obtidos no período pré-operatório. Os níveis séricos das vitaminas A, C, E, B12 e ácido fólico, os marcadores inflamatórios (proteína C reativa, alfa-1-glicoproteína ácida e ferritina) e marcadores de estresse oxidativo (glutationa reduzida - GSH e Substâncias Reativas do Ácido Tiobarbitúrico - TBARS) foram determinados nas fases pré e pós-operatórias. Os dados foram analisados pelo teste de Wilcoxon pareado. RESULTADOS: Todos os voluntários estavam clinicamente estáveis e apresentavam estado nutricional adequado à admissão hospitalar. Após a cirurgia, houve aumento dos níveis séricos de proteína C reativa [0,4 (0,01-1,0) vs 2,5 (0,6-4,7) mg/dL, p=0,01], enquanto houve redução nos níveis de vitamina A [3,4 (2,1-4,2) vs 2,4 (1,6-4,1) µmol/L, p=0,01]. Não houve mudanças nos níveis séricos de outras vitaminas, ferritina, alfa-1-glicoproteína ácida, GSH e TBARS. CONCLUSÃO: Em pacientes com bom estado nutricional e sem evidência de atividade inflamatória ou infecciosa ocorrem mudanças metabólicas mínimas após enxerto autólogo de pequenas áreas de cicatrizes de queimadura.

Adolescent , Adult , Female , Humans , Male , Young Adult , Burns/complications , Cicatrix/surgery , Oxidative Stress/physiology , Skin Transplantation/physiology , Biomarkers/metabolism , Burns/surgery , Contracture/etiology , Contracture/surgery , Inflammation/metabolism , Prospective Studies , Statistics, Nonparametric , Vitamins/analysis
Rev. chil. cir ; 63(3): 276-279, jun. 2011. ilus
Article in Spanish | LILACS | ID: lil-597516


Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional deficiencies. Contracture scars in this region are difficult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and flaps have shown high rate of morbidity. Integra® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra® for axillary burn contractures between January 2002 and March 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artificial skin substitutes used in other anatomical regions.

Las quemaduras axilares severas son un accidente infrecuente que evolucionan a la retracción generando deficiencias cosméticas y funcionales. Estas cicatrices son difíciles de tratar por las características anatómicas del área, donde la corrección de un vector de movimiento puede alterar otro. Objetivo: Mostrar nuestros resultados utilizando el sustituto cutáneo Integra® en el tratamiento de cicatrices retráctiles axilares por quemadura. Pacientes y Métodos: Se recolectaron antecedentes médicos y fotográficos de pacientes portadores de cicatrices retráctiles axilares por quemadura entre enero de 2002 y marzo de 2006 en el Hospital del Trabajador de Santiago. Se evaluó pre y postoperatoriamente a los pacientes en forma subjetiva por fisiatra y con el Test de Barthel. Resultados: Se incluyeron 4 pacientes en el estudio (3 mujeres y 1 hombre), edad media 27 años (18-41). Todas las quemaduras fueron producidas por fuego. Índice de Barthel preoperatorio fue de 87,5 (levemente dependiente para las actividades de la vida diaria) y rango de movimiento moderadamente afectado. En el postoperatorio los pacientes fueron catalogados como independientes según el Test de Barthel y el rango de movimiento fue descrito como bueno o muy bueno por el fisiatra. No hubo complicaciones peri operatorias, Integra® prendió adecuadamente en todos los casos. Los pacientes fueron seguidos en promedio 16 meses (9-22). Conclusiones: Los sustitutos dérmicos han sido usados para la corrección de cicatrices de quemaduras con buenos resultados, pero no hay reportes en la axila. El pequeño número de pacientes que presentamos tienen un excelente resultado funcional, lo que nos estimula a seguir trabajando en este rumbo.

Humans , Male , Adolescent , Adult , Female , Axilla/surgery , Contracture/surgery , Burns/surgery , Skin, Artificial , Axilla/injuries , Biocompatible Materials , Cicatrix/surgery , Cicatrix/etiology , Contracture/etiology , Prospective Studies , Burns/complications , Range of Motion, Articular , Treatment Outcome
Rev. bras. cir. plást ; 25(1): 213-216, jan.-mar. 2010. ilus
Article in Portuguese | LILACS | ID: lil-590860


Introdução: As queimaduras de espessura total e suas sequelas permanecem como uma das mais complexas doenças com que o cirurgião plástico tem se deparado nos tempos atuais. As sequelas pós-queimadura de espessura total, nas regiões mento-torácica e axilares, sempre levam a retrações, determinando grandes alterações funcionais e estéticas. A correção destas deformidades ainda se constitui num dilema da medicina atual. A operaçãode Zetaplastia é uma ferramenta essencial e poderosa do arsenal do cirurgião para a reconstrução de queimadura. Relato de caso: Os autores descrevem um caso de sequela de queimadura extensa em paciente do sexo masculino, de 8 anos, com retrações axilares e mento-torácica, tratado com a técnica de zetaplastia, que demonstrou mais uma vez sua eficácia e versatilidade no tratamento dessas sequelas.

Introduction: The full-thickness burns and their deformities remain as one of the most complex diseases to which the plastic surgeon has encountered in current times. The full thickness deformity post burn, in the axillary and chest-ment, always lead to retractions, causing some major function and aesthetic changes. The correction of these deformities is still a dilemma of current medicine. The operation of Zetaplastia is an essential and powerful arsenal of the surgeon for the post burn reconstruction. Case report: The authors describe a case of sequelae of extensive burn in male, 8 years, with axillary and chest-ment retractions, which was treated with the technique of zetaplasty, once again demonstrating its effectiveness and versatility in the treatment of burn sequelae.

Child , Axilla , Contracture/surgery , Burns/surgery , Plastic Surgery Procedures , Thoracic Surgical Procedures , Thorax , Diagnostic Techniques and Procedures , Methods , Patients , Treatment Outcome