[Hydrogen sulfide balneotherapy in comprehensive sanatorium-resort treatment of post-burn scars in children]. / Serovodorodnaya bal'neoterapiya v kompleksnom sanatorno-kurortnom lechenii posleozhogovykh rubtsov u detei.

Thermal lesions in children leave behind cicatricial contractions, contractures, deformations of the wrists, feet, face. Sanatorium-resort treatment using balneotherapy is an integral part of rehabilitation measures in such patients. OBJECTIVE: To analyze the results of hydrogen sulfide balneotherapy in children with consequences of thermal injury. MATERIAL AND METHODS: A single-center observational retrospective non-controlled study was carried out, in which sanatorium-resort treatment concerning post-burn scars in 812 children aged 5-17 years was analyzed. Hydrogen sulfide balneotherapy was prescribed to patients depending on the age in mild (5-6 years) or moderate-to-high (7-17 years) exposure modes. The imported hydrogen sulfide mineral water from the T-2000 well of the Matsesta field with the H2S total concentration of 410-420 mg/l was used for treatment. The applications were performed to children alternate days, 8 procedures of balneotherapy per course. RESULTS: Lightening of the affected areas of the skin, reduction of the sensation of contraction and tension of the scars, which became softer, more elastic and more mobile with regard to the subjacent tissues have been noted in patients after the course of balneotherapy. The head mobility increased after applications in the presence of scars. The large joints' range of motion grew up. In addition, an increase in the mobility of the fingers of wrists and feet, a decrease in the stiffness of movements, increase or recovery of the affected skin's tactile sensitivity have been observed. Children well tolerated procedures, adverse events were seen in 0.7% of cases in the form of mild reactions at the beginning of the applications' course, namely of balneological (0.6%) and toxico-allergic (0.1%) nature. CONCLUSION: Hydrogen sulfide balneotherapy in combination with rehabilitation exercises and other sanatorium-resort factors is an effective mean of post-burn scars correction in children.

Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection.

BACKGROUND: Cesarean scar defect (CSD), especially CSD with residual myometrium less than 3 mm is reported to be the highest risk agent associated with uterine rupture for subsequent pregnancy. Currently, laparoscopic resection and suture was the mainstay therapy method for CSD with a residual myometrium less than 3 mm in women with a desire to conceive. Besides, the women have CSD related symptoms, especially postmenstrual bleeding, should be recommended for CSD treatment. This study is to investigate the efficiency of this novel laparoscopic surgery for the repair of cesarean scar defect (CSD) without scar resection for residual myometrium thickening. METHOD: This retrospective clinical study enrolled 76 women diagnosed with CSD who had a residual myometrium thickness less than 3 mm and also had a desire to conceive, had undergone laparoscopic surgery for the repair of CSD in the time period March 2016 to March 2018. Two study cohorts were created among the 76 patients: 40 patients had undergone the novel laparoscopic repair of CSD without processing scar resection (Group A), whereas 36 patients had undergone the traditional laparoscopic resection and suture of CSD (Group B). RESULTS: Residual myometrium thickening occurred among all the 76 patients and the average residual myometrium thickness was increased to almost 6 mm, presenting no between-group difference. In Group A, all the CSD-related postmenstrual bleeding was resolved or improved, but one patient in Group B has no obvious change to postmenstrual bleeding. After CSD repair, 20 patients got pregnant naturally in Group A, and there was no cesarean scar pregnancy and uterine rupture. While, there were 9 cases of natural pregnancy in Group B. No uterine rupture occurred among these 9 pregnant women of Group B, but 1 case of pregnancy was terminated due to cesarean scar pregnancy. CONCLUSION: Laparoscopic repair without processing scar resection seems to be a feasible, safe and simple operative approach for CSD treatment, which can thicken residual myometrium and improve postmenstrual bleeding.

[Self-made finger flexion band and its application in patients with burn scar contracture on the back of hand].

Scar contracture after burn on the back of hand can easily lead to the limitation of flexion function of fingers, which seriously affects daily life activities. Generally, comprehensive rehabilitation treatment is adopted for scar contracture on the back of hand, among which wearing braces is an effective treatment method. However, some braces will limit the normal finger joints or must wait until all the affected fingers heal before they can be worn, and the wearing operation is quite complicated. In order to solve these problems, the author designed and made a finger flexion band, which was used to stretch the patients with limited flexion of finger caused by scar contracture after burn on the back of hand, and achieved good therapeutic effect. According to the measured hand size, the finger flexion band is cut and spliced from the fabric commonly used in daily life. The finger flexion band is designed with finger sleeve, which will not limit the normal finger joints, can interfere with the healed finger in advance, fix the corresponding fingers better, and improve the treatment comfort, especially for children who do not cooperate with the braces wearing. This finger flexion band is simple to make, cheap, convenient to use, and suitable for clinical promotion.

[Scar management strategy in children].

Children are a special group, which have unique physiological characteristics and are still in the period of physical and mental growth and development, thus the prevention and treatment of scar in children are different from that in adults. Scar management in children is a complex and multifaceted system engineering. The grade of scar in children needs to be adjusted according to the age, period, and severity. Corresponding method needs to be chosen for the treatment of scar in children according to the classification of the scar. The compliance of children is poor, and the key to scar treatment is the persistence and cooperation of the parents, so doctors should strengthen propaganda and education to the parents of children with scar. For children with scar, individualized and comprehensive treatment should be used according to the characteristics of children to achieve good results.

Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast.

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function. Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months. A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann-Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate. We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p<0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p<0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function.

[Characteristics of scar hyperplasia after burn and the rehabilitation treatment in children].

After the wound healing of deep burn in children, there will be scar tissue proliferation in varying degrees. Burn scar seriously affects the quality of life and the psychological health during the growth and development of children, so parents of children pay more and more attention to scar treatment and functional rehabilitation after burn. The treatment of scar after burn in children has become an important issue for medical workers in burn, plastic surgery, and rehabilitation. This article analyzes and summarizes the relationship between scar hyperplasia and age, race, and position of scar hyperplasia after burn in children. The treatment and functional rehabilitation methods of scar are also discussed, so as to provide some guidance for the formulation of appropriate individualized treatment plan.

Reliability and clinical utility of the Pliance X for measuring pressure at the interface of pressure garments and burn scars in children.

BACKGROUND: Reliable, clinically acceptable pressure measuring devices are important to accurately record interface pressure. The Pliance X is a device that may overcome previous device limitations (i.e. pressure garment distortion, temperature dependent sensors). This research aimed to identify the test-retest reliability and clinical utility of the Pliance X in children receiving pressure garment therapy post-burn. METHODS: Data was collected as part of a pilot longitudinal cohort study. Immediate test-retest reliability was investigated at baseline and analysed using Intra-Class Correlation Coefficients (ICCs). Clinical utility was evaluated at baseline using the criteria of appropriate, accessible, practicable and acceptable. RESULTS: Thirty-one children completed baseline measurements. Participants had a median age of three years (IQR: 1.5, 7.5), and 61% were male. Test-retest reliability of the Pliance X was close to acceptable for clinical use for stationary interface pressure (ICC=0.87, n=27). The Pliance X was appropriate and acceptable for children of all ages who were not distressed. DISCUSSION: Further reliability testing is required, including inter-rater reliability testing. The device's clinical utility could be improved with alternate sensor styles and an instant mean pressure reading to enable immediately clinically useful information on the interface pressure.

Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature.

INTRODUCTION: The etiology of the stiff knee after total knee arthroplasty (TKA) is largely unknown, although excessive scar tissue due to arthrofibrosis is an important reason for a limited range of motion (ROM) after this procedure. Persistent limited ROM after TKA results in poor patient-reported outcomes and is increasingly becoming a more prominent reason for TKA revision surgery. METHODS: A narrative review of current literature on manipulation under anesthesia (MUA) after TKA analyzing etiology and risk factors for stiffness after TKA, effectiveness of MUA and what is known about rehabilitation after MUA. RESULTS: Literature describes numerous risk factors for insufficient knee ROM after TKA, but a comprehensive valid risk model is lacking. MUA is an effective treatment option with evidence suggesting better outcomes if performed within the first 3 months after TKA. The wide variety in both the indication and timing for MUA, and the lack of scientific evidence on how to rehabilitate patients after MUA, complicates the interpretation of available literature. This is even more so the case on the reporting of one versus two or more MUAs after TKA. CONCLUSION: Future comparative trials, preferably with a randomized study design, should be conducted to elude more clear indications for MUA, to give clinical guidance on correct timing for MUA and on how to rehabilitate patients afterward.

Influence on clinical parameters of depressomassage (part I): The effects of depressomassage on color and transepidermal water loss rate in burn scars: A pilot comparative controlled study.

OBJECTIVE: Depressomassage is a non-invasive massage technique using a mechanical suction device that is used in the treatment of traumatic or burn scars. Since color and transepidermal water loss (TEWL) are respectively the most important physical and physiological characteristic of hypertrophic scar formation, we wanted to investigate the effects of depressomassage on the recovery of color and TEWL in burn scars compared to the traditional physiotherapy. METHODS: In this pilot comparative controlled study a total 43 burn patients were included and allocated into 2 groups. All patients received standard physical therapy, and the test group received additional depressomassage during 6 months. Color was assessed using the POSAS questionnaire (for color, vascularity and pigmentation) and the Minolta Chromameter. TEWL was measured using DermaLab. RESULTS: Patients of both groups were evaluated at baseline, after 1, 3 and 6 months and after 1year. The evidence for a difference in evolution of color and TEWL between both groups in our study was minimal. CONCLUSIONS: In practice, precise indications to begin depressomassage have to be kept in mind. Perhaps other scar abnormalities such as decreased elasticity, increased thickness, excessive pain or itching could be sufficient reasons to begin depressomassage and should be assessed.

The clinical utility of extracorporeal shock wave therapy for burn pruritus: A prospective, randomized, single-blind study.

PURPOSES: To investigate the effect and mechanisms of extracorporeal shock wave therapy (ESWT) on burn scar pruritus. METHODS: Forty-six patients participated (experimental group, n=23; sham stimulation group, n=23). Patients had complaints of severe pruritus ranging from 5 to 10 on the visual analog scale. The experimental group received 1000-2000 shock waves for each treatment with 100 impulses/cm2, each with low-energy flux density (0.05-0.20mJ/mm2) and a 1-week interval between treatments for 3 weeks. The numerical rating scale (NRS), 5D-Itch Scale, and Leuven Itch Scale were evaluated immediately before ESWT and after the third session. Laser Doppler blood perfusion imaging (LDI) was performed immediately before ESWT and after the first and third sessions. RESULTS: In the experimental group, mean NRS scores were 6.30±1.29 before therapy and 3.57±2.09 after the third session, and the difference was significant (p<0.001). NRS scores in the experimental group after the third ESWT were significantly decreased compared to those of the sham stimulation group (p=0.009). The duration, severity, and consequences scores of pruritus on the Leuven Itch Scale after the third ESWT were significantly decreased in the experimental group compared with the sham stimulation group (p=0.033, p=0.007, and p=0.009, respectively). The direction score on the 5-D Itch Scale after the third ESWT was significantly decreased in the experimental group compared to the sham stimulation group (p=0.033). After the first ESWT session and after 3 sessions, the burn area had a significant increase in perfusion according to LDI, compared with the scores before treatment in the experimental group (p=0.023 and p=0.013, respectively). CONCLUSION: ESWT is a non-invasive modality that significantly reduced burn-associated pruritus.

Below the surface: Parents' views on the factors that influence treatment adherence in paediatric burn scar management - A qualitative study.

INTRODUCTION: Parents have a crucial role to play in burn scar management for their children at a time that is extremely stressful for them and their child. Scar management treatments such as pressure garment therapy (PGT) require high levels of adherence. There has been a lack of research into the factors that may influence adherence in paediatric burn scar management. This qualitative research study has investigated parents' experiences of scar management and their attempts to adhere to treatment at home. The aim of this paper is to outline parents' views on the factors that influence adherence. METHODS: 25 parents of paediatric and adolescent burn patients took part in semi-structured interviews. Participants were recruited from three UK burns services. Interviews were conducted in a participant-focussed manner and topics for discussion included parents' accounts of treatment and their experience of PGT. A thematic analysis was undertaken. RESULTS: Four overarching themes describe parents' views and experiences of scar management and adherence. These are the transition from hospital to home; the practical realities of treatment; the emotional labour involved in treatment and; negotiating treatment and regime. The transition from hospital to home is a significant event for parents. They may be apprehensive about this at the same time as they desire that they and their child return to some sense of normality following the burn injury. Parents are required to adopt the role of therapeutic caregiver upon transition from hospital to home. Adherence to scar management is influenced by the practical realities of maintaining treatment (routine, division of care labour, hospital appointments) and the emotional labour involved in doing so. The latter demands that parents manage their own and their children's emotions. Approaches to adherence were often described as flexible in response to these influences. CONCLUSIONS: Some parents negotiate the realities and demands of scar management successfully, whereas others do not. The emotional labour experienced by parents and their ability to cope with this is often a strong influence on their views regarding adherence to scar management. Further research is needed to explore how burns services and staff manage this at present, and whether simple interventions can help with the key practical and emotional influences on treatment adherence.

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial.

OBJECTIVE: To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect. DESIGN: Multicentre randomised controlled trial. SETTING: Eleven hospitals collaborating in a consortium for women's health research in the Netherlands. POPULATION: Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography. METHODS: Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months. MAIN OUTCOME MEASURES: The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation. RESULTS: We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2-7 days) in the intervention group and 7 days (IQR 3-10 days) in the control group (P = 0.04); on a scale of 0-10, discomfort as a result of spotting had a median score of 2 (IQR 0-7) in the intervention group, compared with 7 (IQR 0-8) in the control group (P = 0.02). CONCLUSIONS: In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting-related discomfort. TWEETABLE ABSTRACT: A hysteroscopic niche resection is an effective treatment to reduce niche-related spotting.

[Lay emphasis on early rehabilitation after extensive burn to prevent severe complications in late stage].

The mental disorders, scar, and dysfunction will affect the work and study of patients with extensive burn, which can further affect the quality of life and the rate of return to society. Under the premise of saving life, the function of patients with extensive burn should be reserved as much as possible for a better living quality. In addition to the specialized treatment, body positioning, therapeutic exercise, orthosis application, and psychotherapy can be used in the early stage of burn rehabilitation. Early rehabilitation training is beneficial to the circulatory system, immune system, functional and psychological recovery of patients. It can also improve the quality of extensive burn treatment, and decrease deformities and the incidence of complications in the late stage.

Effect of Exercise Training on the Frequency of Contracture-Release Surgeries in Burned Children.

BACKGROUND: Intensive physical exercise (IPE) increases strength, lean body mass, aerobic capacity, and range of motion in children with extensive burns. However, whether IPE decreases the frequency of burn scar contracture-releasing procedures in children with extensive burns is unknown. MATERIALS AND METHODS: Prospectively collected surgical records of 184 children who had undergone axilla, elbow, and/or wrist contracture-releasing procedures were reviewed. All children were 7 years or older and had sustained burns of at least 40% of the total body surface area. Eighty-two children completed an IPE program, and 102 children did not. For both groups, the axilla, elbow, and wrist were examined for tightness and restricted movement. Children with contractural difficulty were prescribed a releasing procedure. Logistic regression was used to model the relationship between multiple release surgeries and group. RESULTS: Patients in both groups had comparable injury severity. A total of 120 releases were carried out in the 82 IPE patients. In contrast, 211 releases were needed in the 102 non-IPE patients. An approximately 60% decrease in the frequency of rerelease operations was noted in IPE patients (12.5% for the IPE group and 31.8% for non-IPE group; P < 0.05). CONCLUSIONS: When used as an adjunct therapy in postburn rehabilitation, IPE may be useful for reducing the need for contracture release. The mechanisms underlying the beneficial effects of exercise remain undefined and should be investigated.

Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.

BACKGROUND: Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. PURPOSE: Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. METHODS: Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. RESULTS: At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. CONCLUSION: Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population.

Two-year follow-up of outcomes related to scarring and distress in children with severe burns.

PURPOSE: We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn. METHODS: Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01. RESULTS: Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period. CONCLUSIONS: According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

Cutaneous Functional Units Predict Shoulder Range of Motion Recovery in Children Receiving Rehabilitation.

Cutaneous functional units (CFUs) are fields of skin that functionally contribute to range of motion (ROM) at an associated joint. When replaced with scar tissue, the skin is less extensible and may result in loss of movement at the joint. Consideration of the amount of CFU affected by burn injury is increasingly being used to predict the development of burn scar contracture (BSC) in burn survivors. Previous work established that, in adults, burn rehabilitation time per CFU was the greatest predictor of preventing BSC. Our study aimed to examine the direct relationship between percent involvement of CFU and ROM achieved in children with BSC who received 6 months of rehabilitation therapy services. ROM was measured at baseline and throughout the study period using traditional methods of goniometry as well as three-dimensional motion capture during the performance of functional tasks. Burn extent and distribution were mapped using an electronic diagram to calculate the percentage of CFU affected by scarring or skin grafts. Pearson's correlations and multivariate linear regression analyses were performed to determine associations between variables. Results showed that percent CFU involvement was negatively correlated with maximal goniometric and functional shoulder ROM achieved. That is, the amount of a given CFU scarred was predictive of less ROM achieved in the associated area. Percentage of CFU involved did not significantly correlate with baseline shoulder ROM, suggesting that other factors may be associated with initial limitations in ROM. Evaluation of the percentage of CFU scarred is useful for predicting shoulder ROM recovery with rehabilitation and may be used to help guide clinical decision making and allocation of time and resource for therapy services.

Zetaplastia na retração axilar: técnica e tática para facilitar o aprendizado dos residentes / Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents

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.

[Contribution of the physical and rehabilitation medicine in pediatric plastic surgery]. / Apport de la médecine physique et réadaptation en chirurgie plastique pédiatrique.

Physical, non-painful processes guide the scar reshaping in children in order to prevent growth anomalies due to cutaneous shrinkage. The objective of the surgical treatment, coordinated with the reeducation care, is to improve the physical abilities of the skin, to restore the function and avoid the deformations. Reeducation uses various techniques (i.e. sensitive-motility, massage and mobilizations) with or without physical agent (water, aspiration and touch-drive technique). Posture and positioning rely on the small or major aids, from orthosis to prosthesis. Compression is obtained by the adjustment of aids on molding and compression garment. Indications of the reeducation treatment depend on the timing of cutaneous covering and the advance of the healing process. It also depends on the underlying condition including skin traumas (frictions, wounds, burns), skin surgeries (purpura fulminans consequences, skin graft reconstruction after giant nevus resection, malignant lesion or vascular malformations). The final goal is the rehabilitation and development of the child and the adolescent in its entire somatopsychic dimension.