The trapezoid release for scar contractures: early experience

A circumferential incision technique to release wide scar contracture

SUMMARY

Wide scar contracture in patients with large burns is generally treated with a skin graft or flap after release of the contracture. In children, however, the creation of a new scar at the donor site should be avoided because additional operations are sometimes required later in life. Patients with large scars often lack adequate donor sites. We describe a simple technique that effectively reduces wide scar contracture without the use of a skin graft or flap. A spindle-shaped incision line is designed around the contracted scar. The major axis of the spindle should coincide with the direction of strongest contracture. Incision of the skin releases the contracture, and the surrounding skin returns to a normal position. If satisfactory release of the contracture is not obtained by a simple incision, the surrounding skin is slightly undermined. The doughnut-like skin defect resulting from undermining is sutured again, taking care to avoid increased tension in the direction of contracture. We used this technique to treat 28 scar contractures in 21 patients. All sites had good outcomes without any complications, such as congestion or haematoma. Scar contracture markedly resolved, both subjectively as well as objectively. Hard red scars consistently became whiter and softer after the operation. The design is similar to the double opposing V-Y plasty or rhomboid flap but the significant feature of our technique is that the design includes the entire scar in the central area. It makes it possible to release multiple contracture bundles or a largely contracted area at one time. This technique is simple, safe, minimally invasive for patients, and requires no other donor sites. It should be tried before resorting to the use of skin grafts or flaps in patients with large scar contractures.

Burn scar contracture release: a simplified technique utilizing contact media

A technique to overcome the problems of inlay grafting for burn scar contracture release is described. A greater release can be achieved by moving the point of release away from the flexure crease, with the added advantage of grafting on to a 'flat non-mobile' surface. A simplified method of graft fixation and compression is described, along with the use of contact media in the postoperative management to prevent graft shrinkage and the recurrence of contracture. During a 6-year period, burn scar contracture release with inlay grafting was performed on 24 patients (10 limbs with 17 split-skin grafts and 14 fingers with 21 full-thickness grafts) with no recurrence.