367
Total Inguinal Contracture: Anatomy
and Treatment
After widespread burns to the body’s anterior surfaces,
scars deform the form and surfaces of the trunk, inguinal
regions, genitalia, and thighs, and cause hip joint flexion
contractures (Figs. 40.5, 40.6, and 40.7). A severe scar sur-
face deficit excludes reconstruction with local flaps.
Therefore, only dissections and excision of mature scars
through the intermediate layer of a large surface, and
wound resurfacing with whole split skin transplants, are
possible for hip contracture release. This approach signifi-
cantly improves the appearance of a large region of the
body area (Figs. 40.5, 40.6, 40.7, and 40.8).
a
b
c
Fig. 40.5 Abdomen inguinal and thigh regions covered with rough
contracted scars, causing flexion contractures of thighs and abdomen
wall. (a) Pre-surgery; (b) wound after scars incisions and excision,
umbilicus accepted normal position; (c) wound covered with skin trans-
plants, deformation less expressive, inguinal contractures released
Total Inguinal Contracture: Anatomy and Treatment
368
a
c
b
d
Fig. 40.6 Scars of body
anterior surface destroyed
abdomen wall, inguinal zones,
caused inguinal contractures,
deformed thighs and genitalia.
(a) Before the operation; (b)
scars excised, umbilicus
transferred, genitalia freed
from scars, inguinal
contractures released; (c, d)
wound covered with whole
split transplants; appearance
significantly improved,
contractures eliminated,
transplants alive (one week
and three weeks after surgery,
respectively)
40 Inguinal Scar Contractures: Anatomy and Treatment
369
a
b
Fig. 40.7 Postburn deformity of the abdomen wall, genitalia, thighs,
inguinal contractures (mostly right side). (a) Pre-surgery view; (b) scars
excised, local tissues transposed on the wound, most parts of the wound
were skin rafted, inguinal contractures released, umbilicus accepted
normal position, deformity became less expressive
a
b
Fig. 40.8 (a, b) Both total inguinal and lower abdomen wall contracture treatment by wide scar excision and skin grafting in a 5-year-old boy
Total Inguinal Contracture: Anatomy and Treatment
370
Conclusion
The edge inguinal contracture is successfully eliminated
with the thigh adipose-cutaneous trapezoid flap, which
continues to grow, preventing contracture recurrence. The
donor place is cosmetically acceptable and more attrac-
tive with time after surgery. Total inguinal contracture is
treated by contracted scar incision and excision, freed
inguinal zones, genitalia, and abdominal wall; large
wounds are covered with whole split skin transplant
placed transversely.
40 Inguinal Scar Contractures: Anatomy and Treatment
371
© Springer International Publishing AG, part of Springer Nature 2018
V. M. Grishkevich, M. Grishkevich, Plastic and Reconstructive Surgery of Burns,
Index
A
Abdomen inguinal and thigh regions, 367
Achilles-calcaneal zone treatment, 355
Achilles tendon, 353, 354, 356–358, 360, 361
Adduction contractures elimination, 249, 250, 254, 255
Adipose-scar trapezoid flaps, 114, 123, 125, 249, 300
in children, 337
lateral truncal medial contractures, 127–134
Ankle burns, 335, 339
Ankle edge contracture, 20
Ankle edge dorsiflexion scar contracture
anatomical features, 329, 331
cosmetic defects, 329
extension surface, 329
flexion surface, 329
functional limitations, 329
functional surfaces, 330
mild-to-moderate edge ankle contracture, 332
moderate-to-severe ankle flexion contracture elimination, 334
by scars, 331
trapeze-flap plasty, 332
trapezoid flap and skin transplants, 335
Ankle medial dorsiflexion contractures, 28, 345
anatomy, 339
extension surface, 339
flexion surface, 339
functional zones, 340
long fold’s sheets, trapezoid adipose-scar flap, 343
trapeze-flap and V-Y pasties, 344
trapezoid adipose-scar flaps, 341
with trapezoid-flap plasty, 341
Anterior neck scar contracture, 88
Atypical neck scar deformities, 97
Axilla suspension, 194
Axillary trapezoid flaps, 179, 187
Axillary whole flap, 160
B
Bilateral shoulder edge adduction contracture, 181, 183
anatomical and clinical features and signs, 179, 180
axillary fossa condition, 182
with axillary subcutaneous pedicle flap, 186
axillary trapezoid subcutaneous pedicle flaps, 187
axilla suspension, trapezoid subcutaneous pedicle flap, 183
in children, 182
fasciocutaneous and musculocutaneous flaps, 179
formation and functiona zones, 179
island of healthy skin in axillary cupola, 185
one-stage/two-stage procedures, 182
scar surface deficit, 180, 182
wound healing, 179
Bilateral total burned cheeks resurfacing, 79
Bilobe groin flap, 304
Breast-restoration method, see Burn-damaged breast
Burn-damaged breast
abdominal scar deformity excision, wound closure, 143
anatomy, 137
breast parenchyma deficit, 139
inframammary fold, 139
mild-to-moderate edge anterior axilla contracture, 139
nipple-areolar complex, 139, 146
with one adipose-cutaneous trapezoid flap, 140
parenchyma formation, 142
parenchyma mobilization, 138
in prepubescent females, 137
using scar excision, 138
skin transplant and scar tissue, 139, 142
soft tissue deficit, 144
sutures and skin grafting, 138
Burned perineum, 297, 299–302
Burned upper lip, anatomical features of, 33
C
Cervical flap transposition, 65
Cervico-facio-thoraco-periauricular flap, 70
Cervico-periauricular flap, 52
Cervico-thoraco-periauricular flap, 52, 54, 56, 66
total bilateral burned cheeks resurfacing, 76
two-stage unilateral total cheek resurfacing with, 78
Cheek burns, 65
Cheek deformity, 52, 65, 67, 70
Cheek reconstruction, 65
Cheek resurfacing, 79
split ascending
neck flap
bilateral and unilateral, 75, 78
second stage of, 79
Chest wall reconstruction, split cervico-thoracic flap, 104
Chin-manubrium fusion, 125
D
Dorsal commissural contractures reconstruction, 261, 266
Dorsal edge thumb adduction contracture, 255
Dorsal hand surface deformity, 255
Dorsal interdigital edge contractures, 259–261
Dorsiflexion ankle edge contractures, see Ankle edge dorsiflexion
scar contracture
372
E
Edge adduction contractures, 243, 245
formation, 9
management, 249
Edge contracture elimination techniques
by contracted scars excision and wound covering, 314
mild-to-moderate contracture, one trapezoid flap, 310, 311
mobilized popliteal adipose-cutaneous whole layer, 314
moderate contracture, three trapezoid flaps, 312
one-flap plasty, fold’s crest scars ulceration, 311
severe flexion, long fold in trapezoid flaps, 313
Edge elbow flexion contracture, 18
Edge first web space adduction contracture, 18
Edge inguinal contracture, 363, 365
Edge joint flexion contracture formation, 2
Edge postburn scar contracture
anatomy and clinical signs, 10
joints, commissures, neck and inguinal anatomy, 11
Edge scar contracture
anatomy, 16
scar surface deficit, 29
Edge shoulder adduction contractures, 4, 174, 176
adipose-cutaneous axillary trapezoid flap and skin
transplants, 176
adipose-scar and adipose-cutaneous trapezoid flaps, 171
anatomical features and clinical signs, 168
contracture-type formation, 167
functional zones, 167, 168
joint rotation axis and release contracture, 167
with multiple adipose-cutaneous and adipose-scar
flaps, 172, 174, 175
with one adipose-cutaneous axillary flap, 173
with one trapezoid flap, 170
scar excision, shoulder and chest wall, 175
scar surface deficit, 168, 169
trapezoid flaps, 171
surgical technique, 167
with three trapezoid flaps, 171
trapezoid scar surface deficit, 169, 177
Edge wrist contracture, 239
anatomy and elimination with trapezoid flap, 238
Elbow burns, 223
Elbow circular scars, 231
Elbow edge flexion contracture
anatomical features, 214
clinical signs, 214
functional zones and anatomy, 213
with one adipose-cutaneous trapezoid flap, 216
scar surface deficit, 215
scar ulceration, 218
trapezoid adipose-cutaneous and adipose-scar flaps, 218, 220
with trapeze-flap plasty, 217, 219
with trapezoid flaps, 219, 221
Elbow reconstruction, 226
Elbow scar contractures, 12
External jugular vein, 55
Eyebrow resurfacing, 72
F
Facial artery, 55
Fifth finger flexion contracture
anatomy, 281
edge contracture, trapezoid flaps, 282
and palm skin grafting, 277
scar edge flexion contracture, 282
trapezoid flaps, 282, 283
treatment, 281
ulnar hand, long fold, 283
Finger flexion contractures
anatomical features, 270
finger extension, 272
flap mobilization, 272, 273
flap transposition and wound coverage, 272
flaps planning, 272
flexion medial surface deficit, 271
mild-to-moderate contracture elimination with trapezoid flaps per
se, 270, 274, 275
scar sheets, 285
severe elimination, 276
single-stage procedure, 272
with thumb medial contracture, 276
treatment, 279, 280
Finger motion, 269
First finger flexion contracture, 284
First finger metacarpophalangeal joint medial scar contracture, 284
Flap plasty methods, 244
Flexion surface, 1
G
Groin flap
design, 304
perineal, inguinal and perianal contractures, 303, 304, 306
planning, 303
H
Half-cheek resurfacing, 65–72
Half-face resurfacing, 61
Hand border/wrist contractures, 235
Hand burns, 235, 287, 288
Heel burns, 353
I
Inguinal adduction contracture, bi-lobed groin flap, 365, 366
Inguinal burns, 366
Inguinal scar contractures, 363–367, 369
Interdigital fusion, 266
Interphalangeal edge contractures, trapeze-flap plasty, 262–264
J
Joint elbow flexion medial contracture, 226, 229
anatomy, 224
functional zones and anatomy, 223
mild-to-moderate medial elbow contracture, 227
scar surface deficit, 225
surgical techniques
adipose-scar trapezoid flaps, 226
method of plasty, 229
mild-to-moderate elbow medial scar flexion
contracture, 226
scar fold protrusion, trapeze flap plasty, 226
scar surface deficit, 226
semilunar fold, 226
severe elbow medial contracture treatment, 226
trapezoid flaps, 226
trapeze-flap plasty, 228
trapezoid adipose-scar flaps, 225, 228
upper extremity function, 223
Index
373
Joint medial flexion/adduction contracture formation, 3, 21
Joint rotation axis, 32
Joint surfaces, functional zones of, 1, 2
K
Knee burns, 307, 309, 317
Knee edge scar flexion contractures
anatomical features, 307, 309
clinical signs, 309
fold’s length and protrusion, 309
and hypertrophic scars, 315
scar surface deficit, 307, 309, 311
scar ulceration, 310
with trapeze-flap plasty, 316
Knee joint surface
extension surface, 307, 308
flexion surface, 307, 308
Knee medial contractures after burns, 321, 322
anatomical features, 317, 318
elimination techniques
pathologic scars excision and skin grafting, 322
trapeze-flap plasty, 321, 322
functional zones, 317, 318
knee posterior surface, 317
pathological scars excision, 320
with scar excision and skin grafting, 322
scar surface deficit, 319, 320
surface deficit, 317
trapeze-flap plasty, 319
treatment, 317
ulcerous pathologic scars, 322
Knee scar ulceration, 325, 327
L
Lateral cheek resurfacing, 67
Lateral edge neck scar contracture, 23, 91
Lateral medial neck scar contracture, 91
Lateral neck scar contractures, 91
edge
anatomy, 109, 110
scar surface deficit, 109
treatment, 110
with one trapezoid flap, 111
with three trapezoid flap, 110, 111
medial
anatomy, 112, 113
trapeze-flap plasty, 114
treatment, 114
scar deficit, 111
Lateral truncal medial contractures, 127, 130, 133–135
anatomy, 128
scar surface deficit, 129
Lower cheek resurfacing
with split cervico-thoracic flap, 103
technical details, 68
Lower face one-stage resurfacing, split ascending neck flap, 61
Lower-medial cheek and chin resurfacing, 69
M
Medial adduction contracture, 243
elimination with trapeze-flap plasty, 250
Medial axillary adduction contracture, 24
Medial cheek resurfacing, 70
Medial contracture formation, 9
Medial contracture management, 250
Medial lateral neck contracture, 28
Medial mild-to-moderate wrist contracture elimination, 236
Medial neck anterior contracture, 29
Medial perineal contracture, 27, 297
Medial radial wrist treatment, 237
Medial scar contracture
anatomy, 11, 16, 21
clinical signs, 11
flexion/adduction, anatomy of, 7
scar surface deficit, 30
Medial soft tissue defect, 71
Medial wrist contractures, 26, 239
Medio-lateral bilateral anterior neck contracture, 90
Medio-lateral one-side anterior neck scar contracture, 90
Mentosternal contracture, 88, 90
Microstomia, 23, 44
Middle-lateral bilateral neck contracture, 88
Middle-lateral unilateral neck contracture, 88
Middle neck contracture, treatment, 95
Midline neck contracture, 88
anatomy of, 93, 94
anterior scar contracture, 89
treatment with split neck flaps, 94, 96
Moderate edge ankle contracture with three trapezoid flaps, 334
Mouth angle resurfacing, 70
Multi-component hand flexion contracture elimination, 277
N
Nasal contracture
anatomy, 47
follow-up, 49
surgical technique, 48, 49
Nasofrontal angle, 47–49
Neck burns, 87
Neck contracture, 102, 107, 162
Neck deformity, 106
Neck scar contractures, 87
anterior and lateral groups, 87
anterior neck contracture, 88
lateral neck contractures, 91
reconstruction, 92
Total neck anterior scar contracture, See also
Neck tissue transposition, 111
Nose resurfacing, 72
Nose shortening, 48
O
One-side severe inguinal adduction contracture, 366
One-stage elimination of contractures, 184
One-stage reconstruction, bilateral shoulder edge adduction scar
contractures, 182
One-trapeze-flap technique, 332
Oral angle contractures, 41–43
P
Palmar edge adduction contracture treatment with trapezoid flaps, 247
Palmar edge contracture, 265
Palmar interdigital commissural contracture, 265
Pediatric axillary edge contracture, see Shoulder adduction
contractures
Pediatric face reconstruction, 49
Index
374
Pedicle groin flap, 303
Perineal contracture, 297, 301–302
Perineal obliteration, 303–306
Perioral deformity, 37, 38
Philtrum columns, 33
Philtrum injury
anatomical features, 33, 34
surgical technique, 35–38
Postburn ankle scar contractures, 329
Postburn boutonniere deformity
anatomical features, 287, 288
contracture anatomy, 287
damaged PIP joint capsule, 287
functional features, 287, 288
hand reconstruction, 291
preliminary distraction and passive movement restoration,
PIP joints, 289
restoration of PIP joints’ passive movements, 289
soft tissue defects, 287, 295
restoration, 294
surgical interventions, 288
surgical treatment, 292, 293
tendon extension apparatus restoration, 287, 291
tendon transplant preparation, 290
Postburn edge dorsal commissural contractures elimination
with trapeze-flap plasty, 266
Postburn half face resurfacing, 82
Postburn microstomia
anatomy, 41, 42
surgical technique, 43
Postburn perineal obliteration, 303–306
Postburn scar contracture, 1, 10–12
anatomy, 15, 16
edge scar contracture, 16
medial scar contracture, 16, 21
total contracture, 17, 21
contracture treatment, 1
edge contracture formation, 9
edge postburn scar contracture
anatomy and clinical signs, 10
joints, commissures, neck, and inguinal anatomy, 11
joint surfaces, functional zones of, 1, 2
medial contracture formation, 9
medial scar contractures, 11
total contracture formation, 10, 12
Proximal interphalangeal (PIP) joint scar contracture, 273
Proximally based sural adipose-cutaneous flaps, 353, 354, 356
R
Radial medial wrist contracture, 237
S
Scalenus muscle, 55
Scar contractures, 1, 4, 10
Scar excision, 231–234
and grafting, 325–327
Scar flexion medial contractures, fingers, 269
Scar fold formation, 236, 276
Scar surface deficit, 19, 21
contracture cause, 21, 22, 298
edge scar contractures, 29
local flaps and anatomical local-flap technique
substantiation, 21, 22
medial scar flexion contractures, 30
total scar contracture, 31
Scar syndactyly, 259
Severe flexion multiple contracture, 278
Severe medial adduction contracture release with trapezoid flaps
and skin grafts, 252
Severe PIP joint injury, clinical signs, 288
Severe scar surface deficits, 234
Shoulder adduction contractures, 156, 157
in children
anatomical and clinical signs, 159, 160
anterior shoulder joint flexion, 159
with axilla flaps and neck contracture, 164, 165
contracted scar excision, 160
deformation treatment with axilla flap, 161
elbow edge flexion contracture, 162
scar deformity, 162, 163
surgery planning, 162
triangular-flap techniques, 159
upper limb motion, 159
edge anterior
anatomy, 147, 148
with axillary adipose-cutaneous flap and skin transplants, 155
axillary adipose-cutaneous trapezoid flap, 157
axillary and elbow adipose-cutaneous trapezoid flaps, 155
functional zones, 147, 148
mild-to-moderate anterior adduction contracture elimination,
150
mild-to-moderate reconstruction, one trapezoid flap, 152
with one trapezoid flap and skin transplants, 156
scar fold’s sheet surface deficit, 149
skin graft shrinkage, 147
with three trapezoid flaps, 153, 154
trapezoid scar surface deficit, 149
trapezoid-flap plasty, 152
with two trapezoid flaps, 151
Shoulder burns, 167, 179
Shoulder medial contracture
anatomy, 197, 198
contracture release and wound covering, 203
counter-transposed flaps, 200
elbow edge contracture, 201
elimination, 202
functional zones, 198
with one pair of adipose-scar trapezoid flaps, 199
pectoralis major and latissimus dorsi muscles, 197
scar surface-deficiency compensation, 203
scar surface deficit, 197
trapeze-flap plasty, three pairs of trapezoid flaps, 201
trapeze-flap plasty, two pairs of trapezoid flaps, 200
Shoulder posterior adduction contracture, 167
edge type (see Edge shoulder posterior adduction contractures)
Shoulder reconstruction, 182
Shoulder total adduction contracture, 189, 190, 192–194
anatomical forms, 205–207
breast deformity and lateral truncal contracture, 207
in children, 207, 211
donor wound resurfacing, 211
early reconstruction, 206
functional and cosmetic outcomes, 207
joint flexion surfaces, 205
with preserved skin, axilla apex
anatomy, 189
flexion lateral and medial surfaces, 189
reconstructive technique, 189
scar surface deficit with confined island skin, 192, 194
and skin grafting, 190
Index
375
small island of skin, quadrangular scar flap, 193, 194
surgery with confined island skin, 192, 194
quadrangular adipose-scar flap, 207
quadrangular local subcutaneous pedicle scar flap
and skin grafts, 208
quadrangular subcutaneous pedicle flap, 209, 212
scar surface deficit, 205
skin grafting, 207
surgical technique, 207
variant of donor wound covering, 211
wound and severe scar surface deficit, 207
Skin grafting, 233, 325–328, 369
Skin transplantation, 363
Split ascending neck flaps
anatomy and variants of, 51
axial blood supply, 52, 55
bilateral and unilateral cheek resurfacing, first stage of, 75, 78
boundaries, 53
cervico-thoraco-periauricular flap, 54, 56
design and specific technical features, 65, 66
half-face resurfacing, 57, 61
lower face one-stage resurfacing with, 61
mobilization and transposition, 53
principles, 55
second stage of cheek resurfacing, 79
two-stage face resurfacing with, 59, 62, 63
two-stage total cheek resurfacing, 56, 61
Split neck flaps, 65
midline neck contracture treatment with, 96
unilateral neck scar contracture, 104
Sternocleidomastoid muscle, 55
Submandibular burns, 97
Submandibular contracture, 96
Submental deformity and contracture, 88, 91
Submental/submandibular contracture, 97
Subtotal unilateral face resurfacing, 81
Superficial artery, 55
cervical, 68, 75
of neck, 55
perforator, 51
T
Tendon plasty technique, 287–289, 291, 294, 295
Thumb adduction contractures, 243
Total ankle contracture, 347–351
Total bilateral burned cheeks resurfacing,
cervico-thoraco-periauricular flap, 76
Total contracture
anatomy, 17, 21
formation, 10
location, anatomy of, 12
Total elbow flexion contracture, 231–234
Total face deformities, 76, 79
Total finger flexion contracture, 279, 280
Total interdigital contractures, 266
Total knee contracture, 325–328
Total neck anterior scar contracture
adipose-cutaneous flaps, 126
anatomy, 117, 118
contracture elimination, 117
counter-transposed flaps, 121
mentosternal scar fusion, 123–125
moderate-to-severe elimination, 120
with one pair of scar-fascial trapezoid flaps, 119, 120
plasty method, 117
scar-fascial flaps, 119, 126
with scar-fascial trapezoid flaps and skin transplants, 121
skin grafting, 117
Total perineal contracture, 303, 304, 306
Total scar contracture, scar surface deficit, 31
Total shoulder adduction contracture, 31
Total shoulder joint flexion/adduction contracture formation, 3
Total shoulder scar contractures, 12
Total thumb adduction contracture, 243
elimination, 254
Total wrist flexion contracture, 31
Total wrist scar contractures, 240
Trapeze-flap plasty method, 22, 42, 245, 249, 250, 255, 257,
262–264, 269, 270, 275, 277, 281, 319, 321–323,
329, 332, 335, 364
nasal contracture, 48, 49
wrist scar contracture, 235–237, 242
Trapeze-shaped scar surface deficit, 17, 32
Trapezoid-flap plasty method, 299–301
Trapezoid flaps, 26, 28, 29
Trapezoid muscle, 55
Trapezoid scar surface deficit, 243, 245, 250
lateral edge neck contracture, 23
medial axillary adduction contracture, 24
microstomia, 23
Triangular-flap techniques, 15
Truncal scar contractures, 127, 130
Trunk burns, 127, 130
Two-stage bilateral axillary edge contractures, 183
Two-stage bilateral shoulder adduction contracture, 182
Two-stage face resurfacing, split ascending neck flap, 62
Two-stage one-cheek resurfacing, in children, 81
Two-stage total cheek resurfacing, split ascending neck flap, 61
Two-stage unilateral total cheek resurfacing,
cervico-thoraco-periauricular flap, 78
U
Ulcerous soft-tissue defects, Achilles tendon and posterior heel, 353,
355, 356, 361
Unilateral anterior neck scar contracture, 88, 89
Unilateral neck resurfacing, split cervico-thoracic flap, 103
Unilateral neck scar contracture
anatomy of, 101
with contralateral split cervico-thoracic flap, 102
elimination, cervical split flap, 106
reconstructive technique, 103, 104
with split cervico-thoracic flap, 102
Unilateral resurfacing, 84
Upper cheek resurfacing, 72
Upper lip, 71
injury
anatomical features of, 33, 34
reconstruction, 33, 35–38
surgical technique, 35–38
Upper-medial cheek tissue defect, 71
Upper thyroid artery, 55
W
Web space postburn scar contractures
adduction contractures elimination, 249, 250, 254, 255
with trapezoid flaps, 256
anatomical types, 243, 244
dorsal burns, 243
functional deficiencies, 243
Index
376
hand dorsum resurfacing, 255
palmar burns, 243
with quadrangular scar subcutaneous pedicle flap
and skin grafts, 254
thumb abduction and opposition, 243
total hand burns, 243
types, 244
Wrist flexion contracture, 240
Wrist scar contracture, 12
medial ulnar and radial, 235, 239
scar surface deficit, 236
triangular pointed flaps, 235
types, 235
Wrist ulnar medial contracture and hand deviation, 236
Index