Background: Tissue expansion can be considered one of
the fundamental steps in reconstruction ladder. It is a technique
that can provide similar tissues to the defect without sacrificing
other tissues. Tissue expansion offers lots of benefits, it
provides tissue similar in texture and colour for coverage of
defects especially post burn deformities. The high percent of
complications and need of multiple stages has always been
an obstacle to this technique. However in limited donor areas
application of large expanders is very difficult and the gain
of small expanders is limited with need of repeated sessions
with its high complications and risks. In this study, we use
rectangular expanded flaps which yields tissues more than
other circular or crescent expanders and backcuts are added
in order to increase both length and width of the flap.
Aim of Work: To study the value of both vertical and
horizontal back-cuts added to expanded advancement flaps
in reconstruction of post burn deformities in safe and
effective way.
Patients and Methods:
• Twenty expanders were used for 16 patients as two expanders
were applied in 4 cases. The expanders were implanted in
the scalp (n=10), neck (n=3), chest and abdomen (n=3) and
shoulders (n=4). Rectangular expanders were used in all
cases. The capacity of the expanders employed varied from
250 to 750ml.
• Cases were divided into two groups. In group A; we did two
horizontal back cuts located at the base of expanded flap at
the time of expander delivery while in group B; a third
vertical backcut was added on the distal limb of the flap.
• The measurement of length of expanded flap is measured
before doing any back cut and after the two horizontal
backcuts in group A. It is also measured before and after
all back cuts in group B.
• Results during 3 years period from 2015-2017, 16 cases
were subjected to application of 20 rectangular expanders
for reconstruction of post burn scarinng of different parts
of the body, cases were divided into two groups complications
included infection, port exposure, and superficial flap
necrosis of the edges. In group A measurement of the length
of expanded skin was done before and after horizontal back
cuts for both vertical limbs AC, BD. In group B measurement
was taken for the same limbs before and after all the 3
backcuts. The average increase in length in group; A=3.12±
cm, while the average increase in group; B=4.35cm.
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Conclusion: Using both vertical and horizontal back
cuts added to both length and width of expanded flap gain,
enabled us to remove more scarred tissue bilaterally. It also
preserved normal tissues infront of the scarred tissue from
being discarred.