Clinical application of composite skin transplantation combined with systemic rehabilitation in the treatment of extensive scar contracture around the popliteal fossa in children after burns
Objective To explore the clinical effect of composite skin transplantation combined with systemic rehabilitation in the treatment of extensive scar contracture deformity around the popliteal fossa in children after burns.Methods A retrospective observational research method was adopted.Seventeen children with extensive scar contracture deformities around the popliteal fossa after burns who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Military Medical University from March 2018 to April 2022 were selected.Among them,there were 10 males and 7 females,aged 2-11 years,with scar contracture deformities lasting from 10 months to 9 years,all located around the popliteal fossa,10 cases of right popliteal fossa,5 cases of left popliteal fossa,2 cases of bilateral popliteal fossa,scars around the popliteal fossa result in a knee joint extension angle of only 95° to 115°.The scar contracture during surgery was thoroughly released,joint mobility was restored,so as to form a secondary wound range of 10 cm × 8 cm-20 cm × 13 cm.In stage Ⅰ,after completely releasing the scar contracture,the wound was covered with negative pressure closure drainage(VSD)for 2-3 days.In stage Ⅱ,a large autologous blade thick scalp and allogeneic decellularized dermal matrix composite graft was performed to repair the wound around the popliteal fossa.After 8-10 days of surgery,the dressing was changed to check the survival of the skin graft.One week after the skin graft survived,a 12 month orderly knee joint function training was conducted under the guidance of a rehabilitation therapist.Postoperative sequential treatment with a combination of strong pulsed light and ultra pulsed carbon dioxide lattice laser for 5-7 courses of significant scar hyperplasia in the skin graft area and edges.Results 15 cases of pediatric patients had good skin graft survival;One patient developed a wound due to partial displacement of the transplanted autologous scalp,and one patient developed a plasma swelling under the limb graft,which was drained through an opening.Two patients underwent dressing changes for 3 weeks before the wound healed.After follow-up for 6 to 36 months,the elasticity and appearance of the skin graft were similar to those of a medium thickness skin graft.Children with knee joint contracture wereable to fully extend to 180°,and knee joint function was significantly improved.There wasno scar formation or hair loss in the donor skin area.Conclusions The combination of composite skin transplantation and systematic rehabilitation has a good effect on the treatment of extensive scar contracture around the popliteal fossa in children after burns,avoiding the problem of scars left in the donor area due to autologous skin grafting.
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