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Trauma Mon. 2019;24(2): e82921.
doi: 10.5812/traumamon.82921

Scopus id: 85067174106
  Abstract View: 156
  PDF Download: 43

Research Article

Comparing Z-Plasty versus Z-Plasty and Skin Grafting for Surgical Tension-Free Treatment of Post-Burn Elbow Contractures: A Randomized Clinical Trial

Seyed Nejat Hosseini 1 * , Mehran Khorram 1, Masoud Vakili 2, Farnaz Samani 3

1 Department of Burns Surgery, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
2 Department of Health Education and Promotion, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
3 Department of Anesthesiology, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
* Corresponding author: Faculty of Medicine, Zanjan University of Medical Sciences, Mahdavi Blvd., Zanjan, Iran. Postal Code: 4513956111. Tel: +98-9125427479, Fax: +98-2433449353, Email: Email: nejat.hosini@zums.ac.ir

Abstract

Background: Elbow contracture is a common incidence. It has surgical treatments such as scar release and skin graft, Z or V-Y plasty, and lateral or medial arm flap. In this study, we compared Z-plasty versus Z-plasty and skin grafting in the surgical tensionfree treatment of post-burn elbow contractures.

Methods: 30 patients with elbow joint extension restriction participated in this randomized clinical trial in two groups: experimental (Z-plasty with skin graft) and control (Z-plasty alone) groups. In both groups, Z-plasty was designed with a 60 angle. In the experimental group, the flaps were rotated without tension, and then the upper and lower parts of the flaps were grafted by a midsplit-thickness skin graft. The surgery area was examined regarding infections, wound healing time, necrosis, and scar. Significant differences were evaluated using unpaired student t-test.

Results: Only seven participants in the control group had complications. The statistical analysis of all variables in both groups showed that Z-plasty with skin graft treatment had a significantly better result than the Z-plasty alone (P = 0.006). However, the two groups showed no significant differences in terms of infection, flap tip necrosis, surgery site infection, and feeling of pressure in joint extension or scar recurrence (P = 0.273).

Conclusions: Tension-free flap must be used in patients with mild or moderate wide elbow scar contracture. Combining Z-plasty with skin graft is easy and has better results than Z-plasty alone. It is recommended using this technique in patients with intraoperative flap tension.

Keywords: Z-Plasty, Skin Graft, Elbow Contracture, Post-Burn Contracture

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Submitted: 24 Apr 2017
Accepted: 20 Sep 2017
First published online: 18 Aug 2018
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