Double opposing rectangular advancement flap is an alternative technique in the treatment of wide linear postburn scar contractures

Background: Double opposing rectangular advancement is a new and alternative technique in the treatment of postburn scar contractures. The technique consists of opposing two adjacent subcutaneously pedicled rectangular flaps by advancement and lengthening a contracture band. Experimental studies demonstrated that the technique is efficient to elongate a tension line as much as Z-plasty in the rat inguinal skin. In this clinical study we investigated the efficiency and versatility of the technique in the treatment of wide linear postburn scar contractures in various parts of the body. Materials and method: We applied 16 double opposing rectangular advancement in 7 patients (aged 4-56). Flaps were applied in the upper extremity (11 flaps), lower extremity (4 flaps) and trunk (1 flap). Results: Average follow-up was 1-year. All flaps achieved adequate relaxation postoperatively and healed uneventfully. Postoperative measurements indicated that the lengthening provided with the technique ranged from 72 to 100%. The subcutaneous pedicle of the rectangular flaps provided a distinct advantage in terms of vascularity. Recontracture was seen in one patient to whom two double opposing rectangular flaps in series were applied in the axilla. Conclusion: Clinical results indicated that double opposing rectangular advancement is effective in the treatment of wide linear postburn scar contractures. Preoperative planning and application of flaps are simple. One knows preoperatively the exact elongation along the contracture line and narrowing perpendicular to this line which will be provided with the technique. Since the flaps are subcutaneously pedicled, the vascularity of the flaps are reliable. However the technique may not avoid recontracture in the axilla. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.