Perforator Based Interposition Plasty

• Expansion/contraction of the interpositioned skin after 3 months [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Is interpositioned skin of superior quality, as represented by less contraction with the use of the perforator based interposition flaps, compared to the gold standard (full thickness grafts), after 3 months, as measured by transparent sheet planimetry?
  
  

Rationale:

Scar contracture remains a considerable problem for the burned patient. The standard method of treatment is contracture release in combination with the application of a full or split thickness graft to close the defect. Unfortunately, the effectiveness of skin grafts is limited by scar contraction, which often necessitates additional reconstructions. Moreover, parts of the skin graft may be lost due to poor revascularisation or infection.

Since the discovery of perforator vessels, many types of new flaps can be harvested as long as it incorporates a perforator bundle (artery and vein). This flap design based on perforator vessels and local available skin, should lead to an increased flap survival and superior functional outcome. Based on this concept we developed and explored the possibility of an algorithm for treatment by means of a pilot study performed on 22 patients with a scar contracture. Results show a survival of all flaps of 100% and an expansion of the surface area by 16% after a follow up of at least 3 months. However the implications of the use of perforator based flaps for burn surgery by means of a RCT has yet to be determined.

Primary objective:

Is interpositioned skin of superior quality, as represented by less contraction with the use of the perforator based interposition flaps, compared to the gold standard (full thickness grafts), after 3 months, as measured by transparent sheet planimetry?

Secondary objectives:

• Survival of the flap/graft: i.e. measured by the amount of necrosis
• The quality of the scar: elasticity, colour, subjective scar evaluation

Inclusion criteria are:

• Indication for release of burn scar contracture
• Sufficient tissue for a perforator- based interposition flap (preferably normal skin)
• Able to give informed consent

Exclusion criteria are:

• Age < 18 years
• Location: scars on the face and scalp
• Smoking (however, the patient is eligible if smoking is quit > 3 weeks before the operation)
• Psychiatric disorders (if a loss to follow-up is anticipated)
• Language barrier