Traitement Chirurgical Des Brides Cervicales Post Brûlure: À Propos De 47 Cas.

Annals of burns and fire disasters Pub Date : 2022-03-31
M Mahrouch, O E Atiqui, I Yafi, O A Benlaassel, S Zinedine, M Geouatri, M Sahibi, M D Amrani, Y Benchamkha
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Abstract

When their treatment is not optimal, deep cervical burns often develop retractions, ranging between simple vertical retractions to major global ones. They generate functional, aesthetic and psychological sequelae. Surgical treatment, adapted to both the patient and the type of retraction, has several goals including restoring the neck-chin angle, restoring a correct aesthetic aspect, and allowing social rehabilitation. In our unit, we managed 47 patients (mean age 22) with neck contractures over 8 years, from 2012-2020. Scald is more frequent in children while flame burns prevail in adults. Most (58%) patients healed spontaneously. Moderate and severe contractures (Achauer's classification) accounted for 30.6 and 38.8% respectively. In most (94%) patients, the contracture leads to a distortion of the neck-chin angle and limits the extension of the neck. Surgery techniques were skin grafts (67.3%), local plasties (24.5%) and flaps (8.2%). During the follow-up, results were considered as good in 83%, acceptable in 8.5%, while 8.5% needed another surgery. Plasties (Z, IC, VY…) and local flaps (with or without skin expansions) are indicated in minor contractures. Authors still debate on the best technique (graft or flap) for severe and major ones. Post-operative rehabilitation is a cornerstone for good results.

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烧伤后颈椎扭伤的手术治疗:约 47 例。
如果治疗不当,深层颈椎烧伤往往会出现牵拉,从简单的垂直牵拉到严重的整体牵拉不等。它们会造成功能、美观和心理上的后遗症。根据患者情况和回缩类型进行的手术治疗有多个目标,包括恢复颈颏角、恢复正确的美学外观以及社会康复。在 2012-2020 年的 8 年时间里,我们共治疗了 47 名颈挛缩患者(平均年龄 22 岁)。烫伤多见于儿童,而火焰烧伤多见于成人。大多数患者(58%)可自愈。中度和重度挛缩(Achauer分类)分别占30.6%和38.8%。大多数患者(94%)的挛缩导致颈颏角变形,限制了颈部的伸展。手术方法包括植皮(67.3%)、局部缝合(24.5%)和皮瓣(8.2%)。在随访期间,83%的患者认为手术效果良好,8.5%的患者认为手术效果可以接受,8.5%的患者需要再次手术。皮瓣(Z、IC、VY......)和局部皮瓣(带或不带皮肤扩张)适用于轻度挛缩。对于严重挛缩和大挛缩,作者们仍在争论最佳技术(植皮或皮瓣)。术后康复是取得良好效果的基石。
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