Burned perineum reconstruction: a new approach.

The treatment of postburn contractures of perineum remains a complex and an unsolved problem. Fourteen patients were operated. According to our observations, the perineum contracture can have two formations: (a) transverse scar folds formed between both the thighs and (b) obliteration of perineum by scar tissues. The first type, most common, is successfully eliminated by using local trapezoid flaps. The flaps are prepared from the divided sheets and adjacent tissues on both inner thighs' surfaces. The flaps are performed by cross-incisions of the fold; several pairs of adipose-scar flaps are formed. Because of the crescent shape of the fold, the flaps acquire a trapezoid shape. Then, they are transposed toward each other without rotation, doubling the surface of maximum tension thus eliminating the contracture completely. This technique allows releasing the contracture without skin grafting. The flaps are 4 to 5 cm wide, and they contain subcutaneous fat layer and have no sharp angles. All this assures stable circulation and prevents necrosis, flap loss, and contracture recurrence.