Evaluation of role of rhomboid flap and double Z-plasty in post-burn contractures: A prospective case series in Iraq

Background and Aim: Numerous reconstructive options are used to address post-burn scar contractures, including skin grafting, geometric relaxation techniques, local flaps, and free flaps. This study aimed to evaluate the functional and cosmetic outcomes of a combined rhomboid flap and double Z-plasty technique for wide and long post-burn contractures crossing joints in various body parts. Material and Methods: This prospective case series involved 100 patients with post-burn scar contractures in different body areas who underwent surgery using rhomboid flap and double Z-plasty at Al-Wasity Teaching Hospital between January 2020 and July 2024. Patient data, including age, sex, duration of contracture, preoperative and postoperative contracture band length, and improvement in joint range of motion, were recorded. Results: Of the 100 patients included in this study, 98 experienced a significant increase in their joint range of motion and achieved full movement after release using our technique. There were no major flap losses or necrosis, although three patients experienced partial superficial epidermal sloughing, which did not affect the overall results. Only two patients had less than full-range shoulder abduction. Conclusion: The rhomboid flap combined with double Z-plasty is a reliable technique that serves as a valuable option in the reconstructive surgeon's armamentarium for managing wide and long chronic post-burn contractures over joints. This treatment offers the advantages of effective lengthening, excellent postoperative function, and acceptable cosmetic outcomes, while requiring less postoperative splinting and resulting in a low observed incidence of contracture recurrence during short-term follow-up in this series.