SUMMARY. Through the description of a case with inguinal, abdominal and genital contracture, the author discusses the role and function of cutaneous triangles, emphasizing their importance when the pathology involves some entire regions.

Fig. 1 The localisation of the contracture involving some entire regions.

Introduction

In post-burn plastic surgery, the role of angles and triangles and their transfer in the form of Zplasty is indisputable (1, 2, 7). Their creation in cutaneous folds gives the region the necessary mobility and desired function. The realization of a triangle means applying economic incisions, using autochthonous skin in a vascularised form, and minimising the use of epidermo-dermic transplants.
These problems must be taken into consideration by every surgeon prior to surgical intervention, especially before typical cases such as axillary contracture, in the cubital and popliteal fossa, and in the fingers and neck.(3, 4, 5, 6).
Having encountered such a rare complicated case, we decided to describe it, in order to offer evidence ofthe cooperation of cutaneous triangles, in post-bum scars with broad localization, which affect some regions entirely. Reference is made to an evident inguinal, abdominal and genital contracture occurring in a young pregnant woman.
Unfortunately we could not take any photographs of the case, the woman's refusal reflecting a backward mentality.

The patient Z.R, 22-years-old, was burned as a result of fire when four years of age. After wrong local treatment she was affected by a scar contracture which she and her~parents underestimated. She married at the age of 21 and came to be examined by us, while pregnant. She was sent by an obstetrician in order to be helped to have a normal birth. The foetus had a normal development of 21 weeks. 1 Locally the patient had a contracture in the fo of a web space joining two inguinal regions in e centre, and impeding opening of the two infeior extremities. In the upper part this had caused retraction of the abdominal region as far as the proximity of the umbilicus.
The genital organs could be seen only in the gynaecological position, in which a deformation of the labia majora was noticed. It was decided to correct the pathology to enable the abdomen to be distended and at the same time to open the way to a normal birth.

By using a potentiated general and endotracheal anaesthesia with Fluothane, we managed to achieve full relaxation of the patient without damaging the foetus. With the patient in the gynaecological position the incision started on the pubis. We first created triangle number 1, size 5x3 em, which corresponded to the vertical orientation of the vulvar region.

Fig. 2 The position of angles and triangles with the aim of releasing the contracture and eliminating the retractive forces.

Continuing alongside in both directions, immediately out of the base of the first triangle we formed triangles number 2, size 3x2 em, which caused the elimination of the retractive forces and gave the necessary mobility to the vulvar region, including the labia majora. The incisions then passed in linear form into the two inguinal regions, finally creating angles number 3, size 4x3 em. The purpose of these angles was to completely free the regions affected by scarring and to frame them in relation with the femoral region, unaffected by scarring. The same functions pertained to the other angles formed on the upper part of the operated wound, also labelled number 3. This is the only possible way to realize an abdominal opening sidelong and in the centre. We would emphasize that the sizes of the angles and triangles should not be fixed. This depends on the extent of the scarring and the stretching it causes to the tissues. The cutaneous defect, though covering a large surface (25x20 em), was covered by epidermodermic transplant. The median and posterior part of the right femoral region served as the donor site.
The post-operative period passed without any complications. The patient was also under the care of the obstetrician, who recommended giving her progesterone and papaverine for one week. At the end of the first week she was taken off the general treatment (penicillin, solutions, vitamin therapy), while the local treatment lasted until complete consolidation of the transplant.
She was discharged from hospital on 23 June 1993, i.e. 34 days after the operation.

Most vicious post-burn contractures require covering of the wound with epidermo-dermic transplant. It is the plastic surgeon's job to plan proper incisions, to interrupt the retractive forces and to form a new line of forces without tension, in an attempt to approach the initial function. This can be realized through imaginative location of the angles and triangles, especially by combining their reciprocal actions.

RESUME. L'auteur, à travers la description d'un cas de contracture inguinale, adbominale et génitale, discute le rôle et la fonction des triangles cutanés, en soulignant leur importance quand la pathologie intéresse des régions entières.

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