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. 2018 Sep 30;31(3):233-237.

The role of microsurgical flaps in primary burn reconstruction

M Pessoa Vaz  1 , C Brandão  1 , R Meireles  1 , I M Brito  1 , B Ferreira  1 , S Pinheiro  1 , H Zenha  1 , S Ramos  1 , C Diogo  1 , L Teles  1 , L Cabral  1 , J Lima  1
Affiliations

The role of microsurgical flaps in primary burn reconstruction

M Pessoa Vaz et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Despite the wide and growing use of microsurgery, its application in primary burn reconstruction is not very frequent as it faces a number of additional challenges in this setting. A retrospective analysis of the clinical records of all patients submitted to microvascular free tissue transfer for primary burn reconstruction over an 8-year period (from January 2009 to December 2016) was performed. An evaluation of the indications, timing, principles of flap selection, complications and outcomes of free tissue transfer in primary burn reconstruction was made. Fourteen patients required 18 microsurgical flaps for acute soft tissue reconstruction (1.1% of all patients admitted). 64.3% of the patients were male. The mean age was 59.64 years, and mean TBSA was 10.5%. The majority of the injuries were caused by flames (71.4%), followed by electrical contact (21.4%). The primary indication for microsurgical reconstruction was tissue deficit with exposure of tendons, nerves, vessels, bone and/or joints after debridement. The procedure was more often performed in the early period after injury (between the 5th and 22nd day). The most frequently used flaps were the Latissimus dorsi and the anterolateral thigh flap. Major complications included 2 total flap failures (11.1%) and a partial flap failure that required reconstruction with another free flap. Microsurgical free flaps have a valuable role in primary burn reconstruction. Despite the reported higher complication rate in this specific clinical scenario, their use may reduce the total number of surgeries needed to achieve wound closure.

Bien que de plus en plus utilisée, la microchirurgie est rarement utilisée dans la prise en charge initiale des brûlés, et doit faire face à plusieurs difficultés supplémentaires dans cette indication. Nous avons effectué une analyse rétrospective des dossiers de tous les patients brûlés entre janvier 2009 et décembre 2016 ayant bénéficié au stade d’un lambeau libre (LL). Nous avons évalué l’indication, le délai, la sélection du site donneur, les complications et l’évolution du lambeau. Quatorze patients (1,1% du total) dont 64,5% d’hommes ont bénéficié de 18 LL. L’âge moyen était de 59,64 ans, la surface brûlée de 10,5%. La majorité des brûlures (71,4%) étaient dues à une flamme, 21,4% à l’électricité. L’indication principale était l’exposition ostéo-articulaire ou d’éléments nobles (tendons, nerfs, vaisseaux) après excision. La réalisation du LL était précoce (J5-J22). Les sites donneurs étaient Latissimus dorsi et la région antéro-latérale de cuisse. Deux lambeaux ont totalement nécrosé, un partiellement, ce qui a nécessité la réalisation d’un second LL. Les LL ont une place dans la prise en charge initiale des brûlés. Bien de grevés d’un taux de complications plus élevé dans cette indication, ils peuvent permettre de diminuer le nombre d’interventions nécessaires à la cicatrisation.

Keywords: burn; free flap; microsurgery; reconstruction.

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Figures

Table I
Table I. Patient demographics
Table II
Table II. Anatomical location and flaps used
Fig. 1
Fig. 1. Free flap distribution by anatomical location
Fig. 2
Fig. 2. Timing of free flap reconstruction
Table III
Table III. Summary features of all cases included and their outcomes
Fig. 3
Fig. 3. Case 1: Scalp reconstruction with free Latissimus dorsi flap. A - Calvarial exposure after 3rd degree burn debridement. B - Latissimus dorsi muscular free flap inset. C - Immediate result after split-thickness skin graft coverage. D - Follow-up at postoperative month 2
Fig. 4
Fig. 4. Case 2: Left elbow joint coverage with contralateral radial forearm free flap. A - 3rd degree burn of the left elbow. B - Left elbow joint exposure following debridement. C - Contralateral radial forearm flap elevation before pedicle division. D - Result after 7 months
Fig. 5
Fig. 5. Case 3: Dorsum of the foot reconstruction with a free anterolateral thigh flap. A - Bone exposure on the dorsum of the foot after debridement. B - Anterolateral thigh flap after pedicle division. C - Insetting over the dorsum of the foot. D - Photograph at 18th postoperative month.
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