McGregor inguinal flap for coverage of large soft tissue losses due to high-voltage electrical burns in the upper limb: a retrospective study

Abstract

High-voltage electrical burns are potentially devastating and they are associated with significant morbidity and mortality. Due to vascular damage and progressive tissue necrosis produced by electrical burns, there is a large controversy regarding the ideal reconstructive technique for cutaneous coverage of severe lesions in the upper limb. This study aims to analyze our experience using the McGregor inguinal flap technique, for the coverage of large soft tissue losses produced by high-voltage electric burns in the upper limb. We performed a retrospective descriptive study with patients diagnosed with high-voltage electric burns, in which the McGregor inguinal flap technique was used to cover severe lesions in the upper limb. This study was performed at the department of Reconstructive Plastic Surgery and Burns of the Specialist Hospital Eugenio Espejo, from January 2016 to December 2017. The flap technique was performed on twelve patients, out of which, nine were males with a mean age of 33 years old. Furthermore, nine out of the twelve cases occurred as a result of accidents at work. The mean time elapsed between the lifting of the flap, closure of the donor area, and fixation of the flap to the affected area was 56 minutes (44-72 minutes). In the immediate postoperative period, three patients presented signs of infection in the surgical area. No total dehiscence, total necrosis, and/or hematoma were reported in all patients. The success limb salvage rate was 100%. In our experience, the McGregor inguinal flap technique presented a favorable postoperative evolution with complete closure of the lesions and a low rate of complications. Due to the limitations of this study, more studies are needed to prospectively evaluate this flap.

Keywords: Ecuador; McGregor inguinal flap; electrical burns; high-voltage; reconstructive surgical procedures; upper limb.

Figure 1

39-year-old male patient diagnosed with high-voltage electric burns on the right wrist. A. This resulted in significant loss of soft tissue, necrosis of the flexor tendons, loss of the ulnar artery, median, and ulnar nerves. B. The result after debridement, cleaning of devitalized tissue, and use of a negative pressure system. C. Tenorrhaphy with tendinous allografts for deep flexors and end-to-end anastomosis of median and ulnar nerves, requested from a tissue bank. D. Skin coverage with the McGregor inguinal flap. E. Immediate postoperative period after vascular pedicle release. F. Result after 6 months of evolution. G. Result after 12 months of evolution. H. Result after 12 months index thumb opposition.

Figure 2

31-year-old male patient diagnosed with high-voltage electric burn on the first finger of the right hand. A. Inguinal flap lift, loss of soft tissue and bone exposure, conservation of the flexor pollicis longus and thumb main artery. B. Fixation of flap over affected area. C. Immediate postoperative dorsal view. D. Immediate postoperative palmar view. E. Dorsal view results 6 months. F. Index thumb opposition. G. Thumb opposition. H. Palmar view.