Limb Salvage Procedure in a Patient of High-tension Electric Burns Utilising Delay Phenomenon in Perforator-based Flap- A case report (original) (raw)
Electric burn is a devastating injury causing tissue and organ loss. We present here a case of an electric burn injury over bilateral lower limb and bilateral upper limb. The patient had undergone left above knee amputation, thus cross leg flap from the left side was not possible and due to electric burns, the vascularity of the right leg was also doubtful therefore a delayed flap was planned to cover the exposed defect over right knee and defect over the right tibia. The Flaps underwent delay procedure before the final inset so that the flap undergo ischemic preconditioning and the neovascularization that increases the size of the flap and chances of survival of the flap by manifold.
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Plastic Surgery
Introduction: Post electric burn defects are difficult to manage due to deep injury involving all the structures up to bony level. A good vascularized flap is required to resurface the defect for preventing the complication and for reconstruction. Aim of study: Resurface the post electric burn defect with different flaps according to need of defect. Material and method: All patients of electric burn hand and fore arm defect admitted to burn, plastic and reconstructive department of SCB Medical College, Cuttack and Dept. of Burn and Plastic Surgery, AIIMS Bhubaneswar between January 2015 to December 2017 with different flap covers used for reconstruction. Observation: Out of 30 cases of post electric burn forearm and hand reconstruction, 10 cases undergone groin flap cover, 6 cases undergone abdominal flap cover,5 cases undergone cross finger flap cover 4 cases undergone free anterolateral thigh flap cover, four cases undergone free Latissimus dorsi flap cover. Flaps have resurfaced the defect with minor complication like infection and minor necrosis of flaps which were managed. Conclusion: Reconstruction of post electric burn defect of distal fore arm and hand represents great challenge due to depth of injury involving full thickness of skin and other structures Choice depends on size of defect, availability of local or regional tissue, patient's acceptance and cooperation, keeping in mind the cost effectiveness of the procedures.
Burns, 1991
A young patient sustained a high-voltage burn with extensive destruction of the soft tissue in his left lower exfremity. Occlusion of the anferior and posferior tibia1 arteries, loss of foe extensors and the supe+ial and deep pwoneal nerves were noted, besides the exposure of the lower end of the tibia and metafarsal bones. In the absence of proper recipient vessels, a floss-leg free lafissimw dorsi muscle flap with overlying skin and depending on the vessels of the contralateral foot was used successfully for reconsfrucfion of the defect. 7'he pedicle was divided 3 weeks after microvascular anasfomosis and the fip survived completely. 7'his technique permits transfer of free flaps to compromised wounds without available recipient vessels, and the latissimw dorsi muscle flap, with its characterisfics of large size and copiow vascularify, could be split to cover exposed bones in difirenk areas simultaneously.
2020
Defects located on the lower leg and the foot represents a challenging task for the reconstructive surgeon, especially in high voltage electric burned patients. We admitted a 29-year-old male patient for forefeet defects following high voltage electric burns in our national burn and plastic surgery center. There was an exposition of metatarsal bones on both forefeet. We performed the distally-based superficial artery fasciocutaneous sural flap in a one-stage surgery separately for each side; the fascio subcutaneous pedicles were 5 cm wide buried under skin tunnels. We noticed suture dehiscence on the right foot and tip necrosis on the left foot. The bones were still covered. We used a V-Y advancement flap and split-thickness skin graft to complete the reconstruction. The wounds healed without any infectious complication. The ambulation was normal. The patient was satisfied with the flaps and did not complain about the donor sites.
Distally-based neurofasciocutaneous flaps in electrical burns
Burns, 2002
Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5 cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.
Burns, 2013
Background: The use of microsurgery in the management of burn sequelae is not a new idea. According to the properties of various types of free flaps different goals can be achieved or various additional procedures have to be combined. We report the comparison of two different free flaps on a single patient for reconstruction of both upper extremities for burn sequelae. Case report: A 1-year-old child sustained severe burns on both hands, arms and thorax and was initially only treated conservatively. This resulted in severe contractures. At the age of 4-years a free gracilis flap was selected for reconstruction of his left hand and a free anterolateral thigh flap for the right hand. Results: We noticed a better functional and esthetic result for the gracilis flap associated with a shorter operative time and a minor donor site morbidity. The intraoperative technique and time, postoperative complications, functional and esthetic results and donor site morbidities were studied in the two types of flaps chosen. A review of literature was also performed. Conclusion: Our experience reported a better success of the gracilis muscle flap covered with a split skin graft compared to the anterolateral thigh flap in the reconstruction of hand function after severe burn sequelae.
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2006
Background: As the versatility and variability of free flaps have significantly increased during recent years, so have the indications for free tissue transplantation in burn reconstruction expanded. Methods: The authors report retrospectively the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience enabled the authors to establish reconstructive principles pertinent to the type of injury (burn versus high-voltage injuries) and the timing of reconstruction procedures. Results: In high-voltage injuries (n ϭ 17), early free flap coverage with muscular flaps was the most frequently used type of reconstruction. The reconstruction site was predominately the forearm. In burn injuries, free flap coverage was performed during a later stage of the treatment course. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and dorsum of the hand underwent defect coverage in most circumstances. For reconstruction of complex or large defects (n ϭ 6), combined "chimeric" flaps were used. Overall, the flap failure rate was 12 percent (n ϭ 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four of five flap failures occurred within 5 to 21 days after trauma, and all five flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. Conclusions: The authors' data demonstrate that burn and high-voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if the authors' flap failures all occurred during the first 6 weeks, it should not be forgotten that this type of coverage is the only alternative to amputation in selected cases.
Burns & Trauma, 2018
Background In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. Case presentation We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee. Conclusion Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save dono...
The Specificities of Electrical Burn Healing
Scars, 2019
Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. In the event of an electric chock accident, the treatment is medico-surgical and is composed of two main phases: acute phase when general treatment is essential and subacute phase when local treatment is implemented. The study shows that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and also antithrombotic prevention or the use of flaps does not seem to have an impact on healing delays.
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