The Use of Prefabricated Flaps in Burn Reconstruction

The Role of Microsurgery in Burn Surgery

Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free flaps proved effective in functional and aesthetic restoration, with low flap loss rates and minimal contracture recurrence. Prefabricated and prelaminated flaps emerged as a solution for complex cases, ensuring the best functional and aesthetic possible outcomes in challenging facial burn reconstructions.

Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience

INTRODUCTION

Facial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries.

METHODS

During 2000-2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done.

RESULTS

Group A was treated with full-thickness skin grafts (42 patients - 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted.

CONCLUSION

The approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.

Reconstruction of burn contractures of the anterior neck with pre-expanded free anterolateral thigh flaps

Burn contractures of the anterior neck result in severe functional and aesthetic deformities. The release of wide contractures leads to defects that cannot be closed with local flaps. In these cases, tissue expansion of local tissues may be a solution. However, when local tissues are also burned or inadequate, microsurgical free tissue transfer may be necessary. In order to increase the surface are of the transferred flap, pre-expansion of the donor site can be combined with the procedure. Five patients with burn contractures of the anterior neck were treated using pre-expanded free anterolateral thigh (ALT) perforator flaps. The anterolateral thigh was dissected on top of the fascia lata in an avascular plane. The borders of the dissection were kept 2 cm lateral to the pre-identified perforators. A 1000cc rectangular tissue expander was placed. The time of expansion ranged from 4-11 months with a final over expanded volume of 1200cc. The defect sizes ranged from 10 × 21 cm to 20 × 27 cm. There were either one or two perforators included in the flaps. All flaps survived completely with good functional and aesthetic outcomes. Donor areas were closed primarily in one patient and with various amounts of skin grafts in five patients. Overall, pre-expansion decreased the amount of total skin grafted area in the donor site. Pre-expanded ALT perforator flap can be a good option in extensive burns with wide contractures where the regional donor areas are also affected. This technique has several advantages: 1) large flaps can be safely harvested, 2) the expanded skin thins out making it more aesthetically appropriate to resurface superficial defects, 3) expansion period of the thigh is well tolerated by the patients, 4) two teams can work simultaneously, decreasing the operating time, 5) the donor area can be closed either primarily or with minimal skin graft application, and 6) there is no functional loss in the donor area and the donor scar stays under the clothes.

Total aesthetic subunit reconstruction of the burned anterior abdomen using pre-expanded pedicled anterolateral thigh flap-A case report

Combination of tissue expansion and perforator flaps broadened the reconstructive options in burn cases with wide scar contractures. We report a case of total aesthetic subunit reconstruction of the anterior abdominal skin using a pre-expanded pedicled anterolateral thigh (ALT) perforator flap in a patient with postburn contractures. Seventeen-year-old girl had a history of scalding burn to the anterior abdomen, resulting in tight contractures inhibiting her mobility. After an expansion period of 6 months, the flap of 27 × 30 cm was elevated at the suprafascial plane and tunneled to the anterior abdomen. The flap was used to resurface the defect from xyphoid process down to the mons pubis and bilaterally at linea semilunaris. Postoperative course was uneventful. A good quality aesthetic and functional reconstruction was achieved at the 10-year follow-up. Pre-expanded pedicled ALT flaps may be considered as an option in extensive scarring requiring large amounts of tissue.