Use of the pedicled tensor fascia lata myocutaneous flap in the salvage of upper extremity high-voltage electrical injuries

Case report of Hand salvage post burn using pedicled tensor fascia lata (TFL)

INTRODUCTION AND IMPORTANCE

Burn still the major cause of disabilities and challenge facing both patient and surgeon, and when hands were affected a comprehensive planning and work must be obtained to restore functional and aesthetic aspects of hand. Tensor fascia lata (TFL) considered since centuries a useful tool to save hand post burn either it was been harvested with pedicle or as free flap. Although pedicle TFL became seldom but it may be the best option for hand reconstruction. In this article we report a case of hand burn that was managed by pedicle TFL.

CASE PRESENTATION

A 32 year- old man was involved in thermal burn affected multiple areas of his torso and limbs. He was referred to hospital from primary health care center. At hospital reassessment of the patient done was hemodynamic stable and inhalation injury was excluded. Burn estimated at 36 % total body surface area (TBSA) distributed through trunk and left upper limb, but left hand was the most affected area.

CLINICAL DISSOCIATION

After stabilization, he underwent serial debridement and dorsum of hand became skeletonized with exposed bones and tendon. Pedicled tensor fascia lata eventually choose to resurface hand, and fortunately enough covered all hand.

CONCLUSION

Tensor fascia late flap still has favorable use, easy applicable and expected outcome. in this article we report post burn hand injury that managed by pedicled tensor fascia lata.

Contralateral lumbo-umbilical flap: A versatile technique for volar finger coverage

Background:

While contemplating any difficult soft tissue reconstruction, patient comfort and compliance is of paramount importance. Reconstruction of the volar aspect of fingers and hand by the ipsilateral pedicled flaps (groin flap, abdominal flaps) is demanding as the flap inset is difficult for the surgeon and very uncomfortable for the patient. This often leads to flap complications. For the comfort of the patient, better compliance and ease of complete inset, we planned to manage soft tissue defects of the volar aspect of fingers and hand by a new contralateral pedicled lumbo-umbilical flap. This flap is based on the paraumbilical perforators of deep inferior epigastric artery.

Materials and Methods:

The contralateral pedicled lumbo-umbilical flap was used in eight patients with high-tension electrical burn injuries involving the volar aspect of fingers and hand. The patients were closely observed for first 6 weeks for any flap or donor site complications and then followed monthly to assess donor and recipient site characteristics for 6 months to 2 years.

Results and Conclusion:

Large flaps up to 8 cm × 16 cm were raised. All but one flaps survived completely. All patients were mobilised within 48 h and five were discharged in less than a week after initial inset. The flap is reliable, easy to harvest and easy to inset on the volar aspect of fingers. The arm is positioned in a very comfortable position. The main disadvantage, however, is a conspicuous abdominal scar.