Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post-Burn Deformities and Achieving Optimal Reconstruction Outcomes

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-11-05 DOI:10.1002/micr.31254
Hyun Jung Ryoo, Ji Hwan Park, Ji Ah. Park, Youn Hwan Kim, Hyung-Sup Shim
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引用次数: 0

Abstract

Background

Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk.

Method

Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction.

Result

Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.

Conclusions

Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.

胸背血管树连接瓣用于矫正烧伤后的广泛畸形并获得最佳重建效果。
背景:自体皮肤移植一直是重建烧伤后缺损的常用方法。然而,这种技术存在挛缩率高、覆盖面积不足等局限性。本报告旨在提出利用显微外科连接穿孔器皮瓣重建上下肢和躯干大面积烧伤缺损及相关烧伤后瘢痕挛缩的原则和优势:研究对象包括2016年至2023年期间在一家医疗机构接受游离组织转移进行原发性和继发性烧伤创面重建的患者。患者接受胸背血管树连皮瓣治疗,以矫正烧伤后畸形。对术后结果进行了评估,包括皮瓣存活率、并发症和上肢重建DASH自我报告问卷:结果:20 名患者中,12 人需要进行一次重建,8 人使用吻合嵌合游离组织转移进行二次重建。大多数烧伤是由热接触造成的(8 例),其次是火焰(5 例)、烫伤(4 例)、电接触(2 例)和摩擦(1 例)。最常用的组合是胸背动脉穿孔器皮瓣(TDAp)和大腿前外侧皮瓣(ALT)(11 例)。此外,有四例病例将带蒂TDAp皮瓣与下腹深动脉穿孔器(DIEP)皮瓣结合使用。上肢烧伤患者的平均 DASH 评分为 10.58 分:通过连接两个甚至三个独立的游离皮瓣实现三维组织覆盖的方法越来越多地被用于烧伤后重建。这种方法具有多种优势,是烧伤重建的可行选择。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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