Successful pregnancy and delivery after post burn abdominal wall reconstruction using tensor fascia lata fasciocutaneous flap and split-thickness skin graft: A case report.

Abstract

Introduction: Abdominal wall contractures following burn injuries can cause both maternal and fetal complications during pregnancy like maternal disfigurement, breathing difficulties, scar site pain, fetal distress, premature labor, scar breakdown, and keloid formation.

Case presentation: A 26-year-old female presented with second-degree flame burns to her anterior abdomen, perineum, and bilateral proximal thighs, resulting in 18 % TBSA involvement from a cooking accident. She received debridement, wound care, and supportive treatment, and was discharged in improved condition. Four years later, she developed significant abdominal wall scarring with umbilical retraction and thigh contractures, limiting thigh abduction. Contracture release and abdominal wall reconstruction with bilateral fascia lata faciocutaneos flaps and split-thickness skin grafts were performed. The patient later had a successful pregnancy with normal delivery, experiencing no complications except mild stretching sensations at the surgical site.

Discussion: Burn in the perineum is rare due to its protected location, making perineal contracture uncommon. While one case documented severe contractures affecting both the trunk and perineum, leading to fetal distress and emergency cesarean, our patient experienced similar contractures but had successful surgical release and autologous abdominal wall reconstruction prior to pregnancy, avoiding complications. Various surgical options, including expansion abdominoplasty, modified abdominoplasty, and anterolateral thigh flaps, have proven effective in improving outcomes for pregnant women with post-burn abdominal contractures.

Conclusion: An individualized approach is crucial, as evidenced by our use of tensor fascia lata faciocutaneous flap and split-thickness skin grafts, improving both maternal and fetal health.