Perforator flap for burn reconstruction

Abstract

Background

Majority of burn patients in Bangladesh are treated at home and tend to develop scar and scar contracture. Other than physical limitations there are also stigmatization, loss of marriageability or divorce particularly for women. Skin grafts are prone to contraction and need prolonged splintage and physiotherapy. Flaps are often too bulky. Local flaps have the advantage of increased positional comfort as compared to distant flaps like the abdominal or the groin flaps. Free flaps are technically demanding and facilities are not universally available. Advances in knowledge of blood supply of the skin have increased the potentials for perforator based skin flaps.

Methodology

A total of 72 patients who could complete a minimum one year follow up were included in the study. All flaps were rotated around the axis of the perforator ranging from 90 degrees to 180 degrees. Skin pedicles were kept when possible, complete island flaps were designed when rotation was maximum.

Results

Among the 72 cases 54 cases were electric burn wounds and18 were post burn scar contracture, 59 were male and 13 were female. 44 cases were done on leg. Smallest flap was 5 cm in length and the largest was 16 cm. Immediate complications include total flap loss, tip loss, margin loss, wound infection and hematoma under the flap was noted. In one case emergency exploration was required to control hemorrhage. Contour defect, dependent edema in legs, sensorineural deficit, limitation of joint movement was also observed.

Conclusion

A single perforator may safely supply its proper angiosome and up to the half of vascular territory of the adjacent perforator. This possibility is favored by vascular adoption directed toward the periphery that occurs by means of increased vascular pressure in the perforator artery after ligature of collateral subcutaneous and intramuscular arterial branches. The authors percept is, usually perforation is along the intermuscular septum, the portion of the flap that crosses beyond the adjacent intermuscular septum are at risk. Not required to go that far as residual wounds can be grafted with split thickness skin.