Free Split-Cutaneous Perforator Flaps Procured Using a Three-Dimensional Harvest Technique for the Reconstruction of Postburn Contracture Defects

Abstract

With recent advances in free-tissue transfer, microsurgical techniques have been used more frequently for the reconstruction of postburn contracture defects. Traditional methods, including full-thickness skin grafts and local flaps, often result in a good outcome; however, multiple operative procedures, long periods of splinting, and physical rehabilitation are often required. Free split-cutaneous perforator flaps, consisting of one large cutaneous paddle with two perforating vessels split into two separate skin regions, were used for two kinds of postburn contractures: rectangular and spatially separate defects. From September of 2000 to October of 2002, seven patients underwent this method of reconstruction at Chang Gung Memorial Hospital in Taiwan. A three-dimensional flap harvest method, in which the skin paddle is circumferentially elevated early in the harvest, was used. Postburn scar contractures had resulted from flame burns in six cases and an electric burn in one case. The reconstructive regions included the neck in two patients, the breast in one patient, and the hand in four patients. There were six male patients and one female patient, with a mean age of 34.8 years (range, 25 to 49 years). The size of the excised scar ranged from 120 cm2 to 308 cm2 (mean, 162.3 cm2). The size of the unsplit flaps ranged from 144 cm2 to 337.5 cm2 (mean, 192.1 cm2). The average time for flap harvest using this three-dimensional harvest technique was 39.1 minutes. The average total operative time was 4.3 hours. The average total hospital stay was 7.3 days (range, 6 to 11 days). All flaps survived without major complications. The donor site was closed primarily in all cases. At a mean follow-up time of 9 months, the functional and aesthetic outcomes showed significant improvement as compared with the preoperative condition. In this study, a new method of flap harvest using a three-dimensional technique is introduced, and its application in the reconstruction of postburn contractures is evaluated.

A New Plane of Elevation: The Superficial Fascial Plane for Perforator Flap Elevation

“…The knowledge of the superficial fascia and the plane between deep and superficial fat has opened a safe way to debulk a flap to a reasonable thickness. 5,15,16 So by using this plane, we can obtain a thin flap without the need for additional debulking after the elevation. Although anatomical reports have stressed the importance of the vascular communication between the deep fascia and the subdermal plexus, the role of perfusion in these communication has not been evaluated.…”

Reverse Tissue Expansion by Liposuction Deflation Adopted for Harvest of Large Sheet of Full-Thickness Skin Graft

“…5,6,11,12 Initially, contractures require wide release and excision followed by reconstruction using a well-vascularized thin tissue that will neither contract nor leave the patient with a large defect at the donor site. 6 Historically, the use of skin grafts has been the mainstay of treatment whenever the adjacent tissue is scarred and unavailable for local flap repair.…”

“…5,6,11,12 Initially, contractures require wide release and excision followed by reconstruction using a well-vascularized thin tissue that will neither contract nor leave the patient with a large defect at the donor site. 6 Historically, the use of skin grafts has been the mainstay of treatment whenever the adjacent tissue is scarred and unavailable for local flap repair. 1,7,8,10 With proper postoperative splinting, elastic compression and scar management, single-sheet skin grafts or even aesthetic units grafts are ideal for facial and neck reconstruction, yielding in most cases good functional and aesthetic outcomes.…”

“…[1][2][3] Contractures to the anterior neck is are known to cause limited range of motion, musculoskeletal deficits and abnormal postures affecting normal facial functions such as speaking, eating, and aesthetic appearance making the patient a social outcast. [1][2][3][4][5][6] The management of neck contractures has so far proved to be very troublesome worldwide with several methods described. Reconstructive efforts must be focused not only on restoring proper head movement, extension, and flexion, but also on fulfilling the aesthetic and functional needs of the individual patient.…”

Colgajo anterolateral del muslo: anatomía quirúrgica, técnica de disección y aplicaciones clínicas

“…De esta manera se consigue más superficie cutánea o diferentes tejidos pero con un vaso común, de modo que solamente es necesaria una anastomosis. Por ejemplo, se pueden disecar dos paletas cutáneas, cada una con su vaso perforante que tienen en común el mismo tronco vascular; de esta manera se pueden cubrir defectos más grandes o que estén separados por puentes cutáneos sanos (18). También podemos incluir una rama muscular con una porción muscular que nos sirva como segunda paleta y cubrir dos defectos con un mismo colgajo (Fig.…”