Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps

Abstract

Background: Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. Methods: Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12-66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures.Results: Twenty-one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow-up was 17.2 months (range 6-36 months). Conclusion: Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture.

Parotid Fistulas after Reconstructive Surgery for the Face and Neck Burn Contracture

“…Woerd et al reported that sialocutaneous fistula to the external auditory canal was covered with a temporal fascia flap after the excision of salivary glands 11) , where the efficacy of the transplanted free groin flap was maximized for multiple reconstructive objectives, with free flaps being functionally and cosmetically superior in surgery for burn scar contractures 12) .…”

Functional and Aesthetic Outcome of Reconstructive Surgery for Contracted Neck Scars

“…However, novel techniques of reducing FTSGs contraction using dermal substitutes are promising [17]. On the other hand, when a wide area is involved in contracture, it is difficult to reconstruct the neck using conventional methods because skin grafting often results in postoperative re-contracture, and the amount of uninvolved skin available for use as a local flap is usually insufficient [18].…”

Regional Perforator Flaps for Coverage of Complex Wounds in Upper Limbs

“…Complete flap elevation with preservation of the perforator and intermuscular septum is created and the flap was rotated in the defect Fig. (4).…”

“…Reconstruction of complex wounds of the upper limb is a challenge for the plastic surgeon. Machi-21 nary injuries [1], road traffic accidents [2], tumor ablation [3] and burn scars reconstruction [4] are the main causes of complex wounds in the upper extremity. These wounds entails exposure of tendons, bones, nerves or blood vessls and they need flap coverage [5].…”