Caterpillar Advancement for Partially Necrosed Deltopectoral Flap

Abstract

Development of electric lamp by Thomas Elva Edison had significant impact on human civilization. With increasing production of electrical energy to meet ongoing demands of increased frequency of electrical injuries. Despite increased awareness of potential dangers, electricity is responsible for many fatalities all over the world. Electrical burn accounts for ~3% of all burn related injuries. Estimated 3, 000 annual admittions to burn units. Electrical burn have bimodal distribution ~1/3 children <6 yrs (Electric cords & wall outlets) ~2/3 miners, construction, & electrical workers. Our case is one that of a 12 year old male child having electrical injury over face and neck with exposed angle of mandible which was covered by Deltopectoral flap with caterpillar advancement of flap. KEYWORDS: Electrical burn, Flap Necrosis, Flap Divison, Deltopectoral flap with caterpillar advancement. INTRODUCTION:Deltopectoral flap is a fasciocutaneous type of flap. Standard Flap size of 10 X20 cm and Delayed flap size of 10 X 27cm. Sensory nerve supply is from second to fourth intercostal nerve. Dominant pedicle of flap is largely based on first, second and perforating branches of internal mammary artery. Standard flap will reach neck, lower face and oral cavity but delayed flap has a longer reach and may be folded for intra-oral reconstruction or for an extended arc of rotation to the midface. For standard flap, it is located b/w sternum and anterior axillary line and extends from clavicle to 4 th or 5 thc IC space. For extended flap, it is extended over deltoid muscle. A preliminary flap delay is required to extend flap length. The donor site is rather obvious and almost always requires a skin graft for closure.