Implementation and Validation of Free Flaps in Acute and Reconstructive Burn Care

Abstract

Microsurgical free flap reconstruction in acute burn care offers the option of reconstructing even challenging defects in a single stage procedure. Due to altered rheological and hemodynamic conditions in severely burned patients, it bears the risk of a higher complication rate compared to microsurgical reconstruction in other patients. To avoid failure, appropriate indications for free flap reconstruction should be reviewed thoroughly. Several aspects concerning timing of the procedure, individual flap choice, selection and preparation of the recipient vessels, and perioperative measures must be considered. Respecting these specific conditions, a low complication rate, comparable to those seen in microsurgical reconstruction of other traumatic limb defects, can be observed. Hence, the free flap procedure in acute burn care is a relatively safe and reliable tool in the armamentarium of acute burn surgery. In reconstructive burn care, microsurgical tissue transfer is routinely used to treat scar contractures. Due to the more robust perioperative condition of patients, even lower rates of complication are seen in microsurgical reconstruction.

Free Flap Failure and Complications in Acute Burns: A Systematic Review and Meta-analysis

“…After applying inclusion and exclusion criteria, 31 articles were included in the qualitative and quantitative synthesis. 8–10,18–46 A flow chart of the study inclusion process and the reasons justifying the exclusion of the 166 studies are shown in Figure 1.…”

“…[4][5][6] However, in cases of extensive exposure of critical structures (such as the bone, cartilage, tendons, or neurovascular bundles), flap reconstruction proves to be a more appropriate choice. 7,8 It allows for a single-stage reconstruction, thus reducing healing time and hospital period. 8,9 Thus, flap reconstruction may decrease the complications associated with delayed wound healing, which include dehydration of exposed structures and infection.…”

“…7,8 It allows for a single-stage reconstruction, thus reducing healing time and hospital period. 8,9 Thus, flap reconstruction may decrease the complications associated with delayed wound healing, which include dehydration of exposed structures and infection. 10 In circumstances where local flaps are either unavailable or deemed unsuitable, free flaps are utilized.…”

“…Although flap application in acute burns is typically limited to cases of exceptionally severe soft tissue loss or limb-preservation scenarios, there is a paucity of data on the implications of free flap reconstruction in acute burns. 8 This study aimed to determine the failure rate and complication rate of free flaps used in the reconstruction of acute burns.…”

Experiencia en reconstrucción del paciente gran quemado agudo con microcirugía

“…Los avances en tratamiento, las mejoras en la sobrevivencia de los pacientes gran quemado y el mejor entrenamiento en microcirugía con un aumento del número y tipos de colgajos y el florecimiento de la técnica, permitieron que este tipo de cirugía fuera un tratamiento seguro y factible en este contexto de pacientes, en relación con los resultados y tasa de complicaciones. A pesar de la condición clínica crítica y desafiante de estos pacientes, actualmente, se reconoce al CM como una herramienta esencial para la víctima de quemaduras, más específicamente, en las quemaduras de alto voltaje, donde juega un rol importante en el salvataje de la extremidad 6 o como primera opción de tratamiento ante defectos complejos con exposición ósea, de nervios o tendones 16 .…”