Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post‐Burn Deformities and Achieving Optimal Reconstruction Outcomes
ABSTRACT Background Autologous skin grafting has been the popular method for reconstructing post‐burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically...
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description | ABSTRACT
Background
Autologous skin grafting has been the popular method for reconstructing post‐burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post‐burn scar contracture in the lower and upper extremities and trunk.
Method
Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree‐linked flaps for the correction of post‐burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self‐report questionnaire for upper extremity reconstruction.
Result
Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.
Conclusions
Three‐dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post‐burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction. |
doi_str_mv | 10.1002/micr.31254 |
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Background
Autologous skin grafting has been the popular method for reconstructing post‐burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post‐burn scar contracture in the lower and upper extremities and trunk.
Method
Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree‐linked flaps for the correction of post‐burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self‐report questionnaire for upper extremity reconstruction.
Result
Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.
Conclusions
Three‐dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post‐burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.</description><identifier>ISSN: 0738-1085</identifier><identifier>ISSN: 1098-2752</identifier><identifier>EISSN: 1098-2752</identifier><identifier>DOI: 10.1002/micr.31254</identifier><identifier>PMID: 39498673</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Burn patients ; burns ; Burns - complications ; Burns - surgery ; Cicatrix - etiology ; Cicatrix - surgery ; Contracture - etiology ; Contracture - surgery ; Defects ; Electric contacts ; Extremities ; Female ; free flaps ; Free Tissue Flaps - blood supply ; Free Tissue Flaps - transplantation ; Graft Survival ; Humans ; Male ; microsurgery ; Microsurgery - methods ; Middle Aged ; perforator flap ; Perforator Flap - blood supply ; Perforator Flap - transplantation ; Plastic Surgery Procedures - methods ; Retrospective Studies ; Skin grafts ; Skin Transplantation - methods ; Treatment Outcome ; Young Adult</subject><ispartof>Microsurgery, 2024-11, Vol.44 (8), p.e31254-n/a</ispartof><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2824-f1abe61f0d772146bd91683b7ebe7c0270a50966664f2764335f0cc45c1ac4363</cites><orcidid>0000-0001-5156-2239</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fmicr.31254$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fmicr.31254$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39498673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ryoo, Hyun Jung</creatorcontrib><creatorcontrib>Park, Ji Hwan</creatorcontrib><creatorcontrib>Park, Ji Ah</creatorcontrib><creatorcontrib>Kim, Youn Hwan</creatorcontrib><creatorcontrib>Shim, Hyung‐Sup</creatorcontrib><title>Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post‐Burn Deformities and Achieving Optimal Reconstruction Outcomes</title><title>Microsurgery</title><addtitle>Microsurgery</addtitle><description>ABSTRACT
Background
Autologous skin grafting has been the popular method for reconstructing post‐burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post‐burn scar contracture in the lower and upper extremities and trunk.
Method
Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree‐linked flaps for the correction of post‐burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self‐report questionnaire for upper extremity reconstruction.
Result
Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.
Conclusions
Three‐dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post‐burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Burn patients</subject><subject>burns</subject><subject>Burns - complications</subject><subject>Burns - surgery</subject><subject>Cicatrix - etiology</subject><subject>Cicatrix - surgery</subject><subject>Contracture - etiology</subject><subject>Contracture - surgery</subject><subject>Defects</subject><subject>Electric contacts</subject><subject>Extremities</subject><subject>Female</subject><subject>free flaps</subject><subject>Free Tissue Flaps - blood supply</subject><subject>Free Tissue Flaps - transplantation</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Male</subject><subject>microsurgery</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>perforator flap</subject><subject>Perforator Flap - blood supply</subject><subject>Perforator Flap - transplantation</subject><subject>Plastic Surgery Procedures - methods</subject><subject>Retrospective Studies</subject><subject>Skin grafts</subject><subject>Skin Transplantation - methods</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0738-1085</issn><issn>1098-2752</issn><issn>1098-2752</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90c1u1DAUBWCrKmqHwqYPgCx1g5BS_Bc7XpahhUqDBlUD28hxbhi3STzYTqE7ngDxjDwJHqZl0QV3482nI997EDqm5JQSwl4PzoZTTlkp9tCMEl0VTJVsH82I4lVBSVUeoqcxXhNCtFb6AB1yLXQlFZ-hnws33kCLL3qzidh3OK0Br9Y-GOtbH6Lp8WcT7dSbgFcBAHc-4LkPAWxy4xd8_j3BGN0t4I8-pt8_fr2ZwojfQmaDSw4iNmOLz-zawe3WLzfJDTn0CqwfYwpTjvEjXk7J-gHiM_SkM32E5_fvEfp0cb6avy8Wy3eX87NFYVnFRNFR04CkHWmVYlTIptVUVrxR0ICyhCliSqJlHtExJQXnZUesFaWlxgou-RF6ucvdBP91gpjqwUULfW9G8FOs8zWFrChVVaYnj-i1zzvm322VFkJSWWb1aqds8DEG6OpNyIuGu5qSettSvW2p_ttSxi_uI6dmgPYffaglA7oD31wPd_-Jqj9czq92oX8A4LGe9w</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Ryoo, Hyun Jung</creator><creator>Park, Ji Hwan</creator><creator>Park, Ji Ah</creator><creator>Kim, Youn Hwan</creator><creator>Shim, Hyung‐Sup</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5156-2239</orcidid></search><sort><creationdate>202411</creationdate><title>Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post‐Burn Deformities and Achieving Optimal Reconstruction Outcomes</title><author>Ryoo, Hyun Jung ; Park, Ji Hwan ; Park, Ji Ah ; Kim, Youn Hwan ; Shim, Hyung‐Sup</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2824-f1abe61f0d772146bd91683b7ebe7c0270a50966664f2764335f0cc45c1ac4363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Burn patients</topic><topic>burns</topic><topic>Burns - complications</topic><topic>Burns - surgery</topic><topic>Cicatrix - etiology</topic><topic>Cicatrix - surgery</topic><topic>Contracture - etiology</topic><topic>Contracture - surgery</topic><topic>Defects</topic><topic>Electric contacts</topic><topic>Extremities</topic><topic>Female</topic><topic>free flaps</topic><topic>Free Tissue Flaps - blood supply</topic><topic>Free Tissue Flaps - transplantation</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Male</topic><topic>microsurgery</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>perforator flap</topic><topic>Perforator Flap - blood supply</topic><topic>Perforator Flap - transplantation</topic><topic>Plastic Surgery Procedures - methods</topic><topic>Retrospective Studies</topic><topic>Skin grafts</topic><topic>Skin Transplantation - methods</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ryoo, Hyun Jung</creatorcontrib><creatorcontrib>Park, Ji Hwan</creatorcontrib><creatorcontrib>Park, Ji Ah</creatorcontrib><creatorcontrib>Kim, Youn Hwan</creatorcontrib><creatorcontrib>Shim, Hyung‐Sup</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ryoo, Hyun Jung</au><au>Park, Ji Hwan</au><au>Park, Ji Ah</au><au>Kim, Youn Hwan</au><au>Shim, Hyung‐Sup</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post‐Burn Deformities and Achieving Optimal Reconstruction Outcomes</atitle><jtitle>Microsurgery</jtitle><addtitle>Microsurgery</addtitle><date>2024-11</date><risdate>2024</risdate><volume>44</volume><issue>8</issue><spage>e31254</spage><epage>n/a</epage><pages>e31254-n/a</pages><issn>0738-1085</issn><issn>1098-2752</issn><eissn>1098-2752</eissn><abstract>ABSTRACT
Background
Autologous skin grafting has been the popular method for reconstructing post‐burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post‐burn scar contracture in the lower and upper extremities and trunk.
Method
Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree‐linked flaps for the correction of post‐burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self‐report questionnaire for upper extremity reconstruction.
Result
Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (n = 8), followed by flames (n = 5), scalds (n = 4), electrical contact (n = 2), and friction (n = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.
Conclusions
Three‐dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post‐burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>39498673</pmid><doi>10.1002/micr.31254</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5156-2239</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Aged Burn patients burns Burns - complications Burns - surgery Cicatrix - etiology Cicatrix - surgery Contracture - etiology Contracture - surgery Defects Electric contacts Extremities Female free flaps Free Tissue Flaps - blood supply Free Tissue Flaps - transplantation Graft Survival Humans Male microsurgery Microsurgery - methods Middle Aged perforator flap Perforator Flap - blood supply Perforator Flap - transplantation Plastic Surgery Procedures - methods Retrospective Studies Skin grafts Skin Transplantation - methods Treatment Outcome Young Adult |
title | Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post‐Burn Deformities and Achieving Optimal Reconstruction Outcomes |
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