Staged distant muscle flap transfer using a forearm carrier.
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Humans↗
Biomedical subjects
G G Hallock
Publications and source records attributed to G G Hallock.
Closure of the ulnar forearm free flap donor site using a local radial forearm flap.
Thin, pliable cutaneous flaps with large calibre vessels ideal for microsurgical transfers are major attributes of the reliable forearm fasciocutaneous flaps. A major detriment, however, that must always be considered is the management of the residual donor site deformity. Just as this potential morbidity for small radial forearm free flap donor sites may be minimised by the V-Y advancement of a local ulnar forearm flap, the converse, using a local radial forearm flap for closure of the ulnar forearm free flap donor site, may be efficacious.
Forearm↗
The role of the helicopter in management of the burned patient.
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Aircraft↗
The radial forearm flap in burn reconstruction.
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Adolescent↗
The parascapular fasciocutaneous flap for release of the axillary burn contracture.
Major disturbances of shoulder function secondary to axillary burn contracture require some form of surgical release if conservative therapy has been unsuccessful. Any area large enough to need extensive skin grafts should be considered for reconstruction using a parascapular fasciocutaneous flap. This flap, which may be elevated easily, provides an option for single-stage correction of the deformity without the need for long-term rehabilitation or splinting.
Adult↗
Local random fasciocutaneous flaps for repair of the burned elbow.
Wound management of the burned elbow is not always possible with a skin graft alone. Rather than resort to distant pedicle flaps or the complexity of microsurgical tissue transfers, local fasciocutaneous flaps may provide a better source for vascularized tissue. "Random" fasciocutaneous flaps do not require isolation of any discrete vessel, but must be designed to parallel the longitudinal axis of perifascial circulation in the upper extremity. Therefore no vessel in the major extremity need ever be violated, and muscle function is always preserved. Excision-to-fascia techniques for burn escharectomy should probably be minimized in the elbow region, because if the fascia remains intact, the overlying skin-grafted subcutaneous fat will survive flap transposition as a fasciocutaneous flap. Local flaps allow for earlier rehabilitation, and the donor defect is restricted to the already deformed ipsilateral extremity.
Adolescent↗
Regional fasciocutaneous flaps for the burned axilla.
The conventional approach for secondary correction of unstable axillary scars or contractures with skin grafting commonly risks failure of adherence and early recurrence of the problem, even in highly motivated patients. Potential early mobilization and the avoidance of postoperative splinting may be advantages of reconstruction with vascularized tissues instead. The local fasciocutaneous flap is advocated as a simple, rapidly elevated, single-staged option that preserves function while correcting these deformities. Although the dorsal thoracic fascial flaps are the most versatile in the axillary region, if they are unavailable or unsuitable, other unspecified but equally robust alternatives from the upper arm or anterolateral chest are similarly efficacious.
Adolescent↗
A systematic approach to flap selection for the axillary burn contracture.
Any soft-tissue deficiency about the axilla unfortunately may readily be translated into a functional limitation of the upper extremity that should be addressed in a simple yet expeditious fashion. Commonly a sequela of burn injuries, significant skin destruction in kind must be restored. Whatever the etiology of major deformities, the vital axillary structures and preservation of shoulder range of motion may best be accomplished by resurfacing with the use of vascularized tissues taken from sources adjacent to the defect. If this is the case, the efficacious application of these local muscle or fascial flaps mandates a realization that such choices are finite in number. A schema for a reasonable flap selection process has been devised based on the relative severity and anatomic location of the axillary burn scar contracture.
Axilla↗
Enhancement of the burned nasal tip with the use of upper lip scar flaps.
Maximal aesthetic improvement for the patient with burns deserves the same considerations as does functional restoration. The use of burn scars as vascularized flaps is a prime example in which these goals may be simultaneously achieved with an added bonus of salvaging tissues that would otherwise be discarded. Several cases involving revision of commonly encountered perioral scars demonstrate the effectiveness of burn scar flaps in the correction of concomitant nasal deformities, and thus reemphasize this useful principle.
Adolescent↗
Homodigital flaps--especially for treatment of the burned hand.
Burn deformities involving the hand can cause a devastating impairment that often requires ingenious solutions to improve function. Fortunately, a skin shortage usually can be expeditiously replaced by autogenous skin grafts; otherwise, a vascularized flap may be imperative. If that is so, use of a donor site from the digit itself would always be preferable, because normal sensation potentially could be maintained with similar thin, extensile, and durable tissue. The sides of the finger often have been protected from the thermal injury and are available for use as homodigital flaps. Although technically this form of homodigital flap is an axial flap because it incorporates dorsal digital artery branches, the proper digital artery is always spared. The immediate transfer of a homodigital flap completes the desired reconstruction in a single stage, which allows early initiation of hand mobilization and rehabilitation.
Burns↗
Preexpansion of free flap donor sites used in reconstruction after burn injury.
Burn wound management usually can be achieved successfully without reliance on any free tissue transfers. This is true partly because tissue expansion techniques for the creation of local flaps have become increasingly versatile and are a simpler alternative when vascularized tissues are required. However, in special circumstances both concepts can be combined to further enhance reconstruction after burn injury. In addition, pretransfer expansion of free flap donor sites has many advantages over posttransfer expansion because not only is immediate primary donor site closure possible, but fabrication of flaps with desired characteristics of size and thickness can be specifically manipulated simultaneously.
Adolescent↗
Distal-based flaps for reconstruction of hand burns.
Any burn injury, even if considered minimal in extent, can still be catastrophic, if hand burns are severe enough to result in deformities that render the individual unable to perform his own personal daily functions. Usually any necessary skin coverage of the hand can be achieved with skin grafts alone; but occasionally, seemingly heroic measures requiring vascularized flaps will be justified to ensure maximum rehabilitation. Previously, available options included proximal-based local flaps, or distant flaps either pedicled while remaining attached to another body region, or transferred immediately by use of microsurgical techniques. Another new concept that may still be somewhat in the investigational stage for burns is the distal-based local flap. These use more traditional proximal skin territories, but with a distal vascular pedicle that can allow such flaps to reach even the fingertips. More expeditious and technically simpler than the transfer of distant flaps, this alternative deserves further consideration in the appropriate circumstances.
Burns↗
A history of the development of muscle perforator flaps and their specific use in burn reconstruction.
Only rarely does coverage in the burn patient require the use of a vascularized flap. However, when mandatory, a knowledge of all alternatives is essential because common donor sites may have been badly burned and unavailable. The recent development of the muscle perforator flap may prove to be another valuable option. These flaps are nourished by the familiar musculocutaneous perforators but differ in that their complete intramuscular dissection is required during flap elevation so that no muscle need be included with the flap. A review of six cases using muscle perforator free flaps specifically for burn reconstruction or rehabilitation demonstrates how the same large cutaneous territory of a musculocutaneous flap can still be captured while the muscle and therefore its function is preserved.
Adult↗