Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, Korea.
Microsurgery. 2024 Nov;44(8):e31254. doi: 10.1002/micr.31254.
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.
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.
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.
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.
自体皮移植一直是重建烧伤后缺陷的常用方法。然而，这种技术存在一些局限性，如较高的挛缩率和不足的体积覆盖。本报告旨在提出利用显微外科连接穿支皮瓣修复下肢、上肢和躯干大面积烧伤缺损及相关烧伤后瘢痕挛缩的原则和优势。
本研究纳入了 2016 年至 2023 年期间在一家机构接受游离组织移植进行原发性和继发性烧伤创面修复的患者。患者接受胸背血管树连接皮瓣矫正烧伤后畸形。评估术后结果，包括皮瓣存活、并发症以及上肢重建的 DASH 自我报告问卷。
20 例患者中，12 例需要原发性重建，8 例采用吻合杂交游离组织移植进行继发性重建。大多数烧伤损伤是由热接触引起的（n=8），其次是火焰（n=5）、烫伤（n=4）、电接触（n=2）和摩擦（n=1）。最常用的组合是胸背动脉穿支（TDAp）和股前外侧皮瓣（ALT）（11 例）。此外，有 4 例涉及带蒂 TDAp 皮瓣与腹壁下动脉穿支皮瓣（DIEP）联合。上肢烧伤患者的 DASH 评分平均为 10.58。
通过连接两个甚至三个独立的游离皮瓣实现三维组织覆盖，在烧伤后重建中越来越多地被应用。这种方法有多种优势，是烧伤重建的一种可行选择。
