RECONSTRUCTION OF POST-BURN ANTEBRACHIAL CONTRACTURES USING PEDICLED THORACODORSAL ARTERY PERFORATOR FLAP
fatih uygur, Assistant Professor, Celalettin Sever, Serhan Tuncel, Şahin Alagöz, Ersin Ülkür.
Gülhane Military medical academy Haydarpaşa Training Hospital, Istanbul, Turkey.
Purpose: Full thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable, if they are not managed properly. Treatment requires complete release and radical excision of the scar tissues with reconstruction using durable tissue that will not contract during long term follow-up.
Patients and Methods: 9 patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator (TDAP) flap. All patients were male and their ages ranged from 20 to 23 (average, 21.4 years). The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the LD muscle. The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean:8.0), 16.0 to 21.0 cm in length (mean:20.0) and the mean pedicle length was 20.0 cm. Patients were followed up for months 9.3 (range, 6-12 months).
Results: All flaps used for post-burn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps in the early postoperative period. Complete range of motion at the elbow joint was achieved in all patients at the end of the reconstruction.
Conclusion: This study revealed that the pedicled TDAP flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained in order to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts very well to the forearm skin and the donor site scar is considered acceptable.