|
Back to Annual Meeting Program
Ten Years of Experience in Using an Interpositional Random Fasciocutaneous Flap Technique to Reconstruct 1229 Burn Contractural Deformities of the Axillae, Elbows, Wrists, Knees and Ankles
Ted Huang, MD, Ankur Mehta, MD.
University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: Among surgical techniques used to release burn contractures involving the axilla, elbow, wrist, knee and ankle, an interpositional random fasciocutaneous (RFC) flap technique was used most often at our hospitals over the past ten years. The experience gained from managing 778 burn patients with 1229 contracted axillae, elbows, wrists, knees and ankles formed the basis of this report.
METHODS: Surgical Technique- A right angle RFC flap with its adjacent made perpendicular to the line of release, is fabricated in the area adjacent to the site of contractural release. The RFC flap was next rotated 90° to cover the wound resulted from surgical release. (Figure 1a-d)
Clinical Materials and Methods- The records of 778 individuals who had
undergone contractural releasing procedures involving the axilla, elbow, wrist, knee and the ankle between the years 2002 and 2011utilizing an interpositional RFC flap technique were reviewed. The efficacy of technique was assessed with the frequency of re-release.
RESULTS: There were 475 males. The youngest patient was 9 months-old and the oldest was 47 years, with a mean age of 10 years. Of 1229 RFC flaps fabricated, there were 532 for the axilla, 209 for the elbow. 271 for the wrist, 91 and 126 were for the knee and ankle contracture release respectively. The flap dimension was known in 902 instances. However, the flap size in practice varied depending upon the joint involvement and the magnitude of release required. The smallest one was 3 cm x 1.5 cm while the largest was 20 cm x 4 cm. Wound complications such as infection and hemorhagging were encountered in 3 instances in axillary release, 1 instance each for the elbow and ankle release, and 3 for the knee release. The incidence of flap necrosis mostly partial and superficial was noted in 1.1% for the axilla, 0.9% for the elbow, 0.3% for the wrist, 13% for the knee and 6.5% for the ankle. The rate of re-operation was 10.25% for the axilla, 3.83% for the elbow, 7.78% for the wrist, 9.78% for the knee and 10.57% for the ankle joints.
CONCLUSION: The interpositional RFC flap technique was found to be useful for releasing contracted joints. The effectiveness appeared to be attributable to an inclusion of fascial structures in flap design; it allows a change in flap length-to-width ratio from 2:1 to 4~5:1. The morbidities were low and the need for re-releasing was uncommon.
   
Back to Annual Meeting Program
|
