1/13. Distally-based neurofasciocutaneous flaps in electrical burns.Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/13. Delayed obturator artery rupture: a complication of high-voltage electrical injury.Electrical burns cause damage to the cardiovascular system through different mechanisms. Immediate cardiac arrhythmia is one of the common consequences. A large vessel blow out due to an electrical burn is rarely documented. It is often undetected due to its "silent" symptoms. This article reports a delayed obturator artery rupture in a 32-year-old male patient 6 weeks after he sustained severe high-voltage electrical burns. The vessel injury was treated with computed tomography (CT)-aided embolization. The patient recovered to an ambulatory status 10 weeks after the injury.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/13. Unusual explosive growth of a squamous cell carcinoma of the scalp after electrical burn injury and subsequent coverage by sequential free flap vascular connection--a case report.BACKGROUND: Squamous cell carcinomos may arise from chronic ulcerating wounds in scars, most commonly postburn scars. Tumour growth usually takes place over months to years. Localization on the scalp is a relatively rare condition. CASE PRESENTATION: This report presents the case of a 63-year-old man with chronic ulceration of a postburn scar of the scalp due to an electrical burn 58 years ago. Sudden tumour growth started within weeks and on presentation already had extended through the skull into frontal cortex. After radical tumour resection, defect was covered with a free radial forearm flap. Local recurrence occurred 6 weeks later. Subsequent wide excision including discard of the flap and preservation of the radial vessels was followed by transfer of a free latissimus dorsi muscle flap, using the radial vessels of the first flap as recipient vessels. The patient received radiotherapy post-operatively. There were no problems with flap survivals or wound healing. Due to rapidly growing recurrence the patient died 2 months later. CONCLUSION: Explosive SCC tumour growth might occur in post-burn scars after more than 50 years. As a treatment option the use of sequential free flap connections might serve in repeated extensive tumour resections, especially in the scalp region, where suitable donor vessels are often located in distance to the defect.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
4/13. Use of the lateral intercostal perforator-based pedicled abdominal flap for upper-limb wounds from severe electrical injury.BACKGROUND: Upper-extremity wounds can be covered with a variety of flaps. However, pedicled distant flaps still have a place in treatment, especially in the early stages of wound restoration after a severe electrical injury. The purpose of this clinical study was to present the use of the pedicled abdominal flap, using the blood supply of the lateral intercostal perforator vessel, to cover defects caused by severe electrical injury. methods: Between 2003 and 2005, 6 cases of deep burn wounds were treated with a lateral intercostal perforator-based pedicled abdominal cutaneous flap, with the blood supply originating from the lateral perforator branches of the seventh to 10th intercostal arteries. This flap was used to repair deep burn wounds on the elbow, forearms, and hands that were the result of severe electrical injuries. RESULTS: Flaps were harvested in sizes ranging from 16 cm x 12 cm to 9 cm x 7 cm. The pedicle was separated from 18 to 21 days after the operation. Five flaps survived entirely. The sixth underwent marginal necrosis (1.5 cm x 3 cm) at the distal portion of the flap because flap cutting exceeded the paraumbilical line. Results were cosmetically satisfactory for all patients. CONCLUSIONS: This flap is suitable for covering defects in hands, forearms, and elbows. The procedure was performed easily, safely, and reliably, and the flap has several advantages over other commonly used techniques for upper-limb wounds from severe electrical injury. We recommend this flap as the treatment of choice.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/13. Use of a cross-leg free muscle flap to reconstruct an extensive burn wound involving a lower extremity.A young patient sustained a high-voltage burn with extensive destruction of the soft tissue in his left lower extremity. Occlusion of the anterior and posterior tibial arteries, loss of toe extensors and the superficial and deep peroneal nerves were noted, besides the exposure of the lower end of the tibia and metatarsal bones. In the absence of proper recipient vessels, a cross-leg free latissimus dorsi muscle flap with overlying skin and depending on the vessels of the contralateral foot was used successfully for reconstruction of the defect. The pedicle was divided 3 weeks after microvascular anastomosis and the flap survived completely. This technique permits transfer of free flaps to compromised wounds without available recipient vessels, and the latissimus dorsi muscle flap, with its characteristics of large size and copious vascularity, could be split to cover exposed bones in different areas simultaneously.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
6/13. Simultaneous bilateral foot reconstruction using a single radial forearm flap.The radial forearm septocutaneous flap is an excellent source of thin tissue with an anatomically consistent network of large vessels that simplify microsurgical transfer. It may be divided into multiple flaps leaving a single donor-site defect. The clinical usefulness of this concept is demonstrated in a single case in which simultaneous coverage of electrical burns of both feet was required.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/13. Dorsal metacarpal flaps.The history of dorsal metacarpal flaps and their anatomical basis is described. In thirty hand dissections, the fascial variety of the first dorsal metacarpal artery was present in 90% and the second dorsal metacarpal artery in 97%. The origin, course, branches and termination of these arteries are illustrated. Doppler ultrasonic flowmeter studies of the vessels in 52 hands are presented but shown to be unhelpful clinically. Two patients in whom the second dorsal metacarpal flap was used, are described and possible difficulties delineated.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/13. Early vascular grafting to prevent upper extremity necrosis after electric burns: additional commentary on indications for surgery.Early vascular grafting has been used to reestablish circulation to the hand in the treatment of electric injuries of the wrist with arterial damage. Since 1972 this therapy has yielded good results by preventing necrosis of the injured hand and by helping to maintain function. However, the indications and timing for performing this operation still are poorly defined. The surgeon is faced with the difficult task of determining whether the injury is severe enough to affect distal circulation and thereby lead to necrosis. The lack of reliable clinical signs is chiefly responsible for this difficulty; however, the potential for delayed thrombosis of vessels complicates the problem. In this article, indications for early vascular grafting in an electrically injured wrist are discussed based on recent clinical experience, with emphasis on the use of arteriography. A case history involving electric burns of both upper extremities is presented as an illustration.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/13. Double V-Y flap for correction of proximal interphalangeal joint flexion contractures.A double V-Y flap made up of skin available at the site is an alternative to grafts or cross-finger flaps for release of proximal interphalangeal joint contractures. After the initial incision, the technique involves loosening of the contracted skin so that perpendicular nutrient microvessels are preserved. Suggested postoperative management includes subcutaneous dorsal Kirschner wires to maintain extension without jeopardizing the vascular supply of the flap and gentle stretching of the skin as soon as the wires are removed. Three cases are presented to illustrate the variety of applications of double V-Y technique.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/13. Severe electric burn of the skull.We report a case of severe injury of the scalp and skull caused by high tension electric current. The patient developed tetraplegia. The surgical steps undertaken are also described. We used two consecutive free flaps which failed 5 days after each operation. We discuss the possible causes for flap failure, which we think was due to damaged receptor vessels. The wound was closed after expanding the adjacent scalp. scalp expansion was an uneventful procedure, however infection of the cavity developed. We overcame this problem by an aggressive approach (cavity irrigation, daily expansion and systemic antibiotherapy). The use of a synthetic mesh to avoid cerebral herniation through the bone defect is also described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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