Clinical Characteristics of Thermal Injuries Following Free TRAM Flap Breast Reconstruction

횡복직근 유리피판술로 유방재건 후 발생한 화상의 임상적 특성

  • Lee, Paik Kwon (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Bae, Joon Sung (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Sang Tae (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Oh, Deuk Young (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Rhie, Jong Won (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Han, Ki Taik (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea)
  • 이백권 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 배준성 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 안상태 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 오득영 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 이종원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 한기택 (가톨릭대학교 의과대학 성형외과학교실)
  • Received : 2005.03.24
  • Published : 2005.07.10

Abstract

Following a transverse rectus abdominis musculocutaneous(TRAM) flap breast reconstruction, denervated state of the flap causes the flap skin prone to thermal injury, calling for special attention. During the last 5 years, 69 breast reconstruction with 72 free TRAM flaps, were performed. Four out of thesse 69 patients sustained burn injury. Heat sources were a warm bag(n=2), heating pad(n=1) and warming light (n=1). The thermal injuries occured from 2 days to 3 months following the reconstruction. Three patients healed with conservative treatment, but one patient required debridement and skin graft. Initially 3 out of 4 patients with the burn had shown superficial 2nd degree burn with small blebs or bullae. However all 4 patients healed with scars. Mechanism of burn injuries of the denervated flap are known to be resulting from; 1) loss of behavioral protection due to denervation of flap with flap elevation and transfer, 2) loss of autonomic thermoregulatory control with heat dissipation on skin flap vasculature contributing to susceptibility of burn injury. 3) changes of immunologic and normal inflammatory response increasing thromboxane, and a fall in substance P & NGF (nerve growth factor). Including the abdominal flap donor site, sensory recovery of the reconstructed breast varies individually from 6 month even to 5 years postoperatively. During this period, wound healing is delayed, resulting in easier scarring compared to that observed in the sensate skin. Patients should be carefully informed and warned of possible burn injuries and taught to avoid exposure to heat source at least until 3 years postoperatively.

Keywords

References

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