Journal of the Korean Burn Society (대한화상학회지)

Korean Burn Society (대한화상학회)
권호 표지
DOI QR코드

DOI QR Code

The Usefulness of the Two-Staged Pedicled Latissimus Dorsi (LD) Flap in Fourth-Degree Burns of Upper Extremity

상지의 4도 화상에서 두 단계의 유경 광배근 피판술의 유용성

  • Kim, Jae Hyun (Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Seol, Seong Hoon (Department of Plastic and Reconstructive Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Chung, Chan Min (Department of Plastic and Reconstructive Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Myong Chul (Department of Plastic and Reconstructive Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Cho, Sang Hun (Department of Plastic and Reconstructive Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine)
  • 김재현 (한림대학교 강남성심병원 성형외과) ;
  • 설성훈 (한림대학교 성심병원 성형외과) ;
  • 정찬민 (한림대학교 성심병원 성형외과) ;
  • 박명철 (한림대학교 성심병원 성형외과) ;
  • 조상헌 (한림대학교 성심병원 성형외과)
  • Received : 2021.10.19
  • Accepted : 2021.11.16
  • Published : 2021.12.31
⟨ Previous Next ⟩

Abstract

Purpose: A large defect by fourth-degree burns in the upper limb requires flap reconstruction. Since severe vascular damage and decrease in blood circulation after vascular anastomosis can occur in defects caused by fourth-degree burns. Because of the disadvantages, it is difficult to apply free flap surgery to fourth-degree burns. We reconstructed a upper extremity using the pedicled Latissimus Dorsi (LD) flap in two stages. The purpose of our study is to review our experience and suggest two-staged pedicled Latissimus Dorsi (LD) flap in fourth-degree burns of upper extremities. Methods: A retrospective review was performed from 2016 to 2019, on a total of 12 fourth-degree burn patients undergone two-staged pedicled LD flap surgery as reconstruction of upper extremities in our hospital. We reviewed the location of the injury, etiology, TBSA (%), size of burns requiring flap surgery, period from 1st surgery to secondary division surgery, complications. Results: Using two-staged LD flap as a primary reconstruction, the outcome is satisfactory. This flap preserves the elbow joint and maintains the length of the forearm. We obtain low donor-site morbidity, simplicity and a small incision in the donor site. Conclusion: Using two-staged LD flap in fourth-degree burns of upper extremity is effective, such as preserving elbow joint and maintaining the length of the forearm. Successful reconstruction was achieved with excellent cosmetic results with reducing a postoperative scar, donor-site morbidity. Due to these advantages, two-staged pedicled LD flap can be an optimal option for reconstruction of fourth-degree burns in the upper limb.

Keywords

References

  1. Delay E, Foyatier JL, el Kollali R, Comparin JP, Weil E, Latarjet J. Salvage of extensively burned upper limbs by a pedicled latissimus dorsi flap. Burns 1995;21:449-52. https://doi.org/10.1016/0305-4179(95)00013-2
  2. Cadenelli P, Bordoni D, Ornelli M, Radaelli S. Reconstruction of a large upper arm defect with muscle sparing latissimus dorsi. BMJ Case Rep. 2016 Aug 23;2016:bcr2016216684.
  3. Abu Jamra FN, Massad M, Musharafieh RC. Reconstruction of shoulder and arm defects using the latissimus dorsi myocutaneous flap. A report of five cases. Scand J Plast Reconstr Surg 1986;20:307-11. https://doi.org/10.3109/02844318609004492
  4. Ma CH, Tu YK, Wu CH, Yen CY, Yu SW, Kao FC. Reconstruction of upper extremity large soft-tissue defects using pedicled latissimus dorsi muscle flaps--technique illustration and clinical outcomes. Injury 2008;39(Suppl4):67-74.
  5. Stevanovic M, Sharpe F. Soft-tissue coverage of the elbow. Plast Reconstr Surg 2013;132:387e-402e. https://doi.org/10.1097/PRS.0b013e31829ae29f
  6. Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity. Plast Reconstr Surg 2004;113:1175-83. https://doi.org/10.1097/01.PRS.0000110332.74289.2B
  7. Sadove RC, Vasconez HC, Arthur KR, Draud JW, Burgess RC. Immediate closure of traumatic upper arm and forearm injuries with the latissimus dorsi island myocutaneous pedicle flap. Plast Reconstr Surg 1991;88:115-20. https://doi.org/10.1097/00006534-199107000-00020
  8. Schottstaedt ER, Larsen LJ, Bost FC. Complete muscle transposition. J Bone Joint Surg Am 1955;37-A:897-918;discussion, 918-9. https://doi.org/10.2106/00004623-195537050-00001
  9. Adkinson JM, Chung KC. Flap reconstruction of the elbow and forearm: a case-based approach. Hand Clin 2014;30:153-63. https://doi.org/10.1016/j.hcl.2013.12.005
  10. Pierce TD, Tomaino MM. Use of the pedicled latissimus muscle flap for upper-extremity reconstruction. J Am Acad Orthop Surg 2000;8:324-31. https://doi.org/10.5435/00124635-200009000-00006
  11. Ofer N, Baumeister S, Megerle K, Germann G, Sauerbier M. Current concepts of microvascular reconstruction for limb salvage in electrical burn injuries. J Plast Reconstr Aesthet Surg 2007;60:724-30. https://doi.org/10.1016/j.bjps.2006.12.010
  12. Gacto-Sanchez P. Surgical treatment and management of the severely burn patient: Review and update. Medicina Intensiva (English Edition) 2017;41:356-64. https://doi.org/10.1016/j.medin.2017.02.008
  13. Burstein FD, Salomon JC, Stahl RS. Elbow joint salvage with the transverse rectus island flap: a new application. Plast Reconstr Surg 1989;84:492-7. https://doi.org/10.1097/00006534-198909000-00017