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Clinical Characteristics of Thermal Injuries Following Free TRAM Flap Breast Reconstruction  

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)
Publication Information
Archives of Plastic Surgery / v.32, no.4, 2005 , pp. 403-407 More about this Journal
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
TRAM flap; Denervation; Thermal injuries;
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