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Reconstruction of Extensive Burn Defects with Multiple Flaps: A Case Series
Mare G Kaulakis, BS; Hilary Y Liu, BS; José Antonio Arellano, MD; Christopher J Fedor, MS; Guy M Stofman, MD; Francesco M Egro, MD
University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine
2025-01-13
Presenter: Mare Kaulakis
Affidavit:
I agree.
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE: Full-thickness burns present reconstructive challenges due to extensive tissue damage that often affects skin, deep muscle, and bones. Traditional reconstructive techniques may not provide adequate coverage and vascularity for optimal recovery. This study investigates the effectiveness of multiple flaps for reconstructing a single anatomical region.
METHODS: A retrospective review of patients undergoing multi-flap reconstruction of extensive burn defects at an ABA-verified burn center from 2010-2023 was conducted, collecting demographics, burn characteristics, flap types, and complications.
RESULTS: Six male patients (mean age 49±19.52 years; mean BMI 7.82±7.80) requiring multi-flap intervention for seven burn defects were included. Common comorbidities included diabetes (50%; n=3) and smoking (16.67%; n=1). All patients had full-thickness thermal burns with average total body surface area 40.64±21.53%.
Multi-flap operation was indicated for lower extremity bone exposure in five patients (4 gastrocnemius and soleus muscle flaps, 1 bilateral lateral and medial gastrocnemius flap following above-knee amputation). One patient received extensor carpi radialis and flexor carpi ulnaris muscle flap for upper extremity burn.
Four patients developed wound healing complications, with three requiring additional interventions (excision plus split-thickness skin graft or skin substitute). One patient developed partial flap loss, and another sepsis. No hematoma, seroma, or thrombosis were reported. Successful limb salvage was achieved in three patients and amputation defect coverage in one. Two patients died from respiratory failure.
CONCLUSION: This novel technique of combining multiple free flaps offers a good solution to cover large area deformities. This technique should be considered for extensive burn injuries due to its favorable outcomes.
