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Reconstruction of Postburn Contractures and Scars with Pre-expanded Perforator Flaps
Tahsin Oguz Acarturk
University of Pittsburgh / Div of Plastic Surgery
2012-02-15
Presenter: Tahsin Oguz Acarturk
Affidavit:
Director Name:
Author Category: Attending
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
Participants will be able to learn the technique of applying tissue expansion to perforator flaps for various indications. Tips and hints for a succesful reconstruction will be presented.
How will your presentation be used by practicing physicians in the audience?
This technique has many applications and versatality for complex recons one of which is;
prefabricated free tissue transfer especially for facial reconstruction can be an alternative to facial transplantation or plan B to a failing facial transplant. In addition
Introduction: The release of wide burn contractures leads to defects that cannot be closed with local flaps. In these cases, tissue expansion of local tissues may be a solution. However, when local tissues are also burned or not enough, distant tissue transfer remains the only option. Perforator flaps with their many advantages can be safely used.
Patients: Seven patients with post-burn contractures and scars were treated using pre-expanded anterolateral thigh(6) and thoracodorsal artery perforator(1) flaps. The defects were at neck(4), palmar and wrist(1), abdominal wall(1) and forehead(1). Time of expansion ranged from 4 to 11 months with a final volume of 1000 to 1200 cc. using 9-11 expansions. The defect sizes ranged from 10x21 cm to 24x28 cm. Six patients had free tissue transfer (5 ALT, 1 TDAP) and one had a pedicled flap (1 ALT).
Result: All flaps survived and with good functional and aesthetic outcomes. Two patients underwent postoperative liposuction to further thin the flap. Donor areas were closed primarily in two patients and with various amount of skin grafts in five patients. Overall pre-expansion decreased the amount of total skin grafted area The reconstructions were both functionally and cosmetically excellent.
Conclusion: Tissue expanded perforator flaps can be a good options in wide burn contractures where local tissues are inadequate. The advantages are 1) Very larger flaps can be prepared, 2) The expanded skin thins out making it more cosmetically appropriate to resurface skin only defects, and 3) The donor area morbidity is minimal with no functional loss.
