Reconstruction of Wrist Defects with Free Flaps in High Tension Electrical Burn Patients.

Kim, Ki Seon; Song, Hong Shick; Na, Min Wha; Lee, Tae Seop; Lee, Dong Eun

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2001;28(5):531-536.
Published online September 1, 2001.

Reconstruction of Wrist Defects with Free Flaps in High Tension Electrical Burn Patients.

Ki Seon Kim, Hong Shick Song, Min Wha Na, Tae Seop Lee, Dong Eun Lee

¹Department of Plastic and Reconstructive Surgery, Hanil General Hospital.
²Department of Plastic and Reconstructive Surgery, Dream Aesthetic Clinic, Seoul, Korea.

Abstract

High tension electrical burns affecting the wrist are likely to produce full thickness necrosis of the skin and to damage deep vital structures beneath the eschar, affecting he local tendons, nerves, vessels, even bones and joints which result in serious dysfunction of the hand. An aggressive approach to the treatment of these severe wounds and adequate wound coverage are essential for the successful result. From October 1997 to February 2000, we had treated 23 electrical wrist injuries in 20 patients with free flaps. Among these, 13 anterolateral thigh flaps, 5 forearm flaps, 2 scapular flaps, 2 parascapular flaps, and 1 medial leg flap were executed. About 2-4 weeks after initial injury, we tried free flaps. Preoperative debridement was not carried out. At the time of surgery, debridement of all nonviable tissue was done, but nerves, tendons, and bones were left in place with minimal or no debridement when they had anatomic continuity, regardless of their appearance of viability. In all cases, successful soft tissue coverage and wound healing were achieved, and we obtained the following conclusions. 1. Flap coverage should be executed before damage of the tendons, nerves, vessels. 2. As long as the free flap survives, the infected tendons, nerves, and denuded bone can be salvaged. 3. For later reconstruction of the wrist, fasciocutaneous flap should be preferred to promise tendon gliding and endure several operative procedures.

Keywords: Free flap; Wrist defect; Reconstruction; High tension electrical burn