Delayed reconstruction with free flap: answer to postelectric burn complex wounds: a 3-year experience

Abstract

Background and Purpose : High voltage electric burn patients generally present with complex/composite defects requiring flap cover. Due to physiological factors as well as local factors involved in electric burns, there is high reluctance in performing free flaps in these burns patients. Our study comprised patients who were managed with free flap cover in last 3 years in the absence of local options. Comparison of acute/subacute and delayed (>6 weeks) reconstruction cases were done. Materials and Methods: It is a prospective study of data of 36 patients (32 male, 4 female) who required various free flap cover for the complex defects due to electric burns during January 2012 to December 2014 in Plastic Surgery Department, SMS Hospital, Jaipur. Eighteen patients (50%) underwent delayed reconstruction (>6 weeks) and equal number underwent surgery in acute/subacute settings. Data comprised the complications, causes of exploration and salvage rates in both groups that included various types of free flaps performed during the period. Results : Overall 5 flaps (13.8%) failed out of 36 flaps. Only one flap in delayed (5%) and 4 flaps in acute/subacute (22.2%) setting failed. Overall complication rate was 27.7% (10 patients). Conclusions : Considering low failure rate of 5% in delayed cases, as compared to 22.2% in acute/subacute cases, we propose free flap cover in a delayed manner in post electric contact burn complex defects as a better choice.