Reconstruction of perineal obliteration deformity after extensive deep burn with ilioinguinal flap

Abstract

Objective: To explore the effect of ilioinguinal flap on reconstruction of perineal obliteration deformity after extensive deep burn. Methods: Five patients with perineal obliteration deformity after extensive deep burn were hospitalized from January 2010 to June 2015, with total burn area ranging from 35% to 55% total body surface area, depth of full-thickness burn and wound deep to bone, and course of scar from 6 months to 3 years. Scars of patients were involved in bilateral groins, inner thighs, monsveneris, sacrococcygeal region, and central area of perineum. The abduction angles of double lower limbs ranged from 30 to 65°. Anus was narrow, and defecation was difficult. After release of scar tissue in perineal region, the wound area ranged from 23 cm×12 cm to 28 cm×24 cm. For wound repair and reconstruction of anus, unilateral ilioinguinal flap was used in 3 cases. Due to large wound in two patients, bilateral ilioinguinal flap was used in one patient, and unilateral ilioinguinal flap combined with anterolateral femoral flap was used in another one patient. The area of unilateral ilioinguinal flap ranged from 23 cm×12 cm to 30 cm×20 cm, and the area of anterolateral femoral flap was 21 cm×12 cm. The abdominal donor site was closed with partial suture and partial skin grafting (harvested from split-thickness skin of autologous head or thin intermediate-thickness skin of autologous back). The femoral donor site was directly sutured. After the operation, the double lower limbs were fixed with plaster on abducent position and strictly immobilized. Results: All the flaps survived after operation and the wounds healed well. During the follow-up for 6 to 12 months, the appearance of flaps were good with soft texture and no contracture. Hip joint motion was good, and abduction angles of double lower limbs ranged from 110 to 135°. The appearance of crissum was good without skin inflammation and with normal function of defecation. The appearance of donor site was acceptable to patients or their parents. Conclusions: Ilioinguinal flap is a good choice for reconstruction of perineal obliteration deformity after burn.