Repair and reconstruction of massively damaged burn wounds

Abstract

Objective: To report repair and reconstruction of massively damaged burn wounds under unusual condition. Methods: One hundred forty-eight patients with deep burn tissue defects admitted from January 1993 through December 2000 were analyzed, among them 96 patients suffered from electrical injury which constituted 65.3% of all cases, 18 patients with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, accounting for 12.2 and 12.2%, respectively, 6 cases with radiation injury, comprising 4.0% of all cases, 2 cases with explosive injury, 2 cases with chemical burn and 6 cases caused by erosive chemicals and wound infection. One hundred seventy-six flaps were transferred with mostly local flaps to repair deep burn wounds in 148 patients with tissue defects, in which necrotic tendons were replaced by acellular allogeneic tendons simultaneously in seven cases. Sixty-one iliolumbar arterial axial skin flaps for coverage of soft-tissue defects in hands or wrists were transplanted. Technical innovations to repair large soft-tissue defects of temporal region and ear, chin and lip, and dorso-lateral aspect of foot due to deep burn were explored. New technics to define necrotic tissue and vascular damage as a result of electrical injury were developed. Results: The biggest dimension of flaps in this group was 22 cm×30 cm. The survival rate of flap was 96.5%, while necrosis of the tip of flap occurred in 3.5%. The function and configuration were satisfactory after 4 months to 8 years follow-up. The technique of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy helped identify necrotic tissue before operation, and with the help of digital subtraction arteriogram (DSA) arterial injury could be identified. B-mode ultrasound was helpful to show the extent of endothelial injury, and Colour Doppler was useful to show luminal blood flow signal and filling defect in the injured artery. Conclusions: Repair and reconstruction of massively damaged burn wound at early stage could be achieved. Techniques which helped define the extent of damage to the soft tissues, including arteries and tendons were essential preoperatively for successful reconstruction. Functional and aesthetic reconstruction, as well as the general condition of the patients, could thus be significantly improved early after the devastating injuries. Further innovations of operative technics would benefit more patients with such injuries.