FREE-FLAP RECONSTRUCTION IN MASSIVE UPPER EXTREMITY BURNS

In massive burns, early excision and a free flap reconstruction is, in some cases, limb saving. From October 1979 to August 1993, eleven pat ients with massive burn injury in the upper extremity were treated usi ng a free flap reconstruction. Eight cases were acute or subacute and three were late reconstructions. The following free flaps were used: r ectus femoris microneurovascular musculocutaneous flap (2), latissimus dorsi flap (4), rectus abdominis flap (3), gluteal thigh flap (1), la teral arm flap (1), and serratus flap (1). The gluteal thigh flap was lost and it was later replaced by a rectus abdominis flap. In three ca ses successful reanastomosis was performed. Functional late reconstruc tions were performed in nine patients. In all eleven patients the limb was saved and functional recovery was satisfactory. We recommend that a free musculocutaneous or muscle flap is used, proximal to the wrist , if after careful excision of nonviable tissue, tendons, bone joint o r major vessels are exposed. The rectus femoris musculocutaneous flap is a useful solution to restore extensor musculature of the forearm af ter extensive injury.