The use of flaps in high voltage electrical burns

PurposeThe aim of this study is to obtain maximum functional gain in patients who sufferd from high voltage electrical burns by early debridement and reconstruction of wide defects in which vital organs are exposed, with safe, vigorous flaps and to determine an algorithm in the choice of the flap according to the anatomical site. The choice of these flaps is a very important factor in the achievement of this goal.Materials and MethodsIn this study, which was done retrospectively and clinically, among 633 patients who suffered from electrical burn injury between the years of 1988-2008, 103 patients were analyzed who were reconstructed with the use of flaps. The used parameters were sex, age, burn percentage, additional traumas, number of fasciotomies, the level of amputation, length of hospitalization, types of flaps and complications. In 103 patients, total of 138 flaps were used for reconstruction. Among the 88 patients who suffered from upper extremity defects 45 had groin flap, 15 had pedicled myocutaneous flap, 15 had local flap, 5 had submammarial flap, 2 had adipofascial turn-over flap, 2 had LD flap, 2 had pedicled reverse dorsal metacarpal flap, 1 had pedicled superficial external pudendal artery flap and 1 had pedicled rectus abdominis myocutaneous flap. Among 29 patients who suffered from lower extremity defects 9 had sural flap, 4 had free LD flap, 10 had local flap, 3 had adipofascial turn- over flap, 1 had fascial flap, 1 had fasciocutaneous island flap and 1 had pedicled gastrochinemius muscle flap. Among 19 patients who had scalp defects 10 had local scalp flap, 3 had free LD muscle or myocutaneous flap, 2 fascial flap, 1 free transverse rectus abdominis myocutaneous (TRAM) flap, 1 had free fasciocutaneous island flap, 1 had free serratus muscle flap, 1 had pedicled myocutaneous trapezius flap. Between two patients who suffered from penile injury one was reconstructed with free fibular osteocutaneous flap and the other was reconstructed with a free radial forearm fasciocutaneous flap. At the end of these reconstructions, an algorithm was determined in the choice of flap according to the anatomical site. Patient followups were done on the 1st, 3rd, 6th, 12th months and yearly afterwards. During these follow ups functional operations were performed in required cases.ResultsPatients were followed up for an average of 31 months. It was seen that flap adaptation was good in patients whom underwent secondary operations. Out of 138 flaps full necrosis was seen in 3 free LD flap, 1 gastrochinemius muscle flap, 1 groin flap and 2 local fasciocutaneous flaps. On the other side partial necrosis was seen in 19 different flaps. In 6 flaps necrosis was due to infection and in 1 hematoma.ConclusionAs a result, it is shown that early debridement and reconstruction of wide defects in which vital organs are exposed, after high voltage electrical burns is very important. According to the algorithm that is determined; upper extremity defects reconstruction is more successful with groin flap, pedicled LD flap or if there is sufficient tissue local flaps. In lower extremity defects, sural and free LD flap; in scalp defects scalp or free flaps and in penis reconstruction free flaps must be considered in order to obtain successful results.