Microvascular Free Tissue Transfer in the Management of tissue defects in Burned patients: The Western Australian Adult Burns Unit Experience

Dr Kiran Narula1, Mr Jeremy Rawlins1

1State Adult Burns Unit, Fiona Stanley Hospital, Perth, Australia


Introduction: Free flaps in burns patients were historically unreliable; shifts in haemodynamics, clotting, and wound healing caused by systemic inflammation leading to increased complication rates. However, advances in burns care and skilled units have shown their viability and success in recent years. We describe our experience of microvascular reconstruction in burns patients.

Methods: Retrospective review of patients requiring primary or secondary reconstruction with free tissue transfer between January 2013 and June 2021 in the State Adult Burns Unit (Perth, Australia). The patients were analysed for epidemiological characteristics, burn location, flap types, and complications.

Results: We present 11 flaps performed in 9 burned patients. The most common aetiology was high voltage electrical (45%) followed by heat contact (37%). Ten patients were men, with a mean age of 44.3 years. The TBSA ranged between 0.2% and 55%.

The reconstructed anatomical regions were patients’ lower extremities (7), upper extremities (3) and craniofacial (1). Six different flaps were used according to the needs of the recipient areas; the Anterolateral Thigh flap (5 cases) was used most, followed by the Superficial Circumflex Iliac artery Perforator, and free Latissimus Dorsi flaps (2 cases of each).

There was one partial flap loss, ultimately requiring another free flap. One muscle flap required further skin grafting. One patient returned to theatre for a post-operative haematoma washout. There were no complications of the donor sites.

Conclusion: From our experience, free flaps are a reliable and adaptable technique in burns reconstruction, frequently salvaging limbs and helping patients retain function. These successes are built upon the experiences of performing complex free flaps in other trauma (and elective) settings.


Kiran Narula is an unaccredited plastic surgery registrar from Perth, Western Australia. He has an interest in burns and head and neck surgery. In his spare time, he enjoys being outdoors and reading books, often combining the two!

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