Microsurgery in burn care

Peter Dziewulski FFICM FRCS FRCS(Plast)1

1Clinical Director, Consultant Plastic and Reconstructive Surgeon, St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex CM1 7ET

Free tissue transfer can be useful in reconstruction of regions of the body where large tissue deficits exist and in selected cases, play a pivotal part in optimising patient outcomes. The use of microsurgical free tissue transfer within burn care was initially limited to secondary reconstruction however technical improvements and experience allowed microsurgical reconstruction to become more widespread is now used to provide cover for complex deep burns in the acute phase. Currently, free tissue transfer is often the preferred option to provide primary cover in complex deep burn wounds with exposure of bone, nerves, tendons and vessels. Primary indications for the technique have now become more common than for secondary reconstructive procedures. Microsurgical free tissue transfer in such situations offers a number of distinct advantages including ability to harvest uninjured tissue from a different site on the body, transfer well vascularized tissues to bridge deficits in  compromised areas as well as the ability to transfer vascularized bone, skin, muscle and nerves as composite flaps in necessary quantities to the site of the defect. Furthermore, free tissue transfer offers a one stage solution to these complex injuries and enables early mobilization as well as potentially reducing hospital stay. The talk will delineate the indications, timing, pitfalls and failure rates for free flaps in both acute and secondary reconstructive situations will provide an algorithm for the use of free flaps in burn care.

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