Once Burnt, Twice Burnt: The Vulnerability of Insensate Flap Reconstructions.

The occurrence of a burn injury in the same region as a previous burn is unusual outside the context of deliberate self-harm. Accidental burn injuries sustained to insensate flap reconstructions have previously been well reported in autologous breast reconstruction. Reports of such injuries in distant flap reconstructions of the hand and forearm are however unusual. This case report describes a 40-year-old man who required a pedicled groin flap to reconstruct a burn injury on the ulnar border of his hand. Three years later, he suffered a burn to the same area whilst using an oven. This case highlights the importance of counselling patients with insensate reconstructions regarding increased care and vigilance against inadvertent injury.

Five Simple Techniques to Enable Rapid Elevation and Donor Site Closure of the Anterolateral Thigh Flap.

We describe five technical notes to facilitate rapid elevation of the anterolateral thigh flap for extremity reconstruction. We highlight the advantages of (1) a lateral approach; (2) identification of the perforator with the shortest intramuscular distance; (3) deroofing technique with cutting monopolar for pedicle dissection; (4) taking a cuff of vastus lateralis in some cases to avoid unnecessary long perforator dissection; and (5) closure of large donor sites with a modified keystone flap. Using the sequence reduces flap-raising times to 60 to 90 minutes and improves theater usage while achieving excellent outcomes.