RESUMEN
Background: Severe acute burn injuries represent a challenge to the reconstructive surgeon. Free flap reconstruction might be required in cases of significant critical structure exposure and soft tissue deficits, when local options are unavailable. This study aimed to determine the free flap complication rate in acute burn patients. Methods: A systematic review and meta-analysis were conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on the International Prospective Register of Systematic Reviews database (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was the free flap failure rate. Results: The study identified 31 articles for inclusion. A total of 427 patients (83.3% men, 16.7% women) accounting for 454 free flaps were included. The mean patient age was 36.21 [95% confidence interval (CI), 31.25-41.16]. Total free flap loss rate was 9.91% [95% CI, 7.48%-13.02%], and partial flap loss was 4.76% [95% CI, 2.66%-8.39%]. The rate of venous thrombosis was 6.41% [95% CI, 3.90%-10.36%] and arterial thrombosis was 5.08% [95% CI, 3.09%-8.26%]. Acute return to the operating room occurred in 20.63% [16.33%-25.71%] of cases. Stratified by body region, free flaps in the lower extremity had a failure rate of 8.33% [95% CI, 4.39%-15.24%], whereas in the upper extremity, the failure rate was 6.74% [95% CI, 3.95%-11.25%]. Conclusion: This study highlights the high risk of free flap complications and failure in acute burn patients.
RESUMEN
Extensive full-thickness head and neck burn defects represent some of the greatest challenges because of the exposure of burned calvaria and lack of good local reconstructive options. This study reports the use of a pedicled latissimus dorsi (LD) muscle flap to cover a large full-thickness scalp burn defect measuring 20 × 15 cm, including 15 × 13.7 cm of bone exposure and extending from the posterior neck to the mastoid and vertex of the scalp. The authors discuss the technique to safely maximize the reach, which includes distal dissection to the iliac crest and thoracolumbar fascia, dissection of the pedicle to the axillary vessels, tunnel creation through the pectoralis major muscle, re-attachment of the LD origin to the pectoralis major and teres major, and undermining of the neck skin and subcutaneous tissue to avoid damage of the accessory nerve. This case highlights the reach of a pedicled LD muscle flap for extensive scalp reconstruction for defects all the way to the vertex and beyond. The size and reliability of the LD muscle makes it a valuable alternative for large scalp defects for cases of complex scalp reconstruction in patients deemed not ideal candidates for free flap reconstruction.