A Retrospective Study for Method and Timing of Reconstruction Using Free Latissimus Dorsi Muscle Flap at Foot in Electrical Burn Patients

ABSTRACT

High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.