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Reconstruction of postburn antebrachial contractures using pedicled thoracodorsal artery perforator flaps
Fatih Uygur1, Celalettin Sever, Serhan Tuncer
1Istanbul, Ankara, and Kocaeli, Turkey From the Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital; Department of Plastic and Reconstructive Surgery, Gazi University Medical School; and Department of Plastic and Reconstructive Surgery, Kocaeli University Medical School.
Background:
Full-thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable if the affected areas are not managed properly. Proper treatment requires complete release and radical excision of the scar tissue, followed by reconstruction using durable tissue that will not contract during long-term follow-up.
Methods:
Nine patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator flaps between 2004 and 2008. All of the patients were male, and their ages ranged from 20 to 23 years (mean, 21.4 years). The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean, 8.0 cm) and 16.0 to 21.0 cm in length (mean, 20.0 cm). All of the patients were followed up for 6 to 12 months (mean, 9.3 months).
Results:
All of the flaps used on the postburn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps during the early postoperative period. A complete range of motion at the elbow joint was achieved in all patients by the end of the reconstruction period.
Conclusions:
This study revealed that the pedicled thoracodorsal artery perforator flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts well to forearm skin and the donor-site scar is considered cosmetically acceptable.