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Published on: June 8, 2013
Extensive Chest Wall Tissue Loss and its Management by Vertical Rectus Abdominis Myocutaneous Flap
Sandip Kanti Basu1, Jayanta Bain1, Debarati Chattopadhyay2
1Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Insights
Extensive chest electric burns in children are rare and challenging. A novel surgical approach using a rectus abdominis flap and skin grafting led to excellent recovery in a critical pediatric case.
Area of Science:
- Pediatric Surgery
- Burn Management
- Trauma Care
Background:
- Extensive electric burns of the chest in children are uncommon and present significant management difficulties.
- Delayed presentation of such injuries can lead to critical systemic complications and extensive tissue damage.
Observation:
- A 12-year-old male presented with a 9-day-old neglected extensive electric chest burn.
- The patient exhibited critical condition with toxemia, widespread necrosis of skin, subcutaneous tissues, muscles, and exposed ribs/sternum.
- There was a high risk of pleural rupture due to exposed intercostal spaces.
Findings:
- Following resuscitation and debridement of necrotic tissue, a superiorly based vertical rectus abdominis myocutaneous flap was utilized.
- The flap successfully covered the exposed bones and intercostal spaces.
- Remaining raw areas were managed with skin grafting.
Implications:
- This case highlights the successful application of a rectus abdominis myocutaneous flap in reconstructing extensive pediatric chest electric burns.
- The surgical technique facilitated excellent recovery and positive outcomes in a previously critically ill child.
- This approach may offer a viable solution for complex pediatric chest wall reconstruction following severe burns.
Abstract:
Extensive electric burn around the chest in children is rare and this type of injury always poses a great challenge for its management. A 12-year-old male child with extensive electric burn of the chest wall was admitted to hospital. It was a neglected case of 9 days old burn; the young boy was in critical condition having systemic features of toxemia with widespread necrosis of the skin, subcutaneous tissues, and muscles along with exposed bones (ribs and sternum) with the risk of impending rupture of pleura through the exposed intercostal spaces. After initial resuscitation, a thorough debridement of all necrotic tissues was done. Thereafter, a superiorly based vertical rectus abdominis myocutaneous flap was harvested to cover the exposed bones and intercostal spaces. The remaining raw areas were skin grafted. The child made an excellent recovery with good outcome.
