Bilateral Lower Limb Salvage after Fourth-degree Burns: Subscapular Axis Free and Chimeric Flaps Effectiveness in...

Area of Science:

• Plastic Surgery
• Microsurgery
• Burn Reconstruction

Background:

• Fourth-degree burns represent severe traumatic injuries requiring complex reconstructive strategies.
• Microsurgery is crucial for salvaging lower limb defects, especially in extensive burn cases.

Observation:

• A 48-year-old male patient presented with 40% total body surface area flame burns, affecting both lower limbs circumferentially.
• Debridement revealed exposed bone (tibias), medial malleolus, and Achilles tendon, necessitating extensive reconstruction.

Findings:

• A combined latissimus dorsi (LD) and a three-component chimeric subscapular axis free flap (LD, serratus anterior, parascapular) were utilized for bilateral lower limb reconstruction.
• The LD flap covered the left tibia, while the right side reconstruction involved LD for the tibia, serratus anterior for the medial malleolus, and parascapular flap for the Achilles tendon.
• Anatomical variations required complex anastomoses to both proximal and distal posterior tibial vessels for flap viability.

Implications:

• This case demonstrates the efficacy of microsurgical techniques and chimeric flaps in achieving limb salvage for extreme lower limb burn injuries.
• Successful reconstruction led to significant functional recovery, enabling autonomous walking with a single crutch after rehabilitation.
• The study underscores the importance of tailored microsurgical approaches in managing complex burn defects.