A 10-Year Single-Burn Center Review of Free Tissue Transfer for Burn-Related Injuries

Skin grafting is the mainstay treatment in burn patients. However, in the scenario of soft tissue deficit along with exposure of critical structures, free flap is the only reconstructive option to provide adequate coverage. The aim of the study is to review indications and surgical outcomes of burn patients requiring free tissue transfer. A retrospective cohort study was conducted to review all patients who underwent free tissue transfer for burn-related injuries between March 2012 and June 2023. A total of 13 patients required a free flap for their reconstruction. Eleven flaps were performed during the acute care and 2 were performed for delayed reconstruction. Patients were 69% males and 31% females, with a mean age of 45.5 ± 16 years and a mean BMI of 25.4 ± 6.5. The mean follow-up was 13.5 ± 13.9 months. Indications for free tissue transfer were bone exposure (92%) and severe neck burn contracture (8%). Overall complications rate was 54%. Complications included free flap loss (15%), hematoma (15%), vein thrombosis of the anastomosis (15%), infection (8%), amputation (8%), and wound healing issues (23%). Overall, 38% of the patients required re-operations including venous anastomosis revision, hematoma evacuation, debridement, skin grafting, and debulking. Although sometimes free flap remains the only reconstructive option in severe burn-related injuries, it is only rarely used. However, they carry a high risk of complications and should be considered only as the last resort for limb or life-threatening situations.