Pre-expanded thin DIEP free flap in pediatric upper extremity reconstruction for burn sequelae: A case report

Area of Science:

• Plastic Surgery
• Microsurgery
• Pediatric Burn Reconstruction

Background:

• Reconstructing deep burn sequelae of the upper limb presents significant surgical challenges, particularly in pediatric patients.
• Limited local reconstructive options and compromised donor sites complicate these cases.
• Free flap reconstruction is often hindered by small recipient vessel diameters and vasospasm risk.

Observation:

• A 13-year-old girl with severe retractile sequelae of the left upper limb, including wrist immobilization, hyper-extension, ulnar deviation, and ulno-carpal dislocation, was treated.
• A two-stage reconstruction was performed, beginning with the placement of two subfascial kidney-shaped expanders in the hypogastric region.
• After four months of bi-weekly expansion, scar tissue excision and free deep inferior epigastric artery perforator (DIEP) flap transfer were completed.

Findings:

• The pre-expanded free DIEP flap transfer resulted in satisfactory aesthetic and functional outcomes at the 12-month follow-up.
• The reconstruction achieved good contour restoration and regained wrist mobility.

Implications:

• This case demonstrates the efficacy of a pre-expanded free DIEP flap in managing complex pediatric upper limb burn sequelae.
• The two-stage approach, incorporating tissue expansion, offers a viable solution for challenging reconstructions where local tissues are compromised.
• Successful functional and aesthetic restoration highlights the potential of advanced microsurgical techniques in improving patient outcomes.