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Pedicled and Free Flap Lower Extremity Reconstruction in Acute Burn Injuries
Mario Alessandri Bonetti1, Tiffany Jeong, Hilary Y Liu
1From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Annals of Plastic Surgery
|April 10, 2025
Summary
Flap reconstruction for lower extremity acute burns is uncommon but necessary for exposed critical structures. Free flaps have higher complication and total flap loss rates compared to pedicled flaps.
Area of Science:
- Reconstructive surgery
- Burn management
- Lower extremity trauma
Background:
- Limited research exists on flap reconstruction outcomes for acute lower extremity burns.
- Flap coverage is essential for exposed critical structures in these injuries.
Purpose of the Study:
- To compare outcomes of pedicled versus free flap reconstruction in acute lower extremity burns.
- To report complication rates and reoperations associated with these procedures.
Main Methods:
- Retrospective cohort study (August 2010 - December 2022).
- Compared pedicled (n=17) and free flap (n=11) reconstructions.
- Analyzed demographics, injury/flap characteristics, complications, and reoperations using chi-squared tests.
Main Results:
- Free flap group: 54.5% overall complication rate.
- Pedicled flap group: 25.0% overall complication rate.
- Free flaps had significantly higher total flap loss (18.2% vs 0%, P=0.021).
Conclusions:
- Flap coverage for lower extremity acute burns is infrequently used but vital when needed.
- Higher complication rates, particularly flap loss, are associated with free tissue transfer.
- Awareness of these risks is crucial for complex reconstructions.
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