Pedicled and Free Flap Lower Extremity Reconstruction in Acute Burn Injuries

A paucity of studies investigates the outcomes of flap reconstruction in lower extremity acute burns. The aim of this study is to report outcomes of lower extremity acute burn requiring pedicled or free flap coverage.

A retrospective cohort study was conducted to compare the outcomes of patients undergone pedicled versus free flap reconstruction of acute lower extremity burns, between August 2010 and December 2022. Collected data included demographics, injury and flap characteristics, complications, and reoperations. χ 2 tests were used to measure differences in complication rates between pedicled and free flaps.

A total of 28 patients were involved in the study. Among them, 17 patients underwent 28 pedicled flap procedures, while 11 patients received a single free flap surgery each. In the free flap group, the overall complication rate was 54.5%. In the pedicled flap group, the overall complication rate was 25.0%. Free flaps showed a significantly higher rate of total flap loss compared to pedicled flaps (18.2% vs 0%, P = 0.021). Other differences were not statistically significant.

Flap coverage in lower extremity acute burns is rarely employed. Yet, in case of critical structures exposure it is often necessary. However, it is important to be aware of the high risk of complications, especially for more complex reconstructions requiring free tissue transfer.