Secondary burn reconstruction: recent advances with microvascular free flaps, regional flaps, and specialized grafts

A representative series of cases are presented which demonstrate secondary reconstructive plastic surgery procedures for the burn victim utilizing microvascular free flaps, regional flaps, and specialized skin grafts. The unstable burn scar of the lower extremity could be managed either by a microvascular free-flap transfer, a muscle transfer, a myocutaneous flap transfer, or a reverse dermis graft, or overgrafting. In the present day, there are many treatment modalities available to us. Long-term wearing of the Jobst pressure stocking is essential in many cases to minimize the hypertrophic burn scar. In our experience, Kenalog injection into a hypertrophic burn scar always has resulted in improvement of the condition although it is usually necessary to give multiple injections into the hypertrophic burn scar at eight week intervals. We have never known Kenalog to fail to improve a hypertrophic scar by flattening it out to a significant extent, but it may take a year or more of injections to accomplish this goal. Microvascular surgery is most definitely a team effort requiring at least two fully trained microvascular surgeons, plus experienced operating room personnel. One microvascular surgeon harvests the free flap, and the other microvascular surgeons prepares the recipient area. Both microvascular surgeons participate in the multiple anastomoses that are required. A microvascular laboratory is essential to the success of a microvascular team, and constant practice is mandatory to maintain and enhance these precision skills. The primary burn surgeon ideally must always keep in mind ways to minimize functional and aesthetic deformity and to continue to improve the quality of life of the burn victim.