Use of previously burned skin in local fasciocutaneous flaps for upper extremity reconstruction

Thermal injuries are characterized by varying degrees of damage to the skin and underlying structures. In the vast majority of patients, the initial thermal injury is limited to the skin and subcutaneous fat. The underlying fascia and its vasculature usually are spared. Flaps are required to cover nongraftable wounds (exposed tendon, bone, joints, and so on) and also are used to release joint and web space contractures. Contrary to frequent opinion, previously burned skin or skin-grafted fascia can safely be used as fasciocutaneous flaps when necessary. We present our series of burned patients in whom local flaps originating from within the burned area were used, avoiding the need for more distant or free flaps to accomplish appropriate wound coverage. This series consists of 40 fasciocutaneous flaps in 22 patients. The flaps included lateral arm (4), posterior interosseous (7), radial forearm (4), ulnar forearm (2), metacarpal (3), and digital (20).