The Need for Flaps in Burn Surgery

Background: Due to the improvement of surgery and intensive care more and more patients survive even severe burn injuries. Therefore we have to pay attention not only to survival alone but also to the achievement of a good quality of life. Thereby, one of the most important aspects is sufficient tissue coverage. After appropriate debridement functionally important structures may be exposed. Therefore, these areas require more than split skin coverage. These cases necessitate flap coverage for preservation of function or, respectively, limb salvage. In secondary reconstruction flaps are commonly used for scar revision. The aim of this study is to give more detailed information about the need for flaps in burn surgery. Patients and Methods: All burn patients of our burn centre who received free or local flap coverage between January 1997 and February 2008 were analysed retrospectively. We evaluated the following parameters: indication (acute or late), flap type (pedicled or free flap), localisation, cause of accident and complication rate. Small local flaps like Z-plasties have been excluded. Results: 45 patients have been included into this study. They received 53 flaps. In 53% the cause of accident was flame, in 22% scald and in 24% electrical burn, whereby electrical burn injuries most frequently required flap coverage related to their incidence. Most of the flaps have been performed for primary reconstruction. More than half of all flaps have been used for the upper extremity, concerning just the hand in 36%, 19% for the lower extremity, 15% for the trunk and 11% for the head. There have been three total flap failures during the study period. In all other cases we reached good results. Two of these flap failures occurred during the vulnerable phase between the 6th and the 21st day after trauma. Conclusion: Limb salvage was the dominant indication for primary reconstruction compared to the improvement of function and aesthetics for secondary reconstruction. The timing of reconstruction has an important influence on the flap outcome and has to be considered when the decision for reconstruction is made. So, if possible, the period between the 6th and the 21st day should not be chosen for flap coverage.