Arch Hand Microsurg.  2019 Dec;24(4):381-387. 10.12790/ahm.2019.24.4.381.

Salvage Procedure of a Lower Leg in a Contact Burn: Latissimus Dorsi Muscle Free Flap and Scalp Skin Graft

• Oh SJ
• Moon D

• KMID: 2464475
• DOI: http://doi.org/10.12790/ahm.2019.24.4.381

Abstract

Intentional carbon monoxide (CO) poisoning has become rapidly increased occurrence, also if the surviving patient is burnt and unconscious, the patient's burn wound is likely to be severely deep and to need flap surgery. A 44-year-old female patient suffered from a deep contact burn to the left posterior lower leg during intentional CO poisoning. The patient underwent escharotomy and treatment with a latissimus dorsi muscle neuro-vascularized free flap and scalp skin grafts. While harvesting 0.008 inches (300 cm²) of the scalp skin, some 25 cm² of the skin was accidentally harvested as a thick split-thickness skin graft (SSG) from the right occipital scalp. Interfollicular epidermal and dermal regeneration was achieved at eleven days postoperatively at the thick SSG donor site. The patient's deep burn wound was reconstructed by two staged surgeries. The patient was able to walk with the help of a supportive shoe one year postoperatively.

Keyword

Poisoning; Burn; Free tissue flap; Scalp; Transplant

MeSH Terms

Adult
Burns*
Carbon Monoxide
Female
Free Tissue Flaps*
Humans
Leg*
Poisoning
Regeneration
Scalp*
Shoes
Skin*
Superficial Back Muscles*
Tissue Donors
Transplants*
Wounds and Injuries
Carbon Monoxide

Figure

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  Fig. 1 Fasciotomy of a severe burn wound involving the deep muscles of the posterior aspect of the left lower leg.

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  Fig. 2 Water-fat saturated T1-weighted magnetic resonance imaging of the proximal 1/3 of the left lower leg showing the border of the muscle damage marked with arrowheads.

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  Fig. 3 Neuro-vascular microanastomosis area showing a latissimus dorsi muscle flap.

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  Fig. 4 Thick skin graft with a histological thickness of 0.035 inches harvested at an incorrect depth setting (H&E, ×40).

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  Fig. 5 Scalp wound of the 0.035-inch-thick split-thickness skin graft donor site in the right occipital area showing complete epithelization 11 days after surgery.

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  Fig. 6 Re-exploration of the wound showing granulation tissue under the surface of the free flap, residual damaged muscle in the anterior compartment and exposed fibular bone 64 days after the first surgery.

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  Fig. 7 Regenerated tissue of the deep donor wound 64 days after surgery (H&E, ×12.5); arrowheads mark the border between residual reticular and regenerated fibrotic tissue.

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  Fig. 8 The inconspicuous scar-less healing of scalp donor sites harvested with thick split-thickness skin one year after surgery.

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  Fig. 9 The reconstructed contour of the posterior aspect of the left leg one year after surgery.

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  Fig. 10 Full flexion appearance of the lateral aspect of the left knee one year after surgery.

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