Arch Hand Microsurg.  2023 Sep;28(3):194-198. 10.12790/ahm.23.0012.

Reconstruction of extreme post-burn scar contracture of the ankle using a thoracodorsal artery perforator flap: a case report

• Park SH
• Chang LS
• Kim HS
• Park SO
• Kim YH

• KMID: 2545530
• DOI: http://doi.org/10.12790/ahm.23.0012

Abstract

Post-burn scar contracture associated with deep second-degree or higher burns in the joint area can lead to joint immobility and may cause chronic ulcers, substantially impacting patients’ quality of life. Surgical intervention is necessary, with local flaps or skin grafts being the first option. In extreme cases, free flap transfer may be required to address large defects that occur after contracture release. This study presents a successful case of reconstruction using free flap transfer in a patient with severe post-burn scar contracture, which resulted in a club-like deformed ankle with a nonfunctional joint. Despite the extreme deformity and nonfunctioning joint, we utilized a thoracodorsal artery perforator flap to stably cover the newly fused joint in a neutral position. After reconstruction, the patient was able to wear shoes and ambulate. This case highlights the potential of free flap transfer even in the most challenging situations where joint function is severely compromised.

Keyword

Ankle; Scar contracture; Perforator flap; Arthrodesis

Figure

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  Fig. 1. 58-year-old male patient with hyper-dorsiflexion of the ankle joint and repeated ulceration and healing due to inadequate medical services, resulting in total fusion of the ankle joint, presented to the clinic. Preoperative clinical photograph presenting a frontal view (A), lateral view (B), foot anteroposterior X-ray (C), and foot lateral X-ray (D).

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  Fig. 2. Computed tomography angiography revealed preserved patency of the right anterior tibial artery, posterior tibial artery, and peroneal artery at the ankle level (red arrow).

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  Fig. 3. (A) An immediate preoperative clinical photograph showed walking impairment and chronic ulceration in the ankle. (B) The orthopedic surgery team performed talonavicular joint capsulectomy and arthrodesis with a Kirschner wire in the neutral position. (C) A thoracodorsal artery perforator flap with a long axis of 20 cm, short axis of 10 cm, and pedicle length of 8 cm was elevated. (D) An immediate postoperative clinical photograph showed a stable ankle joint without any acute complications.

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  Fig. 4. Thoracodorsal artery perforator flap reconstruction of the ankle was performed, and no complications were observed during the 18-month follow-up period. (A) Long-term postoperative clinical photograph showing a medial view. (B) X-ray. (C) The patient was able to bear weight and wear shoes.

Reference

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