Color Atlas of Burn Reconstructive Surgery (eBook)

Prefaces 5
Contents 9
PART 1: Primary Burn Wound Management 13
CHAPTER 1: Primary Wound Management: Assessment of Acute Burns 14
Introduction 14
Evaluation of the Total Body Surface of the Burns 14
Rule of 9 14
TBSA Following Age 14
Estimation of Burn Depth 14
Clinical Evaluation 15
First Degree 15
Superficial Second Degree 15
Deep Second Degree 16
Third Degree 16
Conclusion 17
CHAPTER 2: Primary Wound Management: Strategy Concerning Local Treatment 18
Introduction 18
Blister Management 18
When to Operate 18
Local Dressings 18
Pain Management 19
Surgery 19
Dermis and/or Skin Substitutes 19
Conclusion 21
CHAPTER 3: Debridement of the Burn Wound 22
Rationale for Debridement 22
Debridement of Blisters 22
Timing of Debridement 23
Technical Considerations 23
Debridement of Hand Burns 24
Debridement in Facial Burns 25
Tangential Excision 25
Fascial Excision 25
Hydrosurgical System Versajet 26
CHAPTER 4: Application of VAC Therapy in Burn Injury 27
Burn Wound Paradigm 27
Subatmospheric Pressure Wound Therapy 28
Summary 28
CHAPTER 5: Use of Vacuum-Assisted Closure (V.A.C.)® and Integra® in Reconstructive Burn Surgery 33
Skin Substitutes 33
Negative Pressure Wound Therapy 33
VAC with Integra 34
CHAPTER 6: ReCell 37
Background of the Technique 37
Characteristics and Indications for Use 37
Specific Skill of the Method 38
Clinical Cases 41
Case 1 41
Case 2: One-Year-Old Patient 43
Case 3 45
Case 4 47
CHAPTER 7: Strategies for Skin Regeneration in Burn Patients 49
Evolution of Burn Treatment 49
Seed vs. Soil Paradigm 49
Understanding Skin Regeneration 49
Current Research and Strategies for Skin Regeneration 51
Future of Regenerative Medicine in Burn Therapy 52
PART 2: Burn Scar Management 53
CHAPTER 8: Diagnosis, Assessment, and Classification of Scar Contractures 54
Diagnosis of Postburn Scar Contractures 54
Assessment and Classification of Postburn Contractures 55
CHAPTER 9: Prevention of Scar Using bFGF 71
Background of the Method 71
Characterization and Indication of the Method 72
Specific Points of the Method 72
Case 1 73
Case 2 75
Case 3 77
Case 4 79
CHAPTER 10: Medical Needling 81
Background of the Technique 81
Topical Adjuncts 81
Needle Depth 82
Characteristics and Indication of the Method 82
Indications for Medical Needling Post-Burn Using the 1-mm Roller 82
Indications for Medical Needling Post-Burn Using the 3-mm Roller 82
Advantages of Medical Needling 83
Disadvantages of Medical Needling 83
Specific Skills of the Method 83
CHAPTER 11: Treatments for Post-Burn Hypertrophic Scars 85
Treatment Strategy of Post-Burn Hypertrophic Scars 85
Partial/Complete Surgical Contracture Releasing 85
Complete Surgical Resection 85
Non-Surgical Multi-Modal Therapy 85
Compression Therapy 86
Gel Sheeting 86
Corticosteroid Injection 86
Laser 89
External Agents 90
Internal Agents 90
Make-Up Therapy/Camouflage Therapy 90
CHAPTER 12: Make-Up Therapy for Burn Scar Patients 91
Background 91
The Method of the Make-Up 91
Massage 91
Foundation 91
Make-Up 92
Clinical Cases 93
Case 1 93
Case 2 95
Meaning of Make-Up Therapy 97
PART 3: Dermal Substitutes/Skin Graft 98
CHAPTER 13: Dermal Substitutes 99
Background of the Technique 99
Double Layer Dermal Substitutes 99
Single Layer Dermal Substitutes 100
Clinical Cases 101
Case 1 101
Case 2 103
Case 3 105
Discussion 107
CHAPTER 14: Acellular Allogeneic Dermal Matrix 108
Introduction 108
Preparation of Acellular Allogeneic Dermal Matrix (ADM) 108
ADM Transplantation with Simultaneous Skin Graft Overlay 108
Clinical Results 108
Discussion and Conclusion 108
Tissue-Engineered Autologous Skin Equivalent (TESE) Based on ADM as the Scaffold 109
Preparation of TESE 109
Clinical Application 110
Clinical Results 110
Histological Examination (Case 1) 114
Discussion and Conclusion 114
CHAPTER 15: Application of Integra.®. in Pediatric Burns 116
Background 116
Integra® 116
Neodermis Generation 116
Advantages and Disadvantages 118
CHAPTER 16: Pediatric Burn Reconstruction 125
Background 125
Selection of Methods 125
Further Advancements 126
Case 1 127
Case 2 129
Case 3 131
Case 4 133
Case 5 135
Case 6 137
CHAPTER 17: Skin Grafting 139
Introduction and Historical Perspective 139
Classification of Skin Grafts 139
Split-Thickness and Full-Thickness Grafts 139
Meshed vs. Sheet Grafts 140
Donor Site Selection and Skin Graft Harvest 144
Skin Substitutes 144
Skin Graft Dressings 144
CHAPTER 18: Skin Graft for Burned Hand 146
Introduction 146
Methods 146
Conclusion 150
CHAPTER 19: Tips for Skin Grafting 151
Introduction 151
Debridement with a Metallic Sponge 151
Creation of Drainage Holes with a Flower holder 151
Skin Grafting by External Wire Frame Fixation 151
Case 1 155
Case 2 157
Case 3 159
Case 4 161
PART 4: Local Flap Method 163
CHAPTER 20: Z-Plasties and V-Y Flaps 164
Z-Plasties 164
Conventional Z-Plasties 164
Modified Planimetric Z-Plasties 164
Continuous Planimetric Z-Plasties 164
Case 1 166
V-Y Flaps and Their Analogs 168
V-Y Flaps with Burow’s and Inverted Burow’s Triangle Excisions 168
Double V-Y Flaps 168
V-Y Flaps with Transposition Flaps 168
Application of the Comprehensive Classification of V-Y Flaps and Their Analogs 168
Case 3 174
CHAPTER 21: Use of Z-Plasty in Burn Reconstruction 176
Background of the Technique 176
Characteristics and Indication of the Method 176
Specific Skill of the Methods 177
Clinical Cases 178
Case 1: Axillary Contracture 178
Case 2: Neck Contracture 180
CHAPTER 22: Local Flaps for Burned Face 182
Principles in Facial Burn Reconstructions 182
Resurfacing 182
Contracture Release 182
Contour Restoration 185
Restoration of Hair-Bearing Tissue 185
Secondary Sculpting of Free Tissue Transfer with Local Flaps 188
CHAPTER 23: The Square Flap Method 189
Background of the Technique 189
Characteristics and Indication of the Method 189
Specific Skills of the Method 189
Mathematical Theory 189
Geometrical Theory 189
Computer-Aided Analysis 189
Clinical Cases 193
Case 1 193
Case 2 : Anterior Neck Reconstruction 195
Case 3 197
Case 4 199
CHAPTER 24: Propeller Flap and Central Axis Flap Methods 201
Background of the Technique 201
Characteristics and Specific Skills of the Method 201
Propeller Flap Method 201
Multilobed Propeller Flap Method 201
Clinical Cases 203
Case 1 203
Case 2 205
Case 3 207
Case 4 209
CHAPTER 25: Facial Reconstruction 211
Introduction 211
Principles of Burn Facial Reconstruction 211
Management of Superficial to Mid-Dermal Burns 211
Management of Deep Dermal and Full-Thickness Burns 212
PART 5: Expanded Flap, Prefabricated Flap and Secondary Vescularized Flap 221
CHAPTER 26: The Expanded Transposition Flap for Face and Neck Reconstruction 222
Background of the Technique 222
Characteristics and Indication for the Technique 222
Specific Skills of the Method 222
Clinical Cases 226
Case 1 226
Case 2 228
CHAPTER 27: Expanded Thin Flap 232
Background of the Technique 232
Characteristics and Indication of the Method 232
Specific Skills of the Methods 232
Case 1: Expanded Random-Pattern Flap 234
Case 2: Expanded Perforator Flap 236
Case 3: Expanded Prefabricated Flap 238
CHAPTER 28: Tissue Expansion for Burn Reconstruction 242
Background 242
Basic Principles of Tissue Expansion in Burn Reconstruction 242
Case 1 244
Case 2 248
Case 3 250
CHAPTER 29: Scalp Alopecia Reconstruction 252
Background 252
Scalp Anatomical Characteristics 253
Specific Skill of the Methods 253
Case 1 254
Case 2 256
Case 3 258
Case 4 260
CHAPTER 30: Nasal Reconstruction 262
Background of Nasal Reconstruction 262
Indications Considered 262
Characteristics of Nasal Burn 263
Specific Maneuvers of the Methods 263
Case 1 266
Case 2 268
Case 3 270
CHAPTER 31: Ear Reconstruction 272
Introduction 272
Characteristics of Our Technique 272
Operative Procedure 273
Case 1 274
Case 2 276
CHAPTER 32: Reconstruction in Pediatric Burns 278
Introduction 278
Hair Restoration for Scalp and Eyebrow in Pediatric Burns 278
Facial Reconstruction in Pediatric Burns 279
Axillary Reconstruction in Pediatric Burns 281
Chest Including Breast Reconstruction in Pediatric Burns 282
Hand Reconstruction in Pediatric Burns 285
Neck Reconstruction in Pediatric Burns 287
Aftercare Including Nursing and Physiological Therapy (PT) in Pediatric Burn Reconstruction 288
Summary 289
CHAPTER 33: Secondary Vascularized Flap 290
Background of the Technique 290
Characteristics and Indication of the Method 290
Characteristics 290
Indications 290
Specific Steps of the Method 290
Selection of Vascular Bundle 290
Wrapping Method of the Vascular Bundle 290
Application of Free Vascular Bundle Transfer to Engineered Tissue Transplantation 291
Clinical Cases 292
Case 1 : Bilateral Eyebrow Reconstruction 292
Case 2 : Upper Lip Reconstruction in Male 294
Case 3 : Hemilateral Eyebrow Reconstruction in Female 296
Case 4 : Upper Lip Reconstruction in Male 298
Case 5 : Contralateral Eyebrow Reconstruction in Male 300
CHAPTER 34: Prefabricated and Prelaminated Flaps 302
Background of the Technique 302
Indications 302
Operative Technique for Prefabrication 302
Stage 1: Implantation of Vascular Pedicle 302
Stage 2: Transfer of Flap 304
Operative Technique for Prelamination 304
Stage 1: Introduction of Tissue 304
Stage 2: Flap Transfer 304
Later Stages-Secondary Refinements 304
Clinical Cases 306
Case 1 306
Case 2 308
Case 3: Prelamination 310
CHAPTER 35: Prefabricated Facial Flaps 312
Introduction 312
Technique 312
Results 312
Case 1 314
Case 2 316
Case 3 318
PART 6: Regional Flap and Thin Flap 320
CHAPTER 36: Scarred Flap 321
Background of the Technique 321
Characteristics and Specific Skills of the Method 321
Clincal Cases 323
Case 1 : Axillary Reconstruction 323
Case 2 : Axillary Reconstruction 325
Case 3 : Ankle Joint Reconstruction 327
Case 4 : Ankle Joint Reconstruction 329
CHAPTER 37: Use of Previously Burnt Skin in Local Fasciocutaneous Flaps 331
Background of the Technique 331
Characteristic and Indication of the Method 331
Specific Skill of the Methods 332
Clinical Cases 333
Case 1 333
Case 2 335
Case 3 337
CHAPTER 38: Supraclavicular Flap 339
Background of the Technique 339
Anatomical Characteristics and Indication 339
Specific Skill of the Method 339
Case 1 341
Case 2 343
CHAPTER 39: Superficial Cervical Artery Perforator (SCAP) Flap 345
Introduction 345
Characteristics of the SCAP Flap 345
Tips for Harvesting Flaps 345
Case 1 : Vascular Pedicled SCAP Flap 347
Case 2 : Cutaneous Pedicled SCAP Flap 349
Case 3 : Musculocutaneous Pedicled SCAP Flap 351
Case 4 : Circumflex Scapular Vessels Supercharged SCAP Flap 353
Case 5 : Dorsal Intercostal Perforator Supercharged SCAP Flap 355
CHAPTER 40: Super-Thin Flap 357
Background of the Technique 357
Characteristics of the Method 358
Specific Skill of the Methods 358
Clinical Cases 359
Case 1 359
Case 2 361
Case 3 363
Case 4 365
Case 5 367
CHAPTER 41: Super-Thin Flaps 369
Background of the Technique 369
Classification 369
Special Skills of the Method 369
Clinical Cases 371
Case 1 371
Case 2 373
Case 3 375
PART 7: Free Flap and Perforator Flap 377
CHAPTER 42: Anterolateral Thigh Flap for Reconstruction of Soft-Tissue Defects 378
Background of the Technique 378
Anatomy and Location of Perforators 378
Surgical Techniques 378
Advantages and Disadvantages 379
Case Reports 382
Case 1 (Fig. 42.3) 382
Case 2 (Fig. 42.4) 384
Case 3 (Fig. 42.5) 386
CHAPTER 43: Free Muscle Flaps for Lower Extremity Burn Reconstruction 388
Background 388
Free Muscle Flaps for Lower Extremity Burn Reconstruction 388
Case 1 390
Case 2 394
Case 3 396
CHAPTER 44: Prepatterned, Sculpted Free Flaps for Facial Burns 398
Background 398
Advantages of Prepatterned, Sculpted Free Flaps 398
Steps in Aesthetic Restoration of the Burned Face 399
Technique 399
Case 1 402
Case 2 404
Case 3 406
CHAPTER 45: The Deltopectoral Free Skin Flap: Refinement in Flap Thinning, Pedicle Lengthening, and Donor Closure 408
Background of the Technique 408
Characteristics and Indication of the Method 408
Special Skill of the Methods 408
Case 1 410
Case 2 412
Case 3 414
CHAPTER 46: Shape-Modified Radial Artery Perforator (SM-RAP) Flap for Burned Hand Reconstruction 416
Background of the Methods 416
Specific Skill of the Methods 416
Clinical Cases 418
Case 1 418
Case 2 420
Case 3 422
Case 4 424
Case 5 426
CHAPTER 47: The Radial Artery Perforator-Based Adipofascial Flap for Coverage of the Dorsal Hand 428
Introduction 428
Anatomical Considerations 428
Anterior Aspect of the Forearm 428
Posterior Aspect of the Forearm 429
Operating Technique 429
Clinical Cases 430
Case 1 430
Case 2 432
CHAPTER 48: Microdissected Thin Flaps in Burn Reconstruction 434
Background of the Technique 434
Operative Procedure 434
Developments and Indications of the Method 435
Case 1 436
Case 2 440
CHAPTER 49: Perforator Pedicled Propeller Flaps 442
Background of the Technique 442
Definitions and Classifications of the Propeller Flap 442
Definition 442
Classification 442
Subcutaneous Pedicled Propeller (SPP) Flap 442
Perforator Pedicled Propeller (PPP) Flap 442
Muscle Pedicled Propeller (MPP) Flap 442
Perforator-Supercharged (PS) Propeller Flap 442
Specific Steps of the Method 442
Clinical Cases 444
Case 1: Posterior Tibial PPP Flap 444
Case 2: Facial Artery PPP Flap 446
Case 3: Radial Artery PPP Flap 448
Case 4: Dorsal Pedis Artery PPP Flap 450
CHAPTER 50: Perforator Supercharged Super-Thin Flap 452
Background of the Technique 452
Characteristics and Indications of the Method 452
Specific Skill of the Methods 452
Clinical Cases 454
Case 1: Super-thin Flap using dorsal intercostal perforator and circumflex scapular vessels 454
Case 2: Super-thin Flap using Circumflex Scapular Vessels 456
Case 3: Super-thin Flap using Dorsal ­Intercostal ­Perforator and Circumflex Scapular Vessels 458
Case 4: Super-thin Flap using Pectoral ­Intercostal Perforator 460
CHAPTER 51: Perforator Supercharged Super-Thin Flap 462
Background 462
Supercharged Occipito-Cervico-Dorsal (OCD) “Super-Thin Flap” 462
Indication 462
Technique 462
Tips 462
Clinical Cases 464
Case 1 464
Case 2 466
Case 3 468
CHAPTER 52: Extended Scapular Free Flap for Anterior Neck Reconstruction 470
Background of the Technique 470
Characteristics and Indication of the Method 470
Specific Skills of the Methods 471
Clinical Cases 472
Case 1 472
Case 2 474
Case 3 476
References 478
Index 494