Reverse posterior interosseous flap for defects of the dorsal ulnar wrist using previously burned and recently grafted skin
Baylan JM, Chambers JA, McMullin N, Fletcher JL, Sinha I, Lundy J, King BT, Chan RK (2015) · Burns · n=3
Studienprofil
- Design
- case series of 3 severely burned patients (35-83% TBSA) requiring dorsal ulnar wrist defect coverage (US Army Institute of Surgical Research, San Antonio)
- Stichprobengröße (n)
- 3
- Intervention
- Reverse posterior interosseous artery flap (PIF) reconstruction using previously burned/recently grafted skin; one patient required postoperative leech therapy for venous congestion
- Komparator
- Standard PIF using fresh non-burned skin (historical literature)
- Primärer Endpunkt
- Feasibility of PIF using previously burned and recently grafted skin for dorsal ulnar wrist defect coverage
- Primäres Ergebnis
- Two of three PIF cases succeeded; bilateral PIF case (83% TBSA) required leech therapy for postoperative venous congestion and ultimately successful; one case failed due to deeper injury extending into the posterior interosseous artery
- Follow-up-Dauer
- Postoperative healing through reconstruction completion
- PMID
- 26652146
Wichtigste Ergebnisse
- Bilateral PIF using previously burned/grafted skin feasible
- Leech therapy successfully rescued venous congestion in 83% TBSA case
- Two of three flaps survived
- Donor flap scarcity in massive burn patients motivates novel approaches
- Vigilance for early venous congestion essential
Einschränkungen
- Only 3 cases - hypothesis-generating
- Single US Army Burn Center experience
- One total failure highlights inherent risk in burned tissue
- Cannot quantify leech contribution to overall salvage
- Cannot generalize beyond severe burn population
Klinische Implikationen
Baylan 2015 extends K040187 leech therapy indication into severe burn reconstruction where donor flap scarcity necessitates use of previously burned/grafted skin. For US clinicians and combat casualty surgeons, the US Army Burn Center series demonstrates leech therapy's utility as rescue therapy in marginal-perfusion burned-tissue flaps, with the caveat that fundamental vascular insufficiency cannot be salvaged.
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