TY - JOUR

T1 - Autologous Breast Reconstruction Using a Tensor Fascia Lata/Anterior Lateral Thigh-Freestyle Flap After Extensive Electric Burn

T2 - A Case Report

AU - Boehm, Dorothee

AU - Bergmeister, Konstantin

AU - Gazyakan, Emre

AU - Kremer, Thomas

AU - Kneser, Ulrich

AU - Schmidt, Volker J

PY - 2018

Y1 - 2018

N2 - AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh.METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury. The burn occurred at the age of 9 years, and during the initial treatment, the right breast required amputation because of deep, full-thickness burn. Because the rigid and instable scar including chronic wound developed and an implant-based breast reconstruction was not feasible, the choice of possible free flaps was limited to the right lateral/proximal thigh. Preoperative computed tomography angiography demonstrated 2 intact perforators branching off the lateral femoral circumflex artery and a combined 17 × 24-cm tensor fascia lata/anterior lateral thigh perforator flap with in-flap anastomosis was transferred to the right breast after wound debridement and histological exclusion of Majolin ulcer in the instable scar. The internal mammary vessels were chosen as recipient vessels, and the donor site was covered with a split-thickness skin graft.RESULTS: The postoperative course was uneventful at the right breast; however, the recipient site healed secondarily at the proximal pole. The resulting breast asymmetry was corrected by lipofilling of the central zone of the reconstructed breast and new definition of the inframammary fold as well as a minor liposuction at the cranial margin of the flap. The patient was very satisfied with the result, and no further correction was necessary.CONCLUSIONS: Autologous breast reconstruction is a valuable option for patients after severe burn injury. However, microsurgical expertise and an individualized and flexible surgical strategy are required for optimal reconstructive results. Computed tomography angiography is helpful for preoperative planning of the procedure.

AB - AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh.METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury. The burn occurred at the age of 9 years, and during the initial treatment, the right breast required amputation because of deep, full-thickness burn. Because the rigid and instable scar including chronic wound developed and an implant-based breast reconstruction was not feasible, the choice of possible free flaps was limited to the right lateral/proximal thigh. Preoperative computed tomography angiography demonstrated 2 intact perforators branching off the lateral femoral circumflex artery and a combined 17 × 24-cm tensor fascia lata/anterior lateral thigh perforator flap with in-flap anastomosis was transferred to the right breast after wound debridement and histological exclusion of Majolin ulcer in the instable scar. The internal mammary vessels were chosen as recipient vessels, and the donor site was covered with a split-thickness skin graft.RESULTS: The postoperative course was uneventful at the right breast; however, the recipient site healed secondarily at the proximal pole. The resulting breast asymmetry was corrected by lipofilling of the central zone of the reconstructed breast and new definition of the inframammary fold as well as a minor liposuction at the cranial margin of the flap. The patient was very satisfied with the result, and no further correction was necessary.CONCLUSIONS: Autologous breast reconstruction is a valuable option for patients after severe burn injury. However, microsurgical expertise and an individualized and flexible surgical strategy are required for optimal reconstructive results. Computed tomography angiography is helpful for preoperative planning of the procedure.

KW - Breast/injuries

KW - Burns, Electric/surgery

KW - Debridement

KW - Fascia Lata/transplantation

KW - Female

KW - Free Tissue Flaps/blood supply

KW - Humans

KW - Mammaplasty/methods

KW - Thigh

U2 - 10.1097/SAP.0000000000001429

DO - 10.1097/SAP.0000000000001429

M3 - Journal article

C2 - 29537997

VL - 80

SP - 503

EP - 506

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 5

ER -