Satyajit Sahu1, A. K. Choudhary2, B. B. Nayak3, P. R. Singh4
INTRODUCTION: Post electric burn defects are difficult to manage due to deep injury involving all the structures up to bony level. A good vascularized flap is required to resurface the defect for preventing the complication and for reconstruction of involved structures.
AIM: Resurfacing the post electric burn defect with different flaps according to need of the defect.
MATERIAL AND METHOD: All patients of electric burn hand and fore arm defect admitted to burn, plastic and reconstructive department of SCB Medical College &hospital, Cuttack between January 2012 to December 2012 were included in the study. During this period the patients were followed up at weekly interval for first 2 month, then at 1 monthly interval for next 6-8 month. OBSERVATION: Out of 40 cases of post electric burn forearm and hand reconstruction, 10 cases underwent groin flap cover, 6 cases underwent abdominal flap cover, 5 cases underwent cross finger flap cover 5 cases underwent free anterolateral thigh flap cover, 4 cases underwent free latissimus dorsi flap cover, 5 cases underwent first dorsal metacarpal artery flap cover, 5 cases reverse radial forearm flap cover. All the defects were resurfaced successfully with flaps. Four had marginal necrosis and six had wound infection. Eventually all flaps settled well without further intervention. Due to involvement of all important tendons & nerves, functional outcome is guarded.
DISCUSSION: Hand and forearm are most commonly and most severely affected in electric burn injury because they are mostly first part of body to come in contact with electric circuit. Even though at initial part the injury appears to be superficial, deeper structures like bone, tendon and neurovascular bundles are affected requiring flap cover for future reconstruction of these structures to get functional and sensate hand.
CONCLUSION: Reconstruction of post electric burn defect of distal forearm and hand represents great challenge due to depth of injury involving full thickness of skin and other structures like neurovascular bundle and bones and tendons. Choice depends on size of defect, availability of local or regional tissue, patient’s acceptance and cooperation.
