Deep burns of the lower extremities by electric current or other burning agents while the person is unconscious usually results in destruction of skin, subcutaneous fat, muscle, tendon and even bone, and then may progress not only to osteomyelitis or arthritis but also amputation of the extremity in severe cases.
Early surgical debridement and immediate coverage with a well vascularized skin flap, myocutaneous flap or muscle flap critically important for the management of deep burns of the lower extremities. Among numerous type of flaps, a local flap has limitations in its use due to narrow flap size and injured blood vessels. Free myocutaneous flap by microsurgery can furnish large tissues for the coverage of the defect. However, the myocutaneous flap may be too bulky for the defect and the donor site may not be closed directly due to overtension in a wide wounded area. In order to avoid these disadvantages, the muscle flap can be taken after elevation of the skin flap. There is no problem in the closure of the donor site with the elevated skin flap, and the muscle flap can be molded in the recipient site as wanted. The raw muscle surface is covered with a mesh skin graft. By this method, not only a minimal donor site defect is obtained, but also the natural contour of the recipient site is retained. Among many donor muscles, latissimus dorsi muscle is usually selected due to its large flat muscle, easy muscle dissection, lessened functional defects in the donor site, possession of a long and large vascular pedicle, and the possibility of use of an innervated functional flap.
Two cases of deep burns of the lower leg by electric current and contact burn by burning briquet while the victim was overcome by Co intoxication were treated with neurovascular latissimus dorsi free muscle flap transfers and a skin graft over them.
The results were as follows:
1. Natural contour and symmetry of repaired recipient site due to good molding and shaping of the muscle flap to fit the recipient site.
2. The grafted skin over the transferred muscle healed well and provided durable skin surface.
3. No subsequent difficulty in walking.
4. No excessive donor scar, and any minimal deformity was hidden by the brassier in female patients.
5. No shoulder motion limitation.
6. No scapular winging when the arm is stretched or elevated.
7. No need of defatting procedure.
8. Short hospitalization period.
9. No further necrosis of the remaining burned tissues.
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