title: Microsurgery in the burn population - a review of the literature.
abstract: The management of patients suffering from burn injury poses unique challenges for the reconstructive surgeon, both in the acute and delayed settings. Once resuscitative measures are optimized and hemodynamic stability is achieved, early burn debridement and coverage is performed. Traditionally, this consists of excision of devitalized tissue and subsequent coverage using split thickness skin grafts. However, in certain instances, and depending on the extent and nature of the burn injury, skin grafting (or even local tissue rearrangement) may not be a reasonable option. in these cases, free tissue transfer may provide a viable reconstructive alternative. While free flap reconstruction is rare in burn surgery, particularly in the acute setting, burn injuries that expose vital structures, such as tendon, nerve, bone, or deep vessels, require robust flap coverage. in the delayed setting, unsightly scar formation and contracture often occurs secondary to skin graft coverage. These significant patient morbidities are often amenable to free tissue transfer as well. This review article discusses the indications, applications, and problems with free flap surgery for burn injuries in both the acute and delayed setting, and summarizes the available literature on microsurgical free tissue transfer for burn management.
authors.affiliation: Division of Plastic Surgery, American University of beirut medical Center, beirut, Lebanon.
authors.forename: A E
authors.initials: AE
authors.lastname: Ibrahim
authors.affiliation: Department of Plastic Surgery, The ohio State University, Columbus, USA.
authors.forename: R
authors.initials: R
authors.lastname: Skoracki
authors.affiliation: Division of burn Surgery, massachusetts General hospital, harvard medical School, boston, massachusetts, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Goverman
authors.affiliation: Department of Surgery, University of Toledo College of medicine, Toledo, ohio, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Sarhane
authors.affiliation: The University of Texas medical School at houston, houston, Texas, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Parham
authors.affiliation: Division of Plastic Surgery, American University of beirut medical Center, beirut, Lebanon.
authors.forename: G
authors.initials: G
authors.lastname: Abu-Sittah
authors.affiliation: Division of Plastic Surgery, American University of beirut medical Center, beirut, Lebanon.
authors.forename: I
authors.initials: I
authors.lastname: Kaddoura
authors.affiliation: Division of Plastic Surgery, American University of beirut medical Center, beirut, Lebanon.
authors.forename: B S
authors.initials: BS
authors.lastname: Atiyeh
keywords: acute burn coverage; burn reconstruction; delayed burn management; end-to-end anastomosis; end-to-side anastomosis; flap failure; free tissue transfer; microsurgery; split thickness skin graft