Shoulder reconstruction in a burned patient with Latissimus Dorsi Flap. Clinical Case
DOI:
https://doi.org/10.47464/MetroCiencia/vol29/4/2021/107-112Keywords:
Reconstruction, shoulder, upper limb, latissimus dorsi, electrical burnAbstract
Introduction: Electrical burns are part of a great surgical and reconstructive challenge due to the high rates of morbidity and mortality. In Ecuador, the prevalence is important and affect mostly men. Clinical case: We present the case of a young patient who suffered 10% burned body surface with high voltage electricity; the point of entry was the right hand, which suffered grade III axonotmesis of the ulnar and radial nerve, and the exit point was the left shoulder with a third degree burn, the most affected area. Fifteen surgeries were performed to debride necrotic tissue and use partial thickness grafts for exposed areas. During hospitalization, the patient presented sinus tachycardia, depression, and positive cultures for pseudomonas, receiving wide spectrum antibiotic therapy. Conclusion: As soon as the left shoulder showed granulation tissue, it was decided to use the Latissimus dorsi flap for shoulder reconstruction with excellent functional results, showing the usefulness of this flap in patients with electrical burns.
Downloads
References
Lee DH, Desai MJ, Gauger EM. Electrical Injuries of the Hand and Upper Extremity. Journal of the American Academy of Orthopaedic Surgeons. 2019.
Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res. 2017;
Rubio-Gallegos F, Núñez-González S, Gault C, Simancas-Racines D, Basantes-García E. McGregor inguinal flap for coverage of large soft tissue losses due to high-voltage electrical burns in the upper limb:a retrospective study. Int Burns Trauma. 2019;9(3):52-8
Zikaj G, Xhepa G, Belba G, Kola N, Isaraj S. Electrical Burns and Their Treatment in a Tertiary Hospital in Albania. Open access Maced J Med Sci. 2018 May;6(5):835–8.
Xue-wei W, Jia-ning W, Yung-hua S, Yan-ni L, Nai-ze W, Jia-qi L, et al. Early vascular grafting to prevent upper extremity necrosis after electrical burns. Burns. 1982;
Lee RC, Kolodney MS. Electrical Injury Mechanisms: Dynamics of Thermal Response. Plast Reconstr Surg. 1987;80(5):663–70.
Borghese L, Masellis A, Masellis M. Extremity burn reconstruction. In: Plastic Surgery: Volume 4: Lower Extremity, Trunk, and Burns [Internet]. Fourth Edi. Elsevier Inc.; 2018. p. 435-455.e2. Available from: http://dx.doi.org/10.1016/B978-1-4377-1733-4.00419-5
Hunt JL. Electrical injuries of the upper extremity. Major Probl Clin Surg. 1976;19:72–83.
Antoon AY. Burn Injuries. In: Berhman RE, editor. Nelson Textbook of Pediatrics. 21st ed. Philadelphia; 2020. p. 621–3.
Waldmann V, Narayanan K, Combes N, Jost D, Jouven X, Marijon E. Electrical cardiac injuries: Current concepts and management. Eur Heart J. 2018;39(16):1459–65.
Arnoldo BD, Purdue GF. The Diagnosis and Management of Electrical Injuries. Hand Clin [Internet]. 2009;25(4):469–79. Available from: http://dx.doi.org/10.1016/j.hcl.2009.06.001
Dechent D, Emonds T, Stunder D, Schmiedchen K, Kraus T, Driessen S. Direct current electrical injuries: A systematic review of case reports and case series. Burns [Internet]. 2020;46(2):267–78. Available from: https://doi.org/10.1016/j.burns.2018.11.020
Schneider JC, Qu HD. Neurologic and Musculoskeletal Complications of Burn Injuries. Phys Med Rehabil Clin N Am [Internet]. 2011;22(2):261–75. Available from: http://dx.doi.org/10.1016/j.pmr.2011.01.003
Jain S, Bandi V. Electrical and lightning injuries. Crit Care Clin. 1999;15(2):319–31.
Ho CWG, Yang SH, Wong CH, Chong SJ. High-voltage electrical injury complicated by compartment syndrome and acute kidney injury with successful limb salvage: A case report and review of the literature. Int J Surg Case Rep. 2018;
Tarim A, Ezer A. Electrical burn is still a major risk factor for amputations. Burns. 2013;
Azar FM, James H. Beaty, S. Terry Canale. Campbell’s Operative Orthopaedics, Thirteenth Edition. In: Elsevier. 2017.
Jobe MT. Chapter 63 - Microsurgery [Internet]. Thirteenth. Campbell’s Operative Orthopaedics, 4-Volume Set. Elsevier Inc.; 2019. 3225-3297.e6 p. Available from: http://dx.doi.org/10.1016/B978-0-323-37462-0.00063-X
Sood A, Therattil PJ, Russo G, Lee ES. Functional Latissimus Dorsi Transfer for Upper-Extremity Reconstruction: A Case Report and Review of the Literature. Eplasty. 2017;17:e5.
Pivato G, Gilbert A. Flaps for Upper Limb Reconstruction. Surg Wounds. 2004;217–39.
Jabir S, Frew Q, El-Muttardi N, Dziewulski P. A systematic review of the applications of free tissue transfer in burns. Burns. 2014.
Kesiktas E, Eser C, Gencel E, Aslaner EE, Yavuz M. Reconstruction of transhumeral amputation stumps with ipsilateral pedicled latissimus dorsi myocutaneous flap in high voltage electrical burns. Burns [Internet]. 2015;41(2):401–7. Available from: http://dx.doi.org/10.1016/j.burns.2014.07.011
Muramatsu K, Ihara K, Tominaga Y, Hashimoto T, Taguchi T. Functional reconstruction of the deltoid muscle following complete resection of musculoskeletal sarcoma. J Plast Reconstr Aesthetic Surg [Internet]. 2014;67(7):916–20. Available from: http://dx.doi.org/10.1016/j.bjps.2014.03.018
Wen YZ, Zhang PH, Ren LC, Zhang MH, Zeng JZ, Zhou J, et al. Clinical characteristics and repair effect of 136 patients with electric burns of upper limb. Zhonghua Shao Shang Za Zhi. 2019;
Zhang W, Xie WG, Yang F, Zhang WD, Chen L. [Clinical application of lobulated transplantation of free anterolateral thigh perforator flap in the treatment of electric burns of limbs]. Zhonghua Shao Shang Za Zhi. 2019 Nov;35(11):790–7.
Carroll D. A quantitative test of upper extremity function. J Chronic Dis. 1965;
Makiguchi T, Yokoo S, Kanno Y, Kurihara J, Suzuki K. Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection. J Oral Maxillofac Surg. 2019;
Alhazmi A. Pseudomonas aeruginosa – Pathogenesis and Pathogenic Mechanisms. Int J Biol. 2015;
Downloads
Published
Issue
Section
License
Copyright (c) 2021 Ana Carolina Lizarzaburu Ortiz, Ian Fernando Valdez Crespo, Daniela Domínguez Peralta, María José Flores Reyes, Camila Alejandra Jaramillo Cabezas, Diego Javier Lizarzaburu Bünger
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
