Free flap survival despite severe anemia after fourth degree hand burn

Reconstruction of fingers after electrical injury using lateral tarsal artery flap

Objective

Electrical injuries to the fingers account for the majority of total severe burns that occur each year. While several types of flaps have been used in covering finger defects, all have limitations or disadvantages. The purpose of this study was to introduce our clinical experiences of using the lateral tarsal artery (LTA) flap to successfully restore fingers after electrical injury.

Patients and methods

From 2005 to 2012, 10 patients with 14 severe electrical burns to their fingers, including six thumbs and four index and four middle fingers, were treated with LTA flap. The wound size ranged from 2.0×3.0 cm to 3.5×5.0 cm. The flap with free tendon graft was used to repair the tendon defect in four cases, free nerve graft was used to repair the feeling defect in two cases, and the flap with nerve was used to repair the feeling defect in two cases. All the patients were followed up for 3 months to 2 years.

Results

All skin flaps adhered successfully and there were no complications. All patients were satisfied with the esthetic appearance and functional outcome of the finger reconstruction.

Conclusion

LTA flap is a reliable method to restore fingers after severe electrical injuries.

Preoperative anemia impacts early postoperative recovery following autologous breast reconstruction

INTRODUCTION

Preoperative anemia impacts a significant portion of breast reconstruction patients, though this does not appear to affect surgical outcomes. The impact of anemia on postoperative physical and mental health, however, is unknown. This study aimed to prospectively evaluate the role of preoperative anemia in recovery after autologous reconstruction.

METHODS

From 2005 to 2010, we prospectively assessed autologous breast reconstruction patients with satisfaction surveys, strength and functional tests, and the short form 36 (SF36). Data was collected preoperatively and at early (<90d), intermediate (90-365d), and late (>365d) follow-up. We stratified patients by presence or lack of preoperative anemia (hemoglobin<12 g/dL).

RESULTS

Of 399 patients undergoing reconstruction, 179 enrolled in the study. Anemic patients (n = 31, 17%) had higher rates of preoperative chemotherapy (p = 0.02) and lower rates of radiation (p = 0.001). Preoperatively, anemic patients reported worse physical (p < 0.001), mental (p = 0.003) and overall health (p = 0.0003). These scores worsened postoperatively for anemic and nonanemic patients, though anemic patients had lower average scores in all SF36 categories. This was significant only for early follow-up physical health (p = 0.02). Change in SF36 scores and objective physical exam assessments did not differ between the two cohorts.

CONCLUSIONS

Though preoperative anemia may not impact surgical outcomes, it adversely impacts the recovery of breast reconstruction patients. Subjective physical health differences were significant in early follow-up, though this did not translate to differences in mental health or satisfaction. We advocate for preoperative optimization of hemoglobin to enhance the early recovery potential of breast reconstruction patients.