Innovation of CRAM Flap for Reconstruction of High-Voltage Electrical Burn Injuries – Case Series

  • Bertha Kawilarang Department of Plastic Reconstructive and Aesthetic Surgery, Prof. dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia
  • I Nyoman Putu Riasa Department of Plastic Reconstructive and Aesthetic Surgery and Burn Unit, Prof. dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia https://orcid.org/0000-0002-5826-8195
DOI: https://doi.org/10.5937/scriptamed55-51664
Keywords: Myocutaneous flap, Rectus abdominis, Electric injuries, Burns, electric, Skin transplantation

Abstract


Electrical burns cause devastating injury with major soft tissue loss and pose a major threat to life. The damage caused by electrical injuries can extend to deeper tissues, causing exposed soft tissues such as tendon and nerve. The rectus abdominis muscle is a donor of musculocutaneous flap due to the well-known blood supply and high vascularity. The rectus abdominis pedicled flap can be either performed transversely or vertically oriented. The drawback of both of these techniques is the insufficient coverage particularly when used for wide or circular defects. Crescent-shaped rectus abdominis musculocutaneous (CRAM) flap is an innovation that is intended to be used for coverage of circumferential defects with extensive soft tissues exposed as can be seen in the defect caused by electric burn injury. In this paper, cases of high-voltage electrical injury at different anatomical regions which were successfully reconstructed with CRAM flap are presented. Overall, CRAM flap was a reliable flap resulting in well-vascularised soft tissue coverage and acceptable functionality.

 

References

Khandelwal S. An abdominal flap to save the right forearm and the hand, following a high-voltage electric burn in a child: a case report. J Clin Diagn Res 2013;7(7);1473-5. doi: 10.7860/JCDR/2013/5208.3166.

Eser C, Kesiktas E, Gencel E, Kokacya O, Yavuz M, Kerimov R. Algorithms of flap reconstruction in high-voltage electrical injuries: 26 years experience. Trauma Cases Rev 2015;1(1);1-8. doi: 10.23937/2469-5777/1510001.

Waldmann V, Narayanan K, Combes N, Marijon E. Electrical injury. BMJ. 2017 Apr 12;357:j1418. doi: 10.1136/bmj.j1418.

Elfiah U, Suryani DY. Case report: risk of electric injury on delayed initial treatment. Jurnal Rekonstruksi Dan Estetik. 2021;4(1):14–24. doi: 10.20473/jre.v4i1.24349.

Arumugam PK, Thakur P, Sarabahi S. Changing trends in electrical burns from a tertiary care centre - epidemiology and outcome analysis. Ann Burns Fire Disasters 2021;34(4);351-9. PMID: 35035329.

Pantelides NM, Young SS, Iyer S. The rectus abdominis muscle advancement flap as a salvage option for chest wall reconstruction. Ann R Coll Surg Engl 2017;99(5);142-4. doi: 10.1308/rcsann.2017.0044.

Wu Y, Ho S. Muscle-sparing pedicled transverse rectus abdominis myocutaneous flaps for breast reconstruction: combining benefits of both worlds. Proc Singapore Healthcare. 2018;28(1); 6-9. doi: 10.1177/2010105818779607.

Houdek MT, Bakri K, Tibbo ME, Wagner ER, Rose PS, Sim F, et al. Outcome and complications following vertical rectus abdominis myocutaneous flap surgery to reconstruct sacrectomy defects. Plast Reconstr Surg. 2018 Nov;142(5):1327-35. doi: 10.1097/PRS.0000000000004890.

Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. J Craniomaxillofac Surg. 2014 Dec;42(8):1551-6. doi: 10.1016/j.jcms.2013.11.017.

Basu SK, Bain J, Chattopadhyay D, Majumdar BK. Extensive chest wall tissue loss and its management by vertical rectus abdominis myocutaneous flap. J Indian Assoc Pediatr Surg. 2017 Jan-Mar;22(1):43-5. doi: 10.4103/0971-9261.194621.

Gentileschi S, Servillo M, Garganese G, Simona F, Scambia G, Salgarello M. Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery. Microsurgery. 2017 Sep;37(6):516-524. doi: 10.1002/micr.30077.

Published
2024/12/26
Issue
Vol. 55 No. 6 (2024): Nov-Dec
Section
Case report
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