LOCAL FLAP RECONSTRUCTION OF DEEP HEAD BURN

Zayakova Y.1, Argirova M.2, Tsvetkov B.1
1.Department of Burn, Plastic and Aesthetic Surgery, Multiprofile Hospital for Active Treatment – Varna, Military Medical Academy-Sofia 
2. Clinic of burns and plastic surgery, UMHATEM “N.I. Pirogov”, Sofia, Bulgaria
Reconstruction of scalp defects following deep head burn can be a challenging task for the surgeon. In addition, surgical techniques have its limitations and their use depends largely on the size, depth and the localization of the defect as well as the quality of the surrounding tissue. Accompanying patient’s morbidities must also to be taken into consideration. Deep and large head burn with denuded of periost calvarium does not allow the application of primary closure technique and skin grafting. Such severe injuries require the application of flap either local, regional or free.
The objective of this article is to present and analyze the results from the use of local flaps for the reconstruction of deep head post burn defects. 
Materials and methods: The study presents reconstructive surgeries performed on 23 patients with head defects resulting from deep burn and involving different areas and structures of the scalp and calvaria. The localization of the injuries are as follows: frontal (n=7), occipital (n=5) and central (n=9) parts of the head. The size of the defects varied between ˃20cm2 ˂105cm2.In two patients the defect involves almost half of the scalp. There was available good quality tissue around the wounds in all cases. The defects were treated with local flaps. 
Results: Patients’ recovery was quite quick, without hematoma, seroma or infection. All flaps completely survived except for one advancement flap where total skin necrosis occurred. Conclusion: In cases of deep head burn and good surrounding tissue our preferred reconstructive method is the application of local flaps. They provide stable soft tissue coverage and quick recovery of the patients. The operative time is relatively short and the aesthetic and functional results quite satisfying.

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