Chemical Burn Abdominal Louvre Flap Closure

Severe chemical burns of the hand with partial loss of index finger. Need for soft tissue coverage to preserve the remaining digits and prevent further loss of hand function by extensor tendon loss secondary to exposure and desiccation.

Dorsal view with exposed extensor tendons over MP and PIP joints. Burn eschar and necrotic tissue evident.






Close up view.







Lateral view.







Palmar view.







Debrided wound intra-operative. Doral view.







Debrided wound intra-operative. Lateral view.







Conceptual drawing behing flap design.







Placement of hand on abdominal donor site to design flaps for coverage.






Flaps on abdomen designed and marked out.







Debrided hand overlying flaps confirming placement, position and design of flaps.






Flaps elevated with skin grafts placed on the donor site beds.







Flaps  sutured to recipient sites on the thumb, index, middle, ring and little fingers.






At time of division and insetting of the flaps. Notice healed viable skin graft over dorsal aspect of metacarpophalangeal joints.






Alternate view of same.







Healed wounds with healthy flaps and grafts after division and insetting. De-bulking procedures may be required in the future.






Flexion lateral view.







Flexion dorsal view.







Flexion palmar view.







Extension palmar view.







Donor site skin graft scars of abdomen.







W-plasty plan for abdominal scar revision.







Primary wound closure abdominal scar revision.