low temperature burn on replanted fingers and free flaps on hand

초록

Background Patients who underwent microsurgery for reconstruction with free flap or finger replantation are vulnerable to heat injury. Moreover, some of these injuries could occur in low temperature. Although temperature does not reach the threshold value to cause burn in adjacent normal tissues, burns can occur in the area undergoing microsurgery. However, this type of burn had not yet been well understood, and there are few studies of clinical prognosis. Methods We reviewed medical records of patients who received warm therapy using infrared heat lamp with appropriate temperature after hand surgery from January 2009 to December 2016. The patients were classified into two groups. Group A was patients underwent free flap or replantation surgery of the hand. Group B was patients underwent other hand surgery without microsurgery such as tenorrhaphy, tenolysis, or joint surgery. Through the medical records, all patients with second or third degree thermal burns were selected. The relationship between the two types of surgery and thermal injury and timing of burn after microsurgery were analyzed. Results In group A, there were 370 patients (mean age: 48.2 years) and in group B, there were 7010 patients (mean age: 44.5 years). Burns requiring treatment occurred in four patients of group A and in one patient of group B. The proportion of low temperature burn was 4 / 370 in group A and 1 / 7010 in group B. The occurrence of low temperature burn was more associated with patients who undergo microsurgery for hand reconstruction with free flap or finger replantation (P<0.05). In patients who underwent microsurgery, all 4 patients had thermal burns within 1 year after surgery. Conclusion Through our result, low temperature thermal burn could be occurred in case of patients who underwent microsurgery for hand reconstruction. It is thought be related the disruption of the thermoregulatory function of the skin and poor nerve regeneration, and more heat accumulation in su