Background and objective

The use of microvascular free tissue transplantation in burn patients has consolidated over the last years. The purpose of this article is to establish practical conclusions in order to optimize the results of free flaps in this group of patients.

Methods

A review of the PubMed and Scielo databases was performed using a combination of the search terms “free flap” or “microsurgery” or “free tissue transfer” and “burn” or “thermal injury”. The search returned 1366 articles that were analyzed to include those with relevant information about: incidence of free flaps in burn patients, complications, strategies to increase success and pre-operative and post-operative management.

Results

Following revision 31 articles were included. Published works report an incidence of free flaps transplantations in burn patients ranging between 1.5 and 1.8%. Complication rate is high compared to other groups of patients, however, it decreases considerably if surgery is not performed between day 5 and 21 after burn injury. Imaging tests are not indispensable to select recipient vessels. It is advisable to keep body temperature over 36 °C, normovolemia and hematocrit between 30 and 40% avoiding hemoglobine values over 70 g/l. In the need of vasopressors norepinephrine and dobutamine are the drugs of choice.

Conclusions

Microsurgery is uncommon but sometimes essential in burn treatment. This review may be valuable guiding not only clinical management of free flaps in burn patients but pointing towards new lines of research.

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