Thermal injuries to free flaps: Better prevented than treated

Denervated free flaps rarely fully recover normal cutaneous sensory function from local reinnervation. The insensate skin of these flaps is, therefore, at increased risk for injury, jeopardizing the reconstructed site. Steps to reduce the morbidity from these injuries should be stressed. Clear and concise counseling should be done to educate the patient about the risks and methods to protect the flap site during daily activities. Additional protection can be offered by neurotized free flaps whenever anatomically possible. This will provide eventual enhanced sensation in the anatomically correct cortically perceived dermatome distribution. However, such flaps are initially insensate and, thus, additional care must be taken while the nerves regenerate. Although superficial thermal injuries seldom cause significant flap loss, they are better prevented than treated!.