Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Reconstructive Surgery in the Tropics
Figure 22. Deltopectoral flap at 3 weeks just prior to
division.
Figure 23. Just after division of deltopectoral flap
under I.V. Ketamine anesthesia.
Figure 24. Post 3 rd degree burn. Scar contracture of anterior
neck.
253
contractures of the anterior neck. This makes a complex full-thickness reconstructive
technique with prolonged postoperative management replaceable using a
single-stage contracture release and flap placement.
The incision for this flap runs from the sternum just under the clavicle and
extends to the mid-shoulder. The distal 3 or 4 inches of this flap needs to be as wide
as it is long on the- anterior shoulder.
Operative Procedure
1. A general endotracheal anesthetic is used with I.V. suxamethonium and
I.V. ketamine for induction and maintenance.
2. A split thickness skin graft to cover the future exposed area on the shoulder,
because it cannot be closed primarily, is taken and this area is dressed
and bandaged.
26