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CC BY-NC-ND 4.0 · Indian J Plast Surg 2014; 47(03): 375-380
DOI: 10.4103/0970-0358.146594
Original Article
Association of Plastic Surgeons of India

Post-burn axillary contracture: A therapeutic challenge!

Durga Karki
Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, India
,
Nikhil Mehta
Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, India
,
Ravi Prakash Narayan
Department of Burns and Plastic Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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Publication History

Publication Date:
26 August 2019 (online)

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ABSTRACT

Background: Axillary post-burn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this paper was to highlight the various options used in managing axillary contractures in our hospital. Materials and Methods: This is a retrospective hospital-based study of axillary contractures managed at Safdarjung Hospital (a tertiary care hospital) from 2009 to 2013.The study consisted of 44 patients from all age group and both sex included in it. Patients with a bilateral axillary contracture were excluded. Axillary contracture was released and resurfaced using split skin graft and/or with different types of flaps including the propeller flap, parascapular flap. All the reconstructed cases were followed-up for a period of 12 months. Assessment was done on the basis of functional and aesthetic outcome. Results: Forty-four patients consisting of 25 males and 19 females presented with axillary contractures that involved 44 axillae. The mean age of the study group was 17.1 years. Injuries involved the anterior axillary fold in 8 (18.18%), posterior fold in ten (22.72%), both folds and axillary fossa in 14 (31.81%) and both folds plus part of the chest wall and arm (sparing the axillary fossa) in 12 (27.27%) axillae. Surgical treatment included split-thickness skin graft in 15 (34.1%), local skin flaps in 4 (9.1%), Z-plasties in 4 (9.1%), parascapular flaps in 3 (6.82%), while propeller flaps in 12 (27.27%) and square flap were used in 6 (13.64%) patients. The percentage of improvement in abduction had a mean of 156°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn axillary contractures can be made according to the pattern of scar contracture and the state of the surrounding skin. The choice of a flap should have priority over the skin graft because of the superior functional and aesthetic results of flaps.

KEY WORDS

Axillary contracture - propeller flap - square flap
 

  • REFERENCES

  • 1 Gupta JL, Makhija LK, Bajaj SP. National programme for prevention of burn injuries. Indian J Plast Surg 2010; 43: S6-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Kurtzman LC, Stern PJ. Upper extremity burn contractures. Hand Clin 1990; 6: 261-79
    PubMedGoogle Scholar
  • 3 Hanumadass M, Kagan R, Matsuda T, Jayaram B. Classification and surgical correction of postburn axillary contractures. J Trauma 1986; 26: 236-40
    CrossrefPubMedGoogle Scholar
  • 4 Olaitan P, Onah I, Uduezue A, Duru N. Surgical options for axillary contractures. Internet J Plast Surg 2007; 3: 154-8
    Google Scholar
  • 5 Teot L, Bosse JP. The use of scapular skin island flaps in the treatment of axillary postburn scar contractures. Br J Plast Surg 1994; 47: 108-11
    CrossrefPubMedGoogle Scholar
  • 6 Salam GA, Amin JP. The basic Z-plasty. Am Fam Physician 2003; 67: 2329-32
    PubMedGoogle Scholar
  • 7 Hyakusoku H, Shirai H, Umeda T, Fumiiri M. The use of the square flap method for repair of axillary burn contracture. Jpn J Plast Reconstr Surg 1985; 28: 585
    Google Scholar
  • 8 Limberg AA. The Planning of Local Plastic Operations on the Body Surface: theory and Practice (translated into English by Wolfe SA. 1984). Lexington: The Collamore Press. D. C. Heath and Co.; 1963
    Google Scholar
  • 9 Pignatti M, Ogawa R, Hallock GG, Mateev M, Georgescu AV, Balakrishnan G. et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg 2011; 127: 716-22
    CrossrefPubMedGoogle Scholar
  • 10 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44: 53-4
    CrossrefPubMedGoogle Scholar
  • 11 Kim DY, Cho SY, Kim KS, Lee SY, Cho BH. Correction of axillary burn scar contracture with the thoracodorsal perforator-based cutaneous island flap. Ann Plast Surg 2000; 44: 181-7
    CrossrefPubMedGoogle Scholar
  • 12 Maruyama Y. Ascending scapular flap and its use for the treatment of axillary burn scar contracture. Br J Plast Surg 1991; 44: 97-101
    CrossrefPubMedGoogle Scholar
  • 13 Sakr WM, Mageed MA, Mo’ez WE, Ismail M. Options for treatment of post burn axillary deformities. Egypt J Plast Reconstr Surg 2007; 31: 63-71
    Google Scholar
  • 14 Güven E, Ugurlu AM, Hocaoglu E, Kuvat SV, Elbey H. Treatment of post-burn upper extremity, neck and facial contractures: Report of 77 cases. Ulus Travma Acil Cerrahi Derg 2010; 16: 401-6
    PubMedGoogle Scholar