Tissue expansion and latissimus dorsi transfer for arm-thorax synechia reconstruction

Inadequate treatment of severe burn injury often results in scar contractures with subsequent functional impairment and cosmetic deformities depending on the body area involved. Arm-thorax synechia is a rare but devastating complication of burns. The authors report a case of a 17-year-old boy with subtotal arm-thorax synechia, secondary to burn contracture. Reconstruction was accomplished, in two stages, with the use of tissue expanders and a latissimus dorsi muscle flap. The postoperative course was uneventful in both stages, with complete survival of both the expanded skin and the muscle flap. Early initiation of intensive rehabilitation resulted in excellent functional outcome, while significant aesthetic improvement was also ensured. In conclusion, the combined use of tissue expansion and latissimus dorsi transfer may prove to be a very good option in the treatment of complex postburn axillary contractures. The main advantages of the suggested method are the best quality of skin provided by tissue expansion and the safe coverage of any vital structures exposed with the use of the muscle flap.