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Subcutaneous pedicle propeller flap: An old technique revisited and modified!
Durga Karki1, Nikhil Mehta1, Ravi Prakash Narayan1
1Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India.
Summary
Subcutaneous pedicle propeller flaps effectively manage post-burn axillary and elbow contractures, restoring significant shoulder abduction and elbow extension. This technique offers superior functional outcomes and easier learning for surgeons.
Area of Science:
- Reconstructive surgery
- Plastic surgery
- Burn management
Background:
- Post-burn contractures of the axilla and elbow present significant reconstructive challenges.
- Achieving adequate shoulder abduction and elbow extension is crucial for functional recovery.
Purpose of the Study:
- To evaluate the efficacy of the subcutaneous pedicle propeller flap in managing post-burn axillary and elbow contractures.
- To highlight the technique and its modifications for improved outcomes.
Main Methods:
- A prospective case study involving 38 patients with post-burn axillary and elbow contractures.
- Utilized subcutaneous pedicle propeller flaps with a central axis pedicle, rotated axially to release contractures.
- Incorporated a Zig-Zag incision modification to prevent scar hypertrophy.
Main Results:
- The study included 23 patients with axillary contractures and 15 with elbow contractures.
- Achieved a mean shoulder abduction of 168° and a mean elbow extension of 175° post-operatively.
- Reported satisfactory functional and aesthetic results.
Conclusions:
- Subcutaneous pedicle propeller flaps are recommended for post-burn upper extremity contractures due to superior functional results and ease of learning.
- The described modification enhances scar healing and prevents scar band formation by interposing healthy skin.
- Surgical approach should be tailored to scar contracture patterns and surrounding skin conditions.
