A Wise Surgical Approach for Reconstruction of Postburn Axillary Contractures and Versatility of Perforator Flaps

Postburn axillary adduction contractures should essentially be released for adequate shoulder function. Many methods have been described for this purpose. However, use of perforator flaps prevents harm to the underlying muscle and provides thin, pliable skin flaps. Despite the major advantages offered by perforator flaps, certain shortcomings of perforator flap surgery restrict their widespread use by inexperienced surgeons, including anatomic variations of perforator vessels. In order to rule out these shortcomings, we devised a new surgical approach with an initial incision that provides access to possible perforator systems on the dorsolateral thoracic area. The approach can easily be converted to a fasciocutaneous transposition flap when attempts for identification of a proper perforator fail. Nevertheless, a proper perforator can easily be reached through the exposure provided by this initial incision. With the intention of using perforator-based flap for reconstruction, we used this surgical approach for coverage in 14 cases of postburn axillary contractures. In 3 cases, conversions of the initial incision to local transposition flap (parascapular flap) were required. There was only 2 tip necrosis observed, which healed with secondary intention. Our current surgical approach may offer taking the advantages of using a true perforator flap for reconstruction while avoiding a second stress on the patient when an operative plan for perforator flap harvest fails.