The Two Facing Square Flaps Method for Release of Anterior and Posterior Axillary Line Burn Contractures

With improved burn outcomes and survival rates, the focus of management in large burns has shifted from merely survival towards optimizing form and function for the burn survivor. Due to its unique structural features and functional demands however, the axilla is prone to contracture formation, and remains complex to reconstruct. Where contractures involve both the posterior and anterior axillary lines, the two facing square flaps method is a suitable choice for a wide range of patients. The flap design is flexible, and is relatively safe with a sufficient blood supply. Superior lengthening of approximately 3-4 times can be achieved, and is maintainable. In this surgical technique paper, we describe the strategy of the two facing square flaps, and present two patterns of its application, with representative cases of the local flap method.