Posterior arm flap in management

of axillary contracture
Dr.Sudipta Bera
PDT –Plastic Surgery(2nd year)
SSKM & IPGMER
• Axillary contracture is a severe functional
deformity and is a common sequle of burn.
• Any handicap related to upper limb has a
detrimental physical, psycohological, and
economical effect.
• Scar contracture at axilla following deep partial
and full thickness burn limit motion at the
shoulder joint, especially abduction and
extension movement
• Management can be difficult.
 Management
Release, Coverage, Physiotherapy:
Options for coverage
• direct closure
• split thickness skin graft
• Z plasty
• flaps
• free tissue transfer
• tissue expansion
 Split-skin graft
• Standard and commonly performed procedure
• Disadvantages:
Failure of take of graft, recontracture and
thereby subjecting to another surgery,
unaesthetic result, long hospital stay and
donor site morbidity, cost related to repeated
adjustment of splintage etc
 Z Plasty
• Various combinations of Z plasties and
multiple Z plasties,V–Y plasties, square plasties
• Limitations: applicable only in cases where
there are single band.
 Flaps
• Muscle & Myocutenious Flaps:Pectoralis
Major flap, Lattissimus Dorsi flap
Disadvantage:
• bulk prevents optimal adduction of the limb.
• donor muscle functioning defect
• Tissue Expanders: limited use as surrounding
skins are usually scarred
• Free flaps: give good results but requires
microvascular experties.
 Fasciocutenious Flaps
• latissimus dorsi, scapular flap and parascapular
flap, medial and posterior arm flap
• advantages of fasciocutaneous flaps are:
(a) simplicity of flap harvest
(b) no donor site function deficit.
(c)thin and supple, hence take the contour of the
defect easily
(d) perforators lies in depth & they are usually
spared in cases of superficial burn.
 Posterior Arm Flap
• axial pattern sensate flap
• reliable pedicle which is constant and can be
easlity located
• This flap is s/b cutaneous branch arising from
the artery supplying the medial head of
triceps which comes from either the brachial
artery or profunda brachii.
• accompanied by venae comitantes and
posterior cutaneous nerve of arm
Schematic diagram of flap.
 CASE
• 40 year, Male, cook by occupation
• Sustained 40% TBSA deep accidental flame
burn involving chest, abdomen,back and arms
2 years ago
• Split thickness skin grafted in the initial post
burn period
• Presented with severe bilateral axillary
contracture
Pic.1:Patient on presentation
• Clinically Kurtzman 3(both anterior and
posterior axillary fold as well as axillary dome
involved)
• Angle of abduction <10 in both side
• Right side operated
• Contracture release and coverage with
Posterior arm flap and Split thickness skin
Graft was done. Flap doner site also grafted.
• Post operative improved abduction(>120)
Post op 1st week
Anterior view:Improved abduction
Posterior view: Improved abduction
Thank You