Wound Repair
Clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture
Duan Mengting, Liang Pengfei, Zhang Pihong, Zhang Minghua, Ren Licheng, Wu Ying, Zeng Jizhang, Guo Le, Hu Jiaxiong, Cui Xu, Huang Mitao, Zhou Situo, Huang Xiaoyuan
Published 2021-04-20
Cite as Chin J Burns, 2021, 37(4): 377-381. DOI: 10.3760/cma.j.cn501120-20201012-00433
Abstract
ObjectiveTo explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture.
MethodsA retrospective cohort study was conducted. From July 2016 to January 2020, 11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University, including 7 males and 4 females, aged 8 to 48 years. The lesions involved unilateral axilla in 9 cases and bilateral axilla in 2 cases, with the joint abduction angle of the affected shoulder ranging from 25 to 100°. The axillary fold contracture scars were excised and released, resulting in wound of 8 cm×5 cm-24 cm×20 cm. According to the condition of the residual normal skin in axilla, 2, 3, and 4-leaf propeller flaps with area of 5 cm×3 cm-24 cm×10 cm were designed to repair the wounds after scar excision and release. The donor site wound was closed by suturing directly, and the residual wound that could not be completely sutured was transplanted with free full-thickness skin grafts from the inner thigh or abdomen. The application of 2, 3, and 4-leaf propeller flaps, the joint abduction angle of the affected shoulder immediately after operation, and the survival of the flaps and skin grafts after operation were recorded. The recurrence of scar contracture, the appearance of the flaps, the joint abduction angle of the affected shoulder, and the functional recovery of the affected shoulder joint and upper arm were observed through a follow-up.
ResultsAmong the 13 axillary propeller flaps transplanted in the 11 patients in this group, there were 9 double-leaf propeller flaps, two 3-leaf propeller flaps, and two 4-leaf propeller flaps. The joint abduction angle of the affected shoulder reached 110-165° immediately after operation. All the flaps survived after operation. Nine flap donor sites were repaired with free skin grafts, with skin grafts survived in 7 flap donor sites after operation. Scar erosion in incision and small area of skin graft necrosis developed in 2 flap donor sites. One of the wounds was debrided and repaired by transplantation of split-thickness skin grafts from inner thigh, and the other wound was healed after dressing changes. A follow-up of 6 to 24 months was conducted after surgery, and all the patients had no recurrence of axillary scar contracture; the color of the flap matched the receiving area; the elasticity of flap was good; the joint abduction angle of the affected shoulder reached 120-165°, and the joint pronation and supination, upper arm lifting and circular rotation of the affected shoulder were all good.
ConclusionsReconstruction of the axillary fold scar contracture with axillary propeller flaps has good result, with better flap appearance and recovery of the shoulder joint activity and upper arm function after operation.
Key words:
Axilla; Surgical flaps; Scar contracture
Contributor Information
Duan Mengting
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Liang Pengfei
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Zhang Pihong
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Zhang Minghua
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Ren Licheng
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Wu Ying
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Zeng Jizhang
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Guo Le
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Hu Jiaxiong
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Cui Xu
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Huang Mitao
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Zhou Situo
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Huang Xiaoyuan
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
