Experience in the management of axillary post-burn scar contractures

Background: Axillary post-burn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this paper is to highlight the various management options used in managing axillary contractures in our hospitals and to itemize the complications commonly encountered. Method: This is a retrospective study of cases of axillary contractures managed at the Komfo Anokye Teaching Hospital, Global Evangelical Mission Hospital and South Tongu District Hospital all in Ghana, from 2003 – 2007. Result: Sixteen patients made up of 10 males and 6 females presented with axillary contractures that involved 25 axillae. The mean age of the study was 25.2 years. Injuries involved the anterior axillary fold in seven (28%), posterior fold in nine (36%), both folds in five (20%) and both folds plus axillary dome in four (16%) axillae. Surgical treatment included split-thickness skin graft in seven (28%), random pattern local skin flaps in five (36%) including z-plasties, parascapular flaps in six (24%), while scapular flaps and posterior trunk skin flap were used in two (8%) and one (4%) axillae respectively. Conclusion: The choice of surgical procedure for reconstruction of post-burn axillary contractures can be made according to the pattern of scar contracture and the state of surrounding skin. The choice of a flap should have priority over skin graft because of the superior functional and cosmetic results of flaps. Keywords: Axillary contracture; Skin grafting; Parascapular flap; Z-plasty; Physiotherapy.