Pedicled latissimus dorsi flap transfer and axillary plasty combined with cicatricial loosening for treatment of severe postburn axillary scar contracture
Zhao Hongshun1, Zhou Yimo1, Li Yonggang1, Xu Kefeng2, Gao Shunhong3
1Department of Orthopedics, Qinghai Red Cross Hospital ,Xining 810000, China; 2Department of Orthopedics Jinhua Central Hospital, Jinhua 321000, China; 3Department of No.2 Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
Abstract：Objective To investigate the clinical effect of latissimus dorsi flap local axillary augmentation combined with scar release to repair severe scar contracture deformity after burn injury.Methods From September 2012 to October 2017, 9 cases of axillary scar contracture repaired by latissimus dorsi flap in Department of Orthopedics, Qinghai Red Cross Hospital were retrospecively analyzed, including 7 males and 2 females, aged 22-43 years old. The cause of injury were 3 cases in electric injury, 4 cases in scald and 2 cases in hot press. According to the classification of scar contracture deformity in axilla, 3 cases were mild, 5 cases were moderate, and 1 case was severe. The time from injury to rehabilitation were 3-10 years. The cicatricial contracture developed after burn injury on the upper limb, the anterior chest and the axilla. The abduction angle of the shoulder was 47.5°±19.7°. The scar was first loosened.The skin defect was covered by partial transfer of latissimus dorsi flap.The area of the flap was 7 cm×12 cm to 12 cm×20 cm. The donor area was direct suture or full/medium thick skin grafting.Results All cases were followed up for 9 to 26 months(average of 18 months). The skin flap survived after operation, 1 case of the skin flap was necrotic and cured after dressing change. 5 cases were directly sutured in the donor area. 4 cases were transplanted with full/medium thick skin grafts, and the skin grafts survived. All cases were free of infection and skin necrosis. At 6 months of follow-up, the skin flaps were soft, the appearance was good and the shoulder joint activity was obviously improved. The average abduction angle was 127.8°±23.5 °. The difference was statistically significant compared to those before operation. (t=7.860, P<0.01) .Conclusions The blood transportation of latissimus dorsi flap is rich,with strong anti infection ability,high survival rate and good appearance.Recovery of shoulder joint function is good,and the clinical effect is satisfactory.
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Zhao Hongshun, Zhou Yimo, Li Yonggang, Xu Kefeng, Gao Shunhong. Pedicled latissimus dorsi flap transfer and axillary plasty combined with cicatricial loosening for treatment of severe postburn axillary scar contracture. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 159-163.
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2020, Vol. 25 
