Thinning of the thoracodorsal perforator-based cutaneous flap for axillary burn scar contracture

Use of the thoracodorsal perforator-based cutaneous flap to release axillary contracture offers many advantages over skin graft and other flaps. The prolonged splinting in abduction and the faithful postoperative physical therapy are avoidable. The exit points of the perforators are far from the burn injury and the long vascular pedicle permits a large flap design, which is very convenient for the adjacent axilla. Furthermore, the axilla is unaffected by the tension of the primarily closed donor site if the flap is vertically designed along its long axis. In addition to these advantages, the thinned thoracodorsal perforator-based cutaneous flap produces aesthetically desirable results without soft-tissue redundancy and excludes secondary debulking procedures. In conclusion, the thinned thoracodorsal perforator-based cutaneous island flap is the most appropriate flap for the reconstruction of severe axillary burn scar contractures. Its clinical use could be extended to thin recipient sites such as the anterior tibial region and the dorsum of the foot as a free tissue transfer.