# Functional and Reconstructive Outcomes of Square Flap in Postburn Axillary Contracture

## TL;DR

This study evaluates the effectiveness of square flap surgery in treating post-burn axillary contractures, showing significant improvement in shoulder movement and patient satisfaction.

## Contribution

The study provides new evidence on the functional and reconstructive outcomes of square flap technique in a Bangladeshi context for post-burn axillary contractures.

## Key findings

- Square flap surgery significantly improved shoulder abduction from 112° to 165°.
- Contracture band length increased from 4.68 cm to 8.66 cm post-surgery.
- 82.5% of patients had good reconstructive outcomes with minimal complications.

## Abstract

Background and aim

Post-burn axillary contracture (PBAC) represents a frequent and disabling sequela of burn injury, often impairing shoulder movement and hindering daily activities. Due to its promising functional and cosmetic outcome, the square flap technique has recently gained attention, yet data in the Bangladeshi context remain scarce. This study was planned to assess the functional and reconstructive outcomes of the square flap technique in PBAC reconstruction.

Methods

A prospective observational study was conducted at the National Institute of Burn and Plastic Surgery, Dhaka, from January 2023 to June 2024. Among the patients with type 1A and 1B PBAC, a total of 40 patients who were planned to undergo contracture release using the square flap technique were purposively included in the study. Patients presenting with unstable scars over the contracture site, presence of ulcers on the scar, skin malignancy at the contracture site, bony deformities of the affected joint, or recurrent contractures were excluded from the study. Preoperative and three-month postoperative assessments, such as shoulder abduction range, contracture band length, complications, and reconstructive outcomes, were recorded.

Results

The majority of the patients with post-burn contracture were adolescents with female predominance (65%). Most (80%) of the participants were suffering from type 1A axillary contracture, and flame burns were identified as the predominant cause, accounting for 92.5% of cases. The mean shoulder abduction improved significantly from 112° ± 20.15° preoperatively to 165° ± 17.03° postoperatively (p value: <0.001). Contracture band length increased from 4.68 ± 1.16 cm to 8.66 ± 1.40 cm (p value: <0.001). Tip necrosis (7.5%) and epidermolysis (10%) were the most common complications. The reconstruction outcome was good (82.5%).

Conclusion

Square flap reconstruction is an effective technique for releasing linear axillary contractures, providing excellent functional and cosmetic outcomes with minimal complications and a high level of patient satisfaction.