Latissimus dorsi myocutaneous flap reconstruction of neck and axillary burn contractures

Neck and axillary burn contractures are both a devastating functional and c osmetic deformity for patients and a challenging problem for reconstructive surgeons. Severe contractures are more commonly seen in the developing wor ld, a result of both the widespread use of open fires and the inadequacy of primary and secondary burn care in these vicinities. When deep burns are a llowed to heal spontaneously, patients develop hypertrophic scarring of the neck and axillary areas. The back is typically spared, however, remaining a suitable donor site. We have used nine latissimus dorsi myocutaneous flaps in a total of six pat ients, finding the flaps effective in resurfacing both the neck and the axi llary regions after wide release of burn contractures. Before flap mobiliza tion, surgical neck release is often necessary to ensure safe, effective co ntrol of the airway in patients with significant neck contractures. Flap bu lkiness in the anterior neck region can eventually be reduced by dividing t he thoracodorsal nerve. Anchoring the skin paddle to its recipient site thr ough the placement of tacking sutures will also help: achieve a more normal anterior neck contour.