THE TREATMENT SEVERE AXILLARY CONTRACTURES USING OF THE PARASCAPULAR FLAP IN CONJUNCTION WITH OTHER RECONSTRUCTION TECHNIQUES

Axillary scar contracture is observed frequently after severe burn insult and is usually accompanied by injuries to the 
adjacent area. ( Kim et al ) Inappropriate treatment of axillary burns frequently results in adduction contractures. 
Management of severe axillary contractures is a challenging task and requires well-planned management. 
One should always aim at restoring full function, and this is best accomplished by performing full release of the contracture to restore the full range of movement together with the creation of a natural non bulky axillary pit with the minimal possibility of recurrence of the contracture and with minimal donor site morbidity. 
Although many therapeutic methods, including skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been 
established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. 
In this study the parascapular flap was used to reconstruct only the axillary pit and the residual raw area on the chest wall closed either using Z-pasty technique or split thickness skin graft and the residual raw area on the inner aspect of the upper arm is either closed primary or covered with a split thickness graft, and very good functional and esthetic results could be accomplished using this technique. 
We concluded that the parascapular flap either pedicled or island (for reconstructing the axillary pit combined with zplasties or split thickness skin grafts to cover any residual raw areas in the arm or chest wall) is the best choice for 
reconstruction of severe types of axillary contracture, releasing defects with satisfactory results in terms of function and 
cosmoses