Scar contracture recurrence after axillary burn reconstruction in adults: a single Institution’s 14-year experience

Abstract Axillary burn contractures impair upper limb function and can reoccur after initial reconstruction. The risk factors for recurrence remain unclear. This study aims to evaluate the recurrence rate of axillary burn contractures and identify associated risk factors. A retrospective chart review was conducted on patients who underwent reconstructive surgery for axillary burn contracture at a single institution between 2009 and 2022. Data collected included demographic information, injury details, reconstruction type, follow-up, re-operations, and complications. There were 30 axillary burn scar contractures in 27 patients (74.1% male, 25.9% female; mean age of 36.8 ± 15.2 years). Almost all burns were thermal (n = 24; 88.9%) and partial thickness (n = 22; 81.5%). The mean time between injury and reconstructive surgery was 10.3 ± 8.5 months, and the mean follow-up period was 18.1 ± 26.4 months. Z-plasty was the most frequently employed reconstructive procedure (n = 12; 40%), followed by split-thickness skin graft (STSG) only (n = 5; 16.7%), and a two-stage procedure with the application of a dermal substitute followed by STSG in two weeks (n = 4; 13.3%). The overall recurrence rate was 30.0% (n = 9). The Z-plasty group (n = 2; 16.7%) demonstrated relatively low rates of contracture recurrence. In contrast, the STSG only (n = 3; 60%) and latissimus dorsi flap with STSG (n = 2; 66.7%) groups had the highest rates of recurrence. Re-operation was performed in 77.8% of recurrent contractures (n = 7). The recurrence rate following axillary burn reconstruction is high, often requiring multiple re-operations. Given the impact of procedure type on contracture recurrence rate, reconstructive surgeons should consider using local flaps over skin grafts to release axillary burn contractures.