Trapezoid Advancement Flaps. Treatment of Severe Upper Extremity Burn Contractures Limiting the Risk of Recurrence

Abstract Introduction Severe postburn contractures cause devastating functional loss, particularly in low-middle-income countries where 90% of burns occur. Traditional reconstruction faces high recurrence rates and graft breakdown. We developed a novel technique that leverages the observation that most contractures exhibit healthy skin on one side and scarring on the other. Methods A retrospective analysis of 27 patients (mean age 16.4 years) treated for elbow/axilla contractures. The technique involves excising the main contracture band, creating a trapezoid flap from the healthy skin side, advancing it over the joint surface, and positioning skin grafts proximal and distal to the flexion creases. Primary outcomes were assessed: range of motion (ROM) and complications. Results Twenty-nine elbow and 16 axilla contractures treated - more than one procedure in some patients. Shoulder ROM improved significantly from 111.0° to 149.4° abduction-adduction (mean improvement 38.4°, p.05). Elbow ROM improved from 76.6° to 108.6° flexion-extension (improvement 33.1°, p.05). Elbow contracture reduced from 60.5° to 18.5° (p.05). One patient required revision for compartment syndrome; 2no skin loss or graft failure occurred. Average follow-up: 3 months. Conclusions Trapezoid advancement flaps provide reliable functional improvement with minimal complications by positioning healthy tissue over joint surfaces and grafts away from high-stress areas. This technique addresses recurrence through biomechanically sound tissue placement, making it ideal for resource-limited settings where contracture burden is highest. The approach allows complete scar excision while providing durable coverage, representing a significant advancement in burn contracture reconstruction with excellent short-term outcomes and low complication rates. Applicability of Research to Practice The technique essentially transforms a complex reconstructive challenge into a more predictable procedure with better long-term outcomes, making quality burn contracture care accessible in diverse environments. Funding for the study N/A.