In Response: Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia

Abstract

The Journal of Burn Care and Research recently published an article titled “Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia” by Lykoudis et al.1 In conclusion the authors stated, “... the combined use of tissue expansion and latissimus dorsi transfer may prove to be a very good option in the treatment of complex postburn axillary contractures.” The statement can mislead the reader, implying that the suggested excessively complex and traumatic technique should be used to solve relatively simple surgical problems. The reviewed article deals with an edge shoulder posterior adduction contracture that is caused by scars on the posterior shoulder joint, trunk, and shoulder surfaces. These contractures can be eliminated using a shorter, easier, less traumatic, single-stage, safe, and effective reconstructive technique: trapeze-flap plasty.2 Edge shoulder posterior adduction contracture is caused by the fold located along posterior axillary fossa's edge. Lateral fold sheet (according to axilla) is scars; medial fold sheet and axillary fossa are healthy skin; and the crest of the fold is the edge of scars. Contracture is caused only by the lateral scar sheet, having scar surface deficiency in length. The deficiency spreads from the fold's crest to the joint rotation axis and has a trapezoid form which can be seen clearly after contracted sheet's dissection with a Y-shaped incision. Therefore, contracture elimination should use a flap of a similar (trapezoid) shape to compensate scar surface deficiency.