A Hybrid Approach with Tailored Parascapular Flap, Skin Graft, and Z-Plasty for Post-Burn Axillary Contracture: A Case Series

Abstract Release and restoration of function in axillary contracture is challenging. A variety of reconstruction methods, such as split-thickness skin graft (STSG), Z-plasty, and locoregional flaps, are in practice depending on its severity. We present a case series of a hybrid approach combining tailored parascapular flap and/or STSG/Z-plasty applied uniformly. This retrospective case series includes 13 axillary contractures operated between July 2020 and December 2024. The range of shoulder abduction, improvement of secondary deformities, and uniformity of postoperative scar were evaluated. Among the cases, type I, II, and III contractures were in three, seven, and three cases, respectively. Secondary deformities were present in nine cases. Mean dimension of the flaps was (29.61 × 10.38) cm. Mean abduction was 103.07 degrees (SD: 22.87) at 1 week postoperatively. In all except two type III cases, full abduction was noted at 6-month follow-up. Secondary contractures were improved in all, and no additional intervention was required in any case. Step deformity at the margin of release and flap was noted in none of the cases. Combined use of tailored parascapular flap, STSG, and Z-plasty enables uniform release of all types of contractures that are not amenable to Z-plasty alone. The procedure required less STSG and showed reduced dependence on splintage, while a gradual improvement in abduction angle was noted. With this approach, correction of secondary deformities and favorable alignment of residual scar tissue can be achieved.