Background and objective.

Postburn axillary contractures affect non burnt neighbor tissues, producing vascular distortion. When functional zones are burnt, the best reconstructive option is needed to optimize healthy skin in order to decrease morbidity. The axillar rhomboid propeller flap provides significant advantages on the treatment of large contractable scars of chest and upper limb in burnt patients, especially in children.

This paper is based on the vascular anatomical study of axillary tissues. The aim is to localize the origin of small perforator vessels to increase good and safe results.

Methods.

This study identifies the anatomical knowledge of axillar irrigation on four steps: 1) bibliographic revision; 2) human cadavers dissection; 3) vascular perforators localization in not burnt patients using doppler flowmetry; and 4) flaps dissection in burnt patients with retractile scars.

Results.

Bibliographic revision identified several methods and local flaps for reconstruction of upper limb, using the perforator flaps. Axillar flap is mentioned as random type.

Cadavers dissections of 6 axillas showed on average 3 perforators by side,(diameters of 1-2 mm), placed in superior and inferior external quadrants; 12 of them, rice from axillar artery as direct branches; 6 of them, rice from collateral arteries: 4 from lateral thoracic artery, and 2 from thoracodorsal artery.

Using doppler flowmetry in 30 axilas from volunteer people, we found more arteries at internal-inferior and external-superior localizations

Finally, in 7 cases operated on with reconstructive surgery, the dissections reached 3-4 cm length; as a result, we could not observe the origin of the vessels.

Conclusions.

The CPA is very useful in severe scar sequels due to burns in the chest and upper limb. The dome axillary anatomy respects it to a great extent in these patients, functioning as a donor site present in 90% of cases as an advantage over other flaps. Although it is not necessary to dissect to the origin of the perforator, knowing its origin provides greater security since the burned tissue does not respect normal anatomy. Our study provides greater precision in the marking and finding of perforators to accelerate their dissection, obtain a longer pedicle to reach distant areas and replace a larger tissue surface.

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