title: STARplasty for Reconstruction of the Burned Axilla.
abstract: BACKGROUND
  Postburn axillary contractures are common and significantly impact quality of life. Simple release combined with split thickness skin grafting necessitates a donor site, requires immobilization, and may result in poor functional outcome. Common methods of adjacent tissue rearrangement are not well designed to treat broad linear contractures. Flaps from the back, flank, or arm can be used, but may come with significant donor site morbidity. We demonstrate the use of the STARplasty, a novel adjacent tissue rearrangement initially developed to treat neosyndactyly, as a useful reconstructive option for the release of Kurtzman type 1 posterior or anterior axillary contractures.
  
  
  METHODS
  A retrospective review was performed to identify patients who underwent STARplasties for treatment of type 1 axillary burn contractures. All reconstructions were performed by a single surgeon at a single ABA burn center (April 2011 to December 2015). A version of the surgical STARplasty technique previously described for treatment of neosyndactyly was modified for use in the axilla. Patient and injury demographics, as well as complications and outcome, were collected.
  
  
  RESULTS
  Twelve patients with upper extremity burns underwent 16 primary STARplasties for treatment of axillary contractures. Three patients underwent simultaneous bilateral procedures. The majority (15/16) of the primary procedures were used to address contractures of the anterior axillary fold. Mean patient age was 51 (R 38-63) and average burn size was 35% (R 18-80). Average time from initial injury to primary reconstruction was 11.1 months (R 3-54). One patient required revision for persistent contracture and another experienced wound dehiscence that ultimately required split-thickness skin grafting. No other significant complications were noted, and all remaining patients had closed wounds and full range of motion by 30 days postprocedure.
  
  
  CONCLUSIONS
  Axillary contractures remain common despite improvements in physical/occupational therapy. While common techniques, such as z-plasty, continue to be helpful for the surgical release of narrow contractures with bilateral laxity, axillary contractures are typically broad based and often contain only unilateral unburned tissue. Based on our experience, the axillary STARplasty represents a safe and efficacious technique to be considered in the case of broad-based contractures involving either the anterior or posterior axillary fold.
authors.affiliation: From the *Division of Burn Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and †Division of Plastic and Reconstructive Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cauley
authors.forename: Sean A
authors.initials: SA
authors.lastname: Hickey
authors.forename: Charles Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Katie
authors.initials: K
authors.lastname: Mathews
authors.forename: Jeremy
authors.initials: J
authors.lastname: Goverman
mesh_terms: D000328:Adult; D001365:Axilla / Q000293:injuries* / Q000601:surgery*; D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome