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Namaste Flap

Modification of Subcutaneous Pedicle Propeller Flaps in the Reconstruction of Postburn Axillary and Elbow Contractures

Karki, Durga MS, Mch (Plastic Surgery), DNB (Plastic Surgery), MNAMS, FICS, FAIS; Muthukumar, Vamseedharan DNB (Gen Sur), MRCS (Ed); Dash, Suvashis MS

doi: 10.1097/SAP.0000000000002076
Burn Surgery and Research

Introduction The reconstruction of the postburn contracture area is always a challenge in the field of plastic surgery. Moreover, the joints are very sensitive to trauma and immobilization, showing a susceptibility to stiffness. The aim of this article is to emphasize the use of “Namaste flap”—modification of subcutaneous pedicle propeller flaps in the reconstruction of postburn axillary and elbow contractures.

Methodology This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using Namaste flap—modification of subcutaneous pedicle propeller flaps from 2010 to 2016. The surgical technique involved raising 2-limbed subcutaneous pedicle-based propellar flap over the contracture using the unburnt skin at the axillary and cubital fossa. The flap with both the limb thus raised was rotated by 90 degrees in the same direction and inserted into the defect.

Results Nine patients including 6 patients with elbow and 3 patients with axillary contractures were included in this study. The mean degree of contracture in axilla and elbow was 78.3 degrees and 59.1 degrees, respectively. The functional results postoperatively were satisfactory. The mean postoperative degree of joint movements in axilla and elbow was 176.3 degrees and 173.6 degrees, respectively. No major complications were encountered. There was a mean period of 12 months of follow-up.

Conclusions In cases where normal skin is still present on the axillary and cubital fossa with scar contracture caused by extensive burns, the subcutaneous propeller flap methods and their modifications should be considered one of the most useful versatile reconstruction methods. Namaste flap in addition to the advantages of subcutaneous pedicle propeller flap also negates the disadvantages caused by the use of split skin grafting of the donor area.

From the Department of Plastic, Burns and Maxillofacial Surgery, Safdarjung Hospital, V.M. Medical College, Delhi, India.

Received September 15, 2018, and accepted for publication, after revision July 18, 2019.

Conflicts of interest and sources of funding: none declared.

Ethics approval and consent to participate: Institutional ethical committee approval for the modification of technique was obtained. The consent of participation was obtained from all the patients.

Consent for publication: The consent of publication was obtained from all the patients.

Authors' contributions: D.K. was the operating surgeon. D.K. contributed to conception and design, acquisition of data, and analysis and interpretation of data. V.M. and S.D. drafted the article and took part in and revising the article. S.D. prepared the artistic representations. All authors gave final approval of the version to be published.

Reprints: Durga Karki, MS, MCh (Plastic surgery), DNB, MNAMS, FICS, FAIS, Department of Plastic, Burns and Maxillofacial Surgery, Safdarjung Hospital, V.M. Medical College, Yamuna 5, Flat No. 201, D/6, Vasant Kunj, New Delhi 110070, India. E-mail:

Online date: October 29, 2019

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