Step-by-Step of New Method Development for Treatment of Postburn total (Severe) Shoulder Adduction Contractures: Anatomic Substantiation and Results - Abstract
Background: The review of literature and personal observations proved that the anatomy of total shoulder adduction contractures is insufficiently researched, and the efficacy of typically used surgical techniques is low. Skin transplants in axilla shrink and contracture often recurs; local triangular and other form flaps are small for big scar/skin surface deficit compensation and complete contracture elimination. Therefore, the thoracic flaps of different form and size are used despite the traumatic nature of the technique. The harvesting of a large flap deforms the chest wall. Often, thoracic flaps have insufficient dimensions; therefore, the contracture is not released completely. Having rich clinical material, we tested existing techniques without a satisfactory outcome, and undertook further research to find a scientific solution to this complex surgical problem. Material and Method: Our research was based on clinical exploration and surgical treatment of 58 patients, pediatric and adults, with total adduction contractures, using the following four techniques consecutively: (a) thoracodorsal flaps; (b) subcutaneous pedicle flap from island axillary skin in conjunction with skin transplants; (c) quadrangular subcutaneous pedicle flap from local axillary scars and skin transplants island axillary skin. The patients’ age ranged from 5 to 43 years old. TBS was from 6 to 56%; patients underwent surgery after 6 months to 2 years after burns. The research was directed towards transformation of the role of the flap: from covering the wound into suspending the axilla. Skin transplants were to be used for wound coverage. Results: Presented new surgical method solved the problem of treatment of the most complex total shoulder contracture. The method is easy to plan and perform, less traumatic, easily tolerated by children, leaving the donor site undamaged. In all cases, total shoulder contractures were fully eliminated, and no re-contractures were noticed. New flap location allowed us to use different forms and sizes of flaps, local and regional, which made the technique less traumatic and more effective and accessible for successful treatment of all total shoulder scar contractures. Conclusion: The new technique is exclusively effective for total shoulder contractures elimination. Method consists in stable axilla suspension with local scar axillary subcutaneous pedicle flap and wounds covering with whole skin transplants. Axilla suspension and wound division on thoracic and shoulder prevents skin transplants shrinkage and contracture recurrence.