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Article Type

Original Study

Abstract

Objectives The aim of the study was to evaluate different options for postburn axillary contracture treatment. Background Axillary postburn contractures remain a frequent problem after thermal burns involving the trunk and upper arm. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. Patients and methods A prospective study of 25 patients with postburn axillary contracture was conducted. The contractures were classified according to the Kurtzaman classification and reconstructed using different methods including skin grafting, local flaps (Z-plasty and five flaps), and regional flaps (parascapular, scapular, and thoracodorsal artery flap). Postoperative follow-up continued for 6 months. Patients had to undergo a physiotherapy course as a routine part of each technique. Results The ages of the patients ranged from 7 to 46 years. Type of contracture was type 1A in 12 cases (48%), type 1B in four cases (16%), type 2 in four cases (16%), and type 3 in five cases (20%). The degree of abduction ranged between 50 and 130° with a mean of 100°. Split thickness graft was used in four cases (16%). Local flaps were used in 16 patients - Z-plasty in six patients (24%) and five flaps in 10 patients (40%) - and regional flaps were used in five patients (20%). The improvement in abduction seen postoperatively in the studied cases ranged from 25 to 80° with a mean of 55°. The overall functional and cosmetic results were satisfactory in most of the cases. Conclusion Z-plasty is suitable for short linear band contractures; the five-flap technique is indicated in longer ones. For type II and III contractures regional flaps are the treatment of choice whenever available. For severe cases release and split skin graft is indicated. Postoperative rehabilitation is very important to avoid recurrence and to maintain the result achieved.

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