Surgical Options For Axillary Contractures

摘要

Background: The axilla is one of the most frequently affected areas by post burn contractures with associated cosmetic and functional problems. A variety of therapeutic options exist but when this is not properly chosen or post operative rehabilitation is not properly adhered to, recurrence is often seen. The aim of this paper is to highlight the various management options used in managing these problems in a burn unit and itemize complications commonly encountered.Materials And Methods: This is a retrospective review of cases of axillary contractures managed at the National Orthopaedic Hospital over a period of 5 years. The sources of information were the operation registers and the case notes of the patients. Information obtained include age, sex, part of the axilla involved, other associated post burn problems, option(s) of treatment, complications and results. Results: A total of 37 patients presented with axillary contractures involving 42 axillae. Their ages range between 2 and 47 years with a mean of 23.1 years. There were 20 males and 17 females. Surgical options used includes local fasciocutaneous flaps, 18(42.8%)axillae, single z-plasty in 6 (14.3%) axillae, split thickness skin graft in 6(14.3%) axillae, multiple z-plasty in 3(7.1%)and myocutaneous flaps including latismus dorsi in 5(11.9%), double opposing z-plasty in 2(4.8%) while v-y plasty and 5-flaps z-plasty were used in 1(2.4%) each.Conclusion: Contracture release with skin grafts has the highest recontracture rate with local flaps in many forms giving good results with minimal complications. Introduction Axillary contractures commonly result from deep burn to the trunk especially when adequate rehabilitation is not given to the patients. It is often seen in our environment following poorly treated burn injuries especially when the conservative approach is the method of achieving cover for a burn wound around the shoulder joint. This often interferes with the ability to feed and perform other important upper extremity functions. Contracture release should therefore encompass the entire axis of rotation of the shoulder to facilitate complete range of motion. A variety of therapeutic methods such as skin grafting, z-plasties, local flaps, island flaps, and free flaps have been reported for treatment of axillary contractures.A review of options of managing this problem in a burn unit of a developing country is hereby presented with various options and complications following each of the options. Materials And Methods A retrospective review of all axillary contractures managed surgically in our burn unit at the National Orthopaedic Hospital, Enugu was carried out. The period of study was between 2000-2004. Sources of information were the patients' folders as well as the operation register.The age, sex, involved axillae; methods of surgical correction and accompanying results of these methods and complications of each method were noted. Results A total of 37 patients presented over the study period with axillary contractures involving a total of 42 axillae. Their ages range between 2 years and 47 years with a mean of 23.1 years. There were 20 males and 17 females. The right axilla was involved in 19(51.4%) patients, left axilla in 14(37.8%) patients while both axillae were involved in 4(10.8%) patients.Agents responsible for the burn injuries in these patients were flame (48%), corrosive (32%) and scalds (20%).Anterior axillary fold was involved in 22 axillae, posterior axillary folds in 9 axillae while both axillae were involved in 4 axillae and the apex of the axilla was involved in 2 patients while the part of the axilla affected in one patient was not stated in the folder.The surgical options used in managing these patients following contracture release includes local fasciocutaneous flap which was the commonest method in 18(42.8%)axillae, single z-plasty in 6 (14.3%) axillae, split thickness skin graft in 6(14.3%) axillae, multiple z-plasty in 3(7.1%), double