Shoulder Medial Adduction Contracture: Anatomy and Treatment with Local Adipose Scar Trapezoid Flaps

Abstract

Medial shoulder adduction contracture is a result of burns and scars of the axillary fossa, the joint flexion medial (FM) surface, and the inner surface of the shoulder and truncal lateral surface. Scars undergo repeat injury with shoulder abduction, and this stimulates connective scar tissue to grow. Therefore, scars of the axilla, growing distally and contracting, cause smoothing of the axillary fossa, pull axilla down, and form a crescent fold, where the crest passes along the medial line of axilla. The shoulder medial contracture is an unknown form of scar contracture, not included in existing classifications, and reconstructive techniques for its elimination have not yet been developed. Our broad experience has shown that medial scar contractures represent 8–10% of all axillary contractures. In this chapter we present all aspects of shoulder medial contractures from formation to treatment.