Total Shoulder Adduction Contracture Treatment with Preserved Skin in Axilla Apex: Anatomy and Treatment

Abstract

Total shoulder adduction contracture is caused by extensive scars covering the flexion lateral and flexion medial shoulder joint surfaces and neighboring and regional areas. In some cases, a small island of healthy skin is preserved in the axilla apex because, during the burn, the shoulder takes on an adducted position. Because of severe scar surface deficit, a large wound appears after contracture release; therefore, a large flap is needed for reconstruction. The treatment is complicated by shrinkage of skin transplants in the axillary region, which causes re-contracture. If the chest wall (donor site) is injured, the flaps can’t be used, and this further complicates reconstruction. The problem is more apparent in pediatric patients. For such cases, we developed a new reconstructive technique based on the use of island skin in the form of subcutaneous pedicle flap by which, after releasing contracture, the axilla is suspended and the large wound is divided into two parts: shoulder and thoracic. This simple and safe method prevents transplants from shrinking and contracture recurrence.