A Clinical Study on Post Burn Contracture of Axilla at a Tertiary Care Centre

Abstract

Introduction: The joint problems and deformities noted in burn patients are mostly due to physical inactivity combined with limitation of joint movement because of scar contracture. Restoration of function in upper limb varies according to the surgical procedure opted and post operative compliance. Surgical intervention is still a challenge, because the axilla is a unique three dimensional pyramid. Aim :To study the outcome of various surgical procedures done for post burn contracture of axilla and their complications.Materials and methods: This prospective study was done on 20 patients who presented with PBC axilla to Department of Plastic & Reconstructive Surgery, Osmania General Hospital, Hyderabad during the period of study i.e., July 2019 to January 2021.Results: 20 patients were included in the study.8 patients presented 6 to 12 months after sustaining burns,7 patients between 13 to 24 months and 5 patients presented after 3 years. Patients gave history of no physiotherapy and splinting for their axilla during the acute burn stage treatment, pre operative abduction ranged between 20° and 90° with a mean of 48°. Post operative abduction achieved was between 90° and 160° with a mean of 130°. 10 patients(50%) had undergone contracture release and SSG, multiple Z plasties were done in 5 patients(25%), one patient had undergone transposition flap and SSG(5%), thoracodorsal artery perforator flap was done in one patient(5%), propeller flap was done in two patients (10%), parascapular flap was done in one patient (5%). One patient had partial graft loss(5%) following contracture release and SSG, one patient had reccurence (5%), one patient had tip necrosis (5%).Conclusion: Axillary burn contracture can be prevented by proper management of acute burns stage, positioning of the shoulder joint, use of abducted split, aggressive early physiotherapy and early resurfacing of raw area. Z plasty and local flaps are used in mild cases. Release and SSG is the best treatment for severe PBC axilla.