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Post-burn axillary contractures in pediatric patients: a retrospective survey of management and outcome
Malachy E Asuku1, Abdulrasheed Ibrahim, Ferdinand O Ijekeye
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, P M B 1026, Zaria 810001, Kaduna State, Nigeria. measuku@yahoo.ca
Insights
Surgical correction of pediatric axillary contractures varied by severity. Local flaps were effective for mild cases, while severe contractures required grafts or fasciocutaneous flaps, impacting functional outcomes.
Area of Science:
- Pediatric Surgery
- Orthopedics
- Reconstructive Surgery
Background:
- Axillary contractures in children can significantly impair shoulder joint mobility.
- Surgical intervention is often necessary for functional restoration.
Purpose of the Study:
- To evaluate the surgical correction outcomes for pediatric axillary contractures based on severity.
- To correlate surgical techniques with functional results in different contracture types.
Main Methods:
- Retrospective analysis of 74 axillary contracture corrections in 63 children (≤15 years) over 5 years.
- Classification of contractures into Type I, II, and III using Kurtzman and Stern's criteria.
- Assessment of shoulder joint movement and functional outcomes 2 years post-surgery.
Main Results:
- Type I contractures (n=56) were successfully treated with local flaps, achieving excellent functional outcomes (A).
- Type II contractures (n=11) required skin grafts or fasciocutaneous flaps, with 82% excellent (A) and 18% good (B) results.
- Type III contractures (n=7) showed varied outcomes: 28% excellent (A), 57% good (B), and 14% poor (C).
Conclusions:
- Surgical technique selection is crucial for pediatric axillary contracture correction.
- Mild contractures have excellent prognoses with local flaps, while severe cases necessitate advanced techniques with variable functional outcomes.
Abstract:
Over a 5-year period, 63 children aged 15 years and less had surgical correction of 74 axillary contractures in our center. They were grouped into three severity categories based on the Kurtzman and Stern's classification. Accordingly, 56 were type I, 11 were type II and 7 were type III axillary contractures. While local flaps sufficed in all the type I contractures, skin grafts and fasciocutaneous flaps were required in types II and III. The principal movements at the shoulder joint were assessed at 2 years after, and functional outcome classified into three outcome categories. Excellent result (A) was obtained in all the type I contractures, 82% of the type II contractures and 28% of the type III contractures. Good result (B) was obtained in 18% of the type II and 57% of the type III contractures and poor result (C) was obtained in 14% of the type III contractures.
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