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The early release of axillary contractures in pediatric patients with burns
D G Greenhalgh1, T Gaboury, G D Warden
1Shriners Burns Institute, Cincinnati, OH 45219.
Insights
Early contracture release for burn scars significantly improves range of motion. Releasing immature scars is not detrimental and leads to similar outcomes as delayed releases, preventing prolonged immobility.
Area of Science:
- Plastic Surgery
- Burn Rehabilitation
- Scar Management
Background:
- Conventional wisdom advises delaying contracture release until burn scars mature.
- Prolonged immobility due to contractures can lead to significant loss of range of motion.
- Early intervention aims to prevent long-term functional deficits.
Purpose of the Study:
- To evaluate the efficacy of axillary contracture releases.
- To determine if releasing contractures in immature scars is detrimental.
- To assess the impact of release timing on range of motion outcomes.
Main Methods:
- Retrospective evaluation of axillary releases performed between 1988 and 1989.
- Analysis of improvements in shoulder abduction and flexion.
- Comparison of outcomes between early (<1 year) and late (>1 year) release groups.
Main Results:
- Axillary releases significantly improved both abduction and flexion.
- Functional improvements were sustained for at least one year post-release.
- While early releases had worse preoperative limitations, final outcomes were comparable to late releases.
Conclusions:
- Early contracture release in immature scars is effective and not detrimental.
- Waiting for scar maturation is unnecessary for achieving good functional outcomes.
- Timely intervention optimizes range of motion recovery after burn injuries.
Abstract:
In spite of the common teaching that contracture releases should be avoided until scars have matured, the Cincinnati Shriners Burns Institute has been releasing contractures in immature scars to prevent prolonged loss of range of motion. To evaluate the efficacy of axillary releases and, especially, to determine whether releases performed in immature scars were detrimental, axillary releases that were performed between January 1, 1988 and December 31, 1989 were evaluated for improvements in abduction and flexion. Overall, axillary releases significantly improved abduction and flexion, and the improvement was maintained for at least 1 year. Comparison of early (less than 1 year after burn injury) with late (more than 1 year after burn injury) releases revealed that the preoperative limitation was worse in the early release group but that the ultimate outcomes were similar. Waiting for scars to mature before performance of contracture releases is not necessary.