Bilateral Shoulder Edge Adduction Contracture: Anatomy and Treatment with Axillary Adipose-Cutaneous Trapezoid and Quadrangular Flaps, a New Approach

Background: Bilateral shoulder edge adduction contractures are result of vast burns and scars, restricting the upper limb motion and its development in children. There is no published research pertaining specifically to the anatomy of bilateral axillary contractures. Therefore, the used techniques based on triangular and other flaps’ forms, local and regional, were not anatomically substantiated. The cause of scar contracture (scar surface deficit) was not explored. Therefore, the suggested flaps did not match the scar surface deficit, and the contracture was often released incompletely. For this reason, we researched bilateral contractures’ anatomy and proposed an adequate scar surface deficit compensation local flap method. Methods: Anatomy and scars’ surface deficit (contracture cause) of bilateral contractures were studied in 45 patients (children and adults), before operation, during, and after surgery. Results: Using the new evidence, a new approach to treatment of shoulder bilateral contracture was developed. The treatment lies in surface deficit compensation using the surface surplus of sheets of the fold and entire tissue of the axillary fossa in the form of trapezoid adipose-cutaneous and neighboring flaps and tissues displacement on the donor wound. The surface surplus of sheets of the fold and undamaged adipose-cutaneous layer of axillary fossa allows scar surface deficit compensation and contracture elimination with one or two-stage technique without skin transplants, triangular local flaps and regional complex traumatic regular and expanded flaps that are typically used in the original technique. The procedure significantly improves the outcomes of the bilateral shoulder contracture treatment. Conclusion: The understanding of the edge contracture formation, anatomy and contracture cause open a new approach to forming of a diagnosis, planning of operation, and successful reconstruction without skin transplants and complex flaps.