Choice of the method for eliminating postburn shoulder joint contractures

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Abstract

BACKGROUND: In the Russian Federation, over 400,000 patients with thermal injuries are registered yearly, with approximately 30% of them requiring hospitalization. Physicians pay special attention to the rehabilitation of patients with complications of deep burns. According to several authors, deep burns occur in 47% of cases. The most common complications of deep burns are contractures and limb deformities. Shoulder contractures occur in over 50% of patients. The outcomes and terms of a patient’s return to active social and working life depend on the timeliness and selection of an optimal surgical intervention from a wide range of reconstructive and plastic techniques.

AIM: This study aimed to improve the functional and esthetic results of surgical treatment in patients with postburn shoulder joint contractures.

MATERIALS AND METHODS: From 2011 to 2020, 198 patients underwent surgery, including 59% women and 41% men. Right shoulder, left shoulder, and right and left shoulder simultaneous joint contractures occurred in 54.5%, 38.5%, and 7% of cases, respectively. The patients’ age ranged from 18 to 72 years, and 99% of them were of working age. The scope of preoperative examination included clinical data, photographic documentation, duplex vascular scanning, and determination of the degree of contracture using a mechanical goniometer. Patients with grade I, II, and III shoulder joint lesions accounted for 29%, 60%, and 11% of the total number of cases, respectively. Early surgical rehabilitation prevents the development of secondary myogenic and arthrogenic contractures and accelerates the patient’s social reintegration. Local tissue plasty using the armpit adipodermal tongue-shaped flap, a nonperforated full-layer or split skin graft, a rotated flap based on perforating vessels, and the expander stretching method were used to eliminate contractures.

RESULTS: Bacterial infection, total and marginal necrosis, hematomas, and seromas were not observed in the immediate postoperative period. Complete elimination of the shoulder joint contracture was achieved in 63% of cases, whereas joint mobility increased by over 60° in 30% of patients.

CONCLUSIONS: The algorithm presented for choosing a method of surgical rehabilitation for patients with shoulder joint contractures leads to an increase in the efficiency of reconstructive surgery after burn injuries.

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About the authors

Pavel V. Sarygin

A.V. Vishnevsky National Medical Research Center

Email: psarygin@mail.ru
ORCID iD: 0000-0003-3787-2147

MD, Dr. Sci. (Med), Professor

Russian Federation, 27, Bolshaya Serpukhovskaya str., Moscow, 117997

Yulia A. Stepanova

A.V. Vishnevsky National Medical Research Center

Email: stepanovaua@mail.com
ORCID iD: 0000-0002-5793-5160

MD, Dr. Sci. (Med)

Russian Federation, 27, Bolshaya Serpukhovskaya str., Moscow, 117997

Nataliya V. Gushchina

A.V. Vishnevsky National Medical Research Center

Author for correspondence.
Email: gnv1009@gmail.com
ORCID iD: 0000-0001-9985-760X
Russian Federation, 27, Bolshaya Serpukhovskaya str., Moscow, 117997

References

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Supplementary files

Supplementary Files
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1. Fig. 1. Appearance of a patient with anterior marginal contracture who underwent surgical treatment by adipodermal tongue-shaped flap plasty: а, before surgery; b, formation of an adipodermal tongue-shaped flap along the lateral border of the latissimus dorsi; c, after surgery.

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2. Fig. 2. Appearance of a patient with anterior marginal contracture of both shoulder joints who underwent single-stage surgical treatment: a, before surgery; b, after surgery.

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3. Fig. 3. Appearance of a patient with bilateral marginal contracture of the shoulder joint who underwent surgical treatment by local tissue plasty and nonperforated split skin autograft: а, before surgery; b, flap formed; c, wound surface closed by split autograft; d, after surgery.

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4. Fig. 4. Appearance of a patient with total contracture of the shoulder joint who underwent surgical treatment with a rotated flap of the a. thoracodorsalis perforator: а, b, before surgery; c, flap separated, the recipient bed free of scar tissue; d, e, after surgery.

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5. Fig. 5. Ultrasound image in color Doppler mapping mode with visualization of the a. thoracodorsalis perforator.

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