title: Long-term postoperative outcomes after axillary contracture release in children with burns.
abstract: Children with upper extremity burns frequently develop axillary contractures that can restrict movement. Surgical axillary contracture release is performed to restore function. The purpose of this study is to determine the long-term effects (up to 7 years) of surgical axillary contracture release on upper extremity motion during simulated activities of daily living using three-dimensional motion analysis. Motion analysis was conducted on 10 subjects (9 males and 1 female; 16 axillary contractures; mean age 10 ± 3 years at baseline; mean TBSA burn 40 ± 15%) before, 1 year after, and 2 to 7 years (mean 3 ± 2 years) after axillary contracture release with split-thickness skin graft surgery. Movements were analyzed during three functional tasks including high reach (reaching overhead for an object), hand to head (combing hair), and hand to back pocket (toileting). Two-tailed paired t-tests were used to compare presurgical and postsurgical scores. Surgical release of the axillary contracture increased shoulder mobility and decreased compensatory movements. Improvements were maintained at long-term follow-up. All shoulder movements with the exception of shoulder flexion during the high reach task and shoulder abduction during the hand to back task were not significantly different than normal values at long-term follow-up. Axillary contracture release surgery improves shoulder function in the short and long term. Motion analysis is a modality that may prove valuable in objectively quantifying changes in movement patterns immediately and in subsequent years after burn injury.
authors.affiliation: Motion Analysis Laboratory, Shriners Hospitals for Children Northern California, Sacramento, California 95817, USA.
authors.forename: Mitell
authors.initials: M
authors.lastname: Sison-Williamson
authors.forename: Anita
authors.initials: A
authors.lastname: Bagley
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D001134:Arm Injuries / Q000503:physiopathology* / Q000601:surgery*; D001365:Axilla / Q000293:injuries* / Q000503:physiopathology* / Q000601:surgery*; D002056:Burns / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D016038:Skin Transplantation; D016896:Treatment Outcome