Shoulder edge anterior adduction contracture in pediatric patients after burns: Anatomy and treatment: A new approach  Viktor M. Grishkevich, Max Grishkevich, Vasiliy A. Menzul  Burns Open  Volume 2, Issue 3, Pages 130-138 (July 2018) DOI: 10.1016/j.burnso.2017.09.001 Copyright © 2017 Terms and Conditions

Fig. 1 Anatomy of shoulder edge scar anterior adduction contracture and treatment with axillary adipose-cutaneous layer. (A) Scars covered shoulder joint anterior flexion lateral (FL) surface, chest wall and shoulder; crescent-shaped ulcerous fold (Fd) along anterior axillary edge; lateral fold sheet is scar and continuation of scars of FL surface; medial sheet and axillary fossa (flexion medial surface (FM)) is healthy skin; contracture caused with scars of FL and Fd; (B) pre-operative view (next case, two-year girl): edge shoulder adduction contracture caused with fresh scars, covering joint’s anterior surface, thoracic and abdomen walls; planning of operation: borders of scars to be excised; (C) scars on anterior shoulder joint surface excised, whole axillary adipose-cutaneous layer mobilized; (D) flap transposed on the wound; (E) one month after operation: contracture eliminated, scar deformity reduced; (F) two years after surgery: surface of transposed tissue increased, axillary region restored. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 2 Edge shoulder anterior adduction contracture anatomy and treatment by contracted deformed scars excision and wound covering with axillary whole adipose-cutaneous layer. (A and B) Pre surgery, anatomy: scar causing contracture covered joint flexion lateral surface (FL) and form the fold lateral sheet of which is scars; E-joint extension surface; FM-flexion medial surface or joint fossa; dotter line- border of scars to be excision; (C) axillary adipose-cutaneous layer mobilized and covered the wound, contracture eliminated; (D) one year after surgery: excellent functional and good cosmetic results; joint anterior surface restored with healthy skin, donor site stayed undamaged. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 3 Edge shoulder anterior contracture and scar deformity (breast including) treatment using scars excision and whole axillary adipose-cutaneous layer transposition on the wound. (A) Pre-operative view: edge adduction contracture, shoulder and breast deformity, planning of operation; (B) - flap mobilized; (C and D) – scars excised, including breast area and shoulder, wound closed with healthy tissue; (E) result (two months after operation): adduction contracture and breast deformity eliminated. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 4 Severe left shoulder adduction edge contracture and lateral neck contracture treatmentr with axillary adipose-cutaneous layer (shoulder) and neck with trapeze-flap plasty. (A) Before operation, anatomy: joint’s surfaces: E-extension; “+” joint rotation axis; FL-flexion lateral; Fd-fold; Cr-crest; FM-flexion medial surface (fossa); (B) planning operation, lines: along fold crest, Y-line- scars dissection from the fold crest to the joint rotation axis; C- scars incised end excised, trapezoid wound appeared; Dt- scar surface deficit, contracture cause; FP-flap/layer; (D) end of operation: contractures removed, part of joint anterior surface covered with skin. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 5 Severe shoulder joint edge adduction contracture treatment with contracted scars excision and wound covering with axillary adipose-cutaneous layer. (A) Pre surgery; (B) scars of FL surface formed wide fold (Fd); (C) contracture anatomy (standard marketing); (D) 25days after operation: complete contracture released and skin restored on joint anterior surface, shoulder and chest wall. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 6 Mild shoulder anterior contracture elimination and scars removal of shoulder joint and the shoulder. (A) Pre surgery view, planning; (B) ten days after operation. Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions

Fig. 7 Results of shoulder joint contracture and deformity elimination with adipose-cutaneous axillary layer. First case (A and B); next case (C and D); last case (E). Burns Open 2018 2, 130-138DOI: (10.1016/j.burnso.2017.09.001) Copyright © 2017 Terms and Conditions