Abstract：
BACKGROUND: Axillary cicatricial contracture is a debilitating condition that can greatly impair shoulder joint function. Therefore, timely correction of this condition is imperative. In light of Ogawa\'s prior classification of axillary cicatricial contracture deformities, we have proposed a novel classification system and reconstruction principles based on a decade of treatment experience. Our proposed system offers a more comprehensive approach to correcting axillary cicatricial contracture deformities and aims to improve patient outcomes.
METHODS: Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II).
RESULTS: For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees.
CONCLUSIONS: We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.
METHODS: Our study included 196 patients with a total of 223 axillary cicatricial contracture deformities. The range of shoulder abduction varied between 10 and 120 degrees. Our treatment approach included various methods such as the lateral thoracic flap, transverse scapular artery flap, cervical superficial artery flap, medial upper arm flap, latissimus dorsi flap, Z-shape modification, and the use of local flaps combined with skin grafting. After 2 weeks, the sutures were removed, and patients were instructed to start functional exercises. To categorize the deformities, we divided them into 2 types: axillary-adjacent region cicatricial contracture (type I) and extended area contracture (type II).
RESULTS: For each subtype, a specific treatment method was chosen based on a designed algorithm decision tree. Out of the total cases, 133 patients underwent treatment with various types of local flaps, including Z-plasty, whereas 63 patients received treatment involving skin grafting and different types of local flaps. At the time of discharge, the abduction angle of the shoulder joint ranged from 80 to 120 degrees. Among the 131 patients who were followed up, 108 of them adhered to a regimen of horizontal bar exercises. After a 1-year follow-up period, the abduction angle of the shoulder joint had significantly improved to a range of 110-180 degrees.
CONCLUSIONS: We have proposed a novel classification method for the correction of axillary cicatricial contracture deformity. This approach involves utilizing distinct correction strategies, in conjunction with postoperative functional exercise, to ensure the effectiveness of axillary reconstruction.
摘要：
背景：腋窝瘢痕挛缩是一种使人衰弱的疾病，可以极大地损害肩关节功能。因此,及时纠正这种情况势在必行。根据小川对腋窝瘢痕挛缩畸形的先前分类，基于十年的治疗经验，我们提出了一种新的分类系统和重建原则。我们提出的系统提供了一种更全面的方法来矫正腋窝瘢痕挛缩畸形，旨在改善患者的预后。
方法：我们的研究包括196例患者，共223例腋窝瘢痕挛缩畸形。肩展的范围在10到120度之间变化。我们的治疗方法包括各种方法，例如胸外侧皮瓣，肩胛骨横动脉皮瓣，颈浅动脉皮瓣,上臂内侧皮瓣,背阔肌皮瓣,Z形修改，并采用局部皮瓣结合植皮。2周后,缝线被移除,并指示患者开始功能锻炼。为了对畸形进行分类，我们将它们分为2种类型：腋窝相邻区域瘢痕挛缩（I型）和扩展区域挛缩（II型）。
结果：对于每个子类型，根据设计的算法决策树选择了具体的处理方法。在所有案件中，133例患者接受了各种类型的局部皮瓣治疗，包括Z-成形术,而63例患者接受了包括植皮和不同类型局部皮瓣的治疗。在出院时，肩关节外展角80～120度。在接受随访的131名患者中，他们中的108人坚持单杠练习的方案。经过1年的随访，肩关节外展角度显著改善至110-180度。
结论：我们提出了一种新的分类方法，用于矫正腋窝瘢痕挛缩畸形。这种方法涉及利用不同的校正策略，结合术后功能锻炼，保证腋窝重建的有效性。
方法：我们的研究包括196例患者，共223例腋窝瘢痕挛缩畸形。肩展的范围在10到120度之间变化。我们的治疗方法包括各种方法，例如胸外侧皮瓣，肩胛骨横动脉皮瓣，颈浅动脉皮瓣,上臂内侧皮瓣,背阔肌皮瓣,Z形修改，并采用局部皮瓣结合植皮。2周后,缝线被移除,并指示患者开始功能锻炼。为了对畸形进行分类，我们将它们分为2种类型：腋窝相邻区域瘢痕挛缩（I型）和扩展区域挛缩（II型）。
结果：对于每个子类型，根据设计的算法决策树选择了具体的处理方法。在所有案件中，133例患者接受了各种类型的局部皮瓣治疗，包括Z-成形术,而63例患者接受了包括植皮和不同类型局部皮瓣的治疗。在出院时，肩关节外展角80～120度。在接受随访的131名患者中，他们中的108人坚持单杠练习的方案。经过1年的随访，肩关节外展角度显著改善至110-180度。
结论：我们提出了一种新的分类方法，用于矫正腋窝瘢痕挛缩畸形。这种方法涉及利用不同的校正策略，结合术后功能锻炼，保证腋窝重建的有效性。
