Shoulder Burn Contracture Surgery in Pune: Releasing a Tight Armpit

What is a shoulder burn contracture?

The armpit (axilla) is one of the most common sites for burn contractures. Burns to the chest, upper arm and side of the body often cross the armpit, and while healing, people keep the arm by their side because it is the most comfortable position. The scar then shortens in that position.

Contractures here take several forms:

• A band along the front fold of the armpit, running from the chest to the arm.
• A band along the back fold, from the shoulder blade to the arm.
• Both folds affected, with the armpit dome spared.
• A web or sheet of scar across the whole armpit, sometimes involving the side of the chest.

The result is difficulty raising the arm, reaching overhead, dressing, washing the back or hair, and carrying out work that needs full shoulder movement.

Who may benefit, and how is it assessed?

Release is considered when the arm cannot be raised enough for daily activities or work, or when the tight scar is uncomfortable or breaks down. The surgeon measures how far the arm lifts to the side and forwards, identifies which folds are tight and how wide the scar is, and checks whether the shoulder joint itself has stiffened from long-standing restriction. Healthy skin nearby is assessed for flaps.

What are the treatment options?

Option	Suits	Points to consider
Stretching and splinting	Early tightening while scars mature	Prevents worsening; limited for established bands
Z-plasty or multiple Z-plasties	Narrow bands at the front or back fold	Lengthens the band using nearby skin
Square, V-Y or other local flaps	Bands with healthy skin on one or both sides	Good function; little contraction
Release and skin graft	Wide scars across the whole armpit	Needs longer splinting; can contract
Flap from the back or chest	Severe, recurrent contractures	Larger surgery; durable result

Grafting is described under skin grafting surgery, and non-surgical options under burn scar treatment. A tight elbow often accompanies an armpit contracture; see elbow burn contracture surgery.

How is armpit contracture release performed?

1. Anaesthesia: general anaesthesia, with the arm positioned to stretch the scar.
2. Design: Z-plasties or flaps are drawn along the tight bands.
3. Release: the bands are cut and the flaps transposed, or the scar is cut across and the arm raised until movement is restored.
4. Cover: flaps are stitched in place, and any remaining gap is grafted.
5. Splinting: the arm is held raised out to the side in a padded splint.

How should you prepare, and what should you ask?

• Continue stretching exercises before surgery.
• Arrange help at home, as one arm will be splinted.
• Wear loose, front-opening clothing.

Questions to ask:

• Which folds are tight, and will you use flaps or grafts?
• How much movement can I expect to gain?
• How long will the splint be needed?
• When can I drive and work?

What is recovery like?

Time	What to expect for most patients
Days 1-5	Arm splinted out to the side; wound checks
Weeks 1-2	Stitches removed; physiotherapy starts
Weeks 2-6	Splint continued as advised; active exercises
Months 2-6	Night splint; scar softening; strength builds

What are the risks?

• Recurrent tightness, more likely after grafts and if splinting stops early.
• Flap tip loss or partial graft loss.
• Fluid collection in the armpit.
• Shoulder stiffness from long-standing restriction.
• Numbness of the inner upper arm.

Contact the team for increasing pain, swelling, fever or discharge from the wound.

What results can you expect?

Most people gain a substantial increase in how far the arm can be raised, especially when bands are released with flaps. Continued splinting and physiotherapy are needed to hold the improvement while the scars mature.

What happens if a shoulder burn contracture is left untreated?

A mature armpit band rarely loosens with daily activity. Over time the shoulder capsule and the muscles around the joint stiffen, so the arm may not rise fully even after the skin is released. People adapt by hitching the shoulder blade or leaning the trunk sideways to reach a high shelf. Bands that extend onto the chest wall may distort breast development in girls and young women. When the armpit, elbow and hand on one side are all tight, the armpit and elbow usually need releasing before hand surgery is practical. While the scar matures, overhead stretches, resting with the arm raised on pillows and a night abduction splint may control an early band.

Common myths about shoulder burn contractures

• “Keeping the arm close to the body helps the armpit heal.” Holding the arm by the side is the very position in which armpit scars shorten, so it is usually rested raised out to the side.
• “Hanging from a door frame will free the band quickly.” Jerky, full-weight stretches can tear scar in the armpit fold, whereas slow, repeated stretches are kinder to healing skin.
• “If the arm lifts halfway, surgery is not worth considering.” Partial restriction can still limit combing hair, hanging clothes and overhead work, so the decision depends on function rather than an angle alone.
• “Shoulder stiffness after a burn is always in the joint, so physiotherapy alone will fix it.” When a mature skin band is the main block, exercises rarely lengthen it enough.

What affects the cost of shoulder burn contracture surgery in Pune?

• Extent of scarring and whether one or both armpits are affected.
• Technique: Z-plasty, local flaps, grafts or larger flaps.
• Hospital stay and anaesthesia.
• Splints and physiotherapy sessions.