Classification Systems & Clinical Outcomes of Axillary Burn Contracture: A Systematic Review & Meta Analysis

Abstract Axillary burn contracture is a common and debilitating complication of burn injuries, impairing mobility and quality of life. Multiple classification systems and reconstructive techniques exist, but optimal management remains unclear due to limited systematic data comparing outcomes across techniques and classifications. A systematic review was performed. PubMed, Embase, and Web of Science were searched for full-text studies reporting surgical treatment of axillary contractures. Data extraction and quality assessment were performed independently by two reviewers. Outcomes were synthesized qualitatively, and recurrence rates were meta-analyzed using a random-effects model. Planned subgroup analyses by contracture type were not feasible due to inconsistent reporting. Of 1196 articles screened, 62 met inclusion criteria, encompassing 1602 patients. Most studies were observational. Formal classification systems were inconsistently applied; Kurtzman and Stern classification was the most common one (16.1%). Commonly reported surgical techniques included trapeze flap plasties (n = 277), skin grafting (n = 239), skin grafting with local flaps (n = 85), and Z-plasties (n = 85). Meta-analysis of 78 studies (855 reconstructions) demonstrated a pooled recurrence rate of 13.0% (95% CI:10.7;15.8), with no heterogeneity (I2 = 0%). Meta-regression suggested higher recurrence rates with longer follow-up. Functional outcomes improved across studies, with flap-based reconstructions demonstrating greater gains in abduction (≈82°) than skin grafting (≈52°). In conclusion, flap-based techniques appear to provide lower recurrence and superior postoperative range of motion compared to skin grafting. However, inconsistent classification, predominance of observational studies, and variable outcome reporting limit direct comparisons. Standardized classification, quantitative range of motion metrics, and minimum follow up durations are needed to guide evidence-based surgical selection.