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PubMed1983

Properties of caffeine- and potassium-contractures in fatigued frog single twitch muscle fibers.

The properties of caffeine contracture and potassium contracture in fatigued single fibers were examined in detail using frog semitendinosus muscle, Rana japonica. Fatigue was caused by repetitive stimulation at 2 Hz. The dose-response curve of caffeine contracture in the fatigued fibers was shifted toward the right; the threshold concentration of caffeine for the contracture in normal fibers was 1.5 mM, whereas that in fatigued fibers was 5 mM. However, in the presence of 25 mM K+ or 0.01% Triton X-100, caffeine contractures occurred sufficiently at the lower concentrations (3-5 mM) even in the fatigued fibers. Furthermore, in the fatigued fibers, the peak tension of the initial component of biphasic potassium contracture with 60 or 80 mM KC1 (C1 constant; 120 mM) was slightly inhibited, whereas the secondary component of the contracture was markedly inhibited. These results indicate that the permeability to caffeine of the transverse tubular membrane (T-membrane) of the fibers and the Ca influx in response to the direct depolarization of T-membrane with K+ are markedly inhibited in the fatigued fibers.

Animals↗
PubMed1975

[Isotonic contraction and contracture of the isolated right rat ventricle. Effect of La3+, prenylamine, ATP, Mg2+ (author's transl)].

1. The isolated right rat ventricle was immersed in Tyrode solution (25) ml) and stimulated electrically at a frequency of 60/min. Changes in the amplitude of isotonic contractions and contractures were assessed. 2. Isotonic contractions were reduced (after Prenylamine, ATP, Mg), or suppressed (by LaCl3 = 10 mM). Contracture was caused by Prenylamine (4 mg/25 ml Tyrode solution or more). 3. Addition of 100 mM KCl (NaCl reduced equimolarily to 37 mM did not influence contracture in the presence of the investigated substances with the exception of MgCl2 = 10 to 15mM, where only the rate of development of potassium contracture was reduced. 4. After previous immersion of the tissue in the presence of LaCl3 - 10 mM and Prenylamine 1-4 mg/25 ml Tyrode solution the contracture developed after removal of NaCl (substitution by sucrose 270 mM), which, however, declined after addition of NaCl only when previously treated with Prenylamine and not when treated with La. 5. Addition of 100 mM KCl (naCl reduced to 37 mM) after previous immersion of the tissue in the presence of the investigated substances caused contracture the rate of rise of which was smaller after La than in controls: after the remaining substances it did not differ. 6. Reduction of the contracture after reduction of KCl from 100 to 5.6 mM developed only after previous immersion of the tissue in the presence of ATP and Mg and not after previous immersion in the presence of Prenylamine and La. 7. The results are compared with biochemical findings. They suggest a shift of contractile Ca in the heart.

Adenosine Triphosphate↗
PubMed2006

[Repair of flexor contracture of the hand].

OBJECTIVE: To investigate the etiology of the flexor contracture of the hand, to diagnose and to explore its surgical treatment. METHODS: From May 1997 to June 2004, 212 cases of flexor contraction of the hand were treated with scar excision, thorough loosening the contracture, covering the secondary skin defects with free skin grafting, "Z"-plasty, double "V-Y" plasty, transposition of the palmar dorsum flap of the hand and iliac-inguinal flap. There were 163 males and 49 females, whose ages ranged from 3 to 61. There were 85 cases of left hands, 54 cases of right hands, and 73 cases of both hands. Contracture sites were as follow: 117 cases were in fingers, 32 cases located in palms and 63 cases were in both. Causes of deformity were as follow: 29 cases derived from burn and explosion, 127 cases came from contracture of palmar aponeurosis, 31 cases were because of traffic accident and machine extrusion, 5 cases for getting an electric shock, 14 cases for improper postoperative immobility, and 6 cases for other reasons. Course of diseases lasted for 2 to 24 months. RESULTS: 149 cases were followed up for 4 to 30 months. One fingertip was in necrosis and ended in nub plasty because of inappropriate time to leave hospital. Flexion contracture recurred in 7 cases, skin necrosis occurred to 3 cases whose scars were healed in the end, poor restoration of function was observed in 2 children patients for lack of exercise, and 2 skins contracted after free cut skin grafting. Others got satisfactory results. CONCLUSION: Once the pathogenesis and contracture factors are clearly known, timing and correct surgical measures are chosen, thorough contracture is loosened, and early postoperative exercises are performed, good effect will be achieved.

Adolescent↗
PubMed2006

[Early clinical outcome of total knee arthroplasty for flexion-contracture deformity knees of different degrees].

OBJECTIVE: To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. METHODS: Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpion posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirty-three patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8 degrees (range, 5-140 degrees). According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexion-contracture less than 20 degrees (range, 0-15 degrees), and group B consisted of the patients with flexion-contracture not less than 20 degrees (range, 20-60 degrees). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7 +/- 8.0 degrees, 104.6 +/- 20.0 degrees, 29.1 +/- 18.0, and 32.6 +/- 20.7, respectively. But the corresponding data were much worse in group B than in group A, which were 28.2 +/- 7.8 degrees, 60.8 +/- 26.6 degrees, 12.1 +/- 13.2, and 26.8 +/- 18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee. RESULTS: The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4 +/- 2.1 degrees, 108.6 +/- 19.0 degrees, 82.1 +/- 13.8, and 72.3 +/- 29.1, respectively; and the corresponding data in group B were 1.3 +/- 3.2 degrees, 98.6 +/- 16.40, 75.9 +/- 8.2, and 81.4 +/- 26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. CONCLUSION: The curative effect is mainly determined by the surgeon's good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexion-contracture deformity. The knee ROM after TKA, which has a "toward middle ROM" phenomenon, is influenced by many clinical factors. It is very important for the patient to perform a functional exercise of the knee as early as possible after operation.

Adult↗
PubMed1994

Breast capsule contracture: is fibroblast activity associated with severity?

Factors responsible for breast capsule contracture remain elusive. Using an in vitro model of wound contraction, the fibroblast-populated collagen lattice (FPCL), breast capsule fibroblasts and control dermal fibroblasts from ten patients were analyzed. Comparison was made to determine (1) if the activity of dermal fibroblasts on a collagen lattice correlated with the activity of breast capsule fibroblasts or if capsular fibroblasts are unique, and (2) if the degree of fibroblast-driven collagen contraction correlated with clinical severity of breast capsule contracture. If so, a preoperative predictor of breast capsule contracture would be available. Dermal fibroblasts and breast capsule fibroblasts were cultured and mixed with media and collagen to form a matrix, and then the degree of lattice contraction was measured. A correlation between breast capsule fibroblasts and control dermal fibroblasts with respect to collagen matrix contraction was confirmed. Collagen lattice contraction coordinated by fibroblasts derived from breast capsules did not correlate with clinical severity of capsular contracture. These results indicate that the degree of breast capsule contracture can not be predicted by fibroblast activity alone. An interaction between inflammatory cells, extracellular matrix, and fibroblasts is hypothesized. Further work is needed to delineate the mechanisms responsible for breast capsule contracture.

Breast↗
PubMed1982

The gastrocnemius muscle flap in the correction of severe flexion contracture of the knee.

Extreme flexion contracture of the knees due to extra-articular contracture of the knee joints is a frequent deformity in catastrophic neurological lesions such as multiple sclerosis, meningomyelocoele, paraplegia, quadriplegia, and cerebral spastic paralysis. Such gross knee contractures together with the coexisting hip flexion contractures create a severe nursing problem. Adequate perineal hygiene and positioning are very difficult to achieve and thus pressure sores frequently develop in these bed-ridden patients in spite of devoted nursing care. The orthopaedic surgeon can help alleviate the plight of these unfortunate victims: first the hip joint contractures are released by the classical methods and then, at the same session, the knee contractures: a simple one stage procedure is described. Primary cover of the large popliteal skin defect is achieved by a gastrocnemius versatile muscle flap, which is itself covered by a free split skin graft. An illustrative case is described.

Contracture↗
PubMed1987

A critical look at capsule contracture in subglandular versus subpectoral mammary augmentation.

A critical comparison of the contracture rate in subglandular versus subpectoral augmentations was done in a personal series (senior author's) of 100 consecutive augmentation patients, 50 with subglandular augmentation and 50 with subpectoral augmentation. The average followup for the series was 27 months. Baker's classification of capsule contracture was utilized. Overall contracture rate in the subglandular group was 58% (29 of 50 patients) while in the subpectoral group it was 22% (11 of 50 patients), p less than 0.0002. Considering only the more severe contractures (Baker III & IV), the subglandular patients had 48% (24/50) while the subpectoral patients had 14% (7/50), p less than 0.0002. Comparing the more severe contractures in individual breasts, the subglandular group had 41% and the subpectoral group had 8%, p less than 0.0001. We conclude that in this personal series of patients, subpectoral placement of the prosthesis has significantly reduced but not eliminated the occurrence of capsule contracture without sacrificing a normal breast appearance.

Adult↗
PubMed2004

Experimental model of knee contracture in extension: its prevention using a sheet made from hyaluronic acid and carboxymethylcellulose.

Treatment once extension contracture of the knee has completed is difficult and costly. The most effective treatment might be the prevention of contracture, especially after joint injury. In order to establish an effective method for contracture prevention we first made an extension contracture in rabbit knees, then studied the effect of a sheet made from hyaluronic acid and carboxymethyl cellulose (HA/CMC) for the prevention of knee contracture. One hundred and twenty two mature male Japanese white rabbits were divided into three groups: (1) group B (n=42), where bony holes were made at the medial and lateral epicondyles, (2) group H (n=40), where HA/CMC sheets were placed on the bony holes, and (3) group S (n=40),where only arthrotomy was performed. All surgical procedures were performed on the right knees. All right knees were fixed at 45 degrees using external fixators; this is the maximum extension angle the rabbit is able to tolerate and still walk. At 1, 3, and 6 weeks after surgery, we measured the moment necessary to flex the knee using a special device. We defined the moment as flexion moment (FM). Forty four left knees were also tested as group N, not operated on and serving as the healthy side. In all groups, FM was increased parallel to the increment of flexion angle from 45 degrees to 115 degrees . At many flexion angles, the FM in group B was higher than those of group S at 3 and 6 weeks. The FM in group H was significantly lower than those of group B at 85 degrees and 95 degrees of flexion at 6 weeks after the operation. By macroscopic observation, the area and degree of adhesion were greater in group B than those of group S. In group H, adhesions around the bony hole were less evident than in group B at 6 weeks after the operation. By histological examination, dense granulation tissue was found adjacent to the bony hole in group B at 3 and 6 weeks after the operation. In contrast, in group H the amount of granulation tissue was smaller at 3 and 6 weeks after the operation than those of group B. The usage of HA/CMC sheet should be effective for prevention of contracture occurring after trauma such as treatment for intra-articular fracture.

Analysis of Variance↗
PubMedDate not supplied

Serologic and histologic findings in patients with capsular contracture after breast augmentation with smooth silicone gel implants: is serum hyaluronan a potential predictor?

BACKGROUND: In this study, breast implant capsular tissues and blood samples from 25 cases were studied to characterize the relationship between capsular findings and serum analysis. The serum fibrosis indexes hyaluronan and the aminoterminal propeptide of procollagen type III (PIIINP) are fairly well correlated in several other studies with the inflammation grade and fibrosis in patients with progressive fibrotic disorders such as liver cirrhosis. METHODS: The study enrolled 25 female patients (average age, 40 +/- 12 years) with capsular contracture after bilateral cosmetic breast augmentation using smooth silicone gel implants (Mentor). The implants were placed in a submuscular position through an incision in the inframammary fold. The implant removals were prompted by development of capsular fibrosis (Baker grades 1-4). Samples of capsular tissue were obtained from all the patients for standard histologic and immunohistochemical analyses. Blood samples were drawn from all the patients immediately before surgery. Sera from 20 healthy female patients (average age, 34 +/- 9 years) who had undergone plastic surgery for reduction mammaplasty were used as controls. RESULTS: Histology. Capsular tissue was significantly thicker in patients with grades 3 and 4 contracture than in women with grade 2 contracture according the classification by Baker. There was a moderate (n = 15) or severe (n = 10) chronic inflammatory reaction in the capsules around the implants. Fibroblasts and macrophages represented the major cell population found in the fibrous capsules. In addition, activated CD4+ cells were detected. An inner layer with synovia-like metaplasia and multinucleated giant cells was found. Fibroblast-like cells formed the most common cell type in the capsules, along with macrophages, scattered polymorphonuclear leukocytes, lymphocytes, plasma cells, and mast cells. Serum analysis. There was a significantly higher level (p < 0.05) of hyaluronan serum concentration in patients with capsular contracture (26 +/- 14 microg/l) than in control subjects (12 +/- 6 microg/l). There was a positive correlation between the grade of capsular contracture (Baker 1-4) and the hyaluronan serum concentration (Baker 1-2: 15 +/- 3 microg/l; Baker 3-4: 35 +/- 12 microg/l) (r2 = 0.73; p < 0.05). CONCLUSION: : In this study, serum hyaluronan levels were significantly elevated in patients with constrictive fibrosis after breast augmentation, and there was a positive correlation with the stage of capsular contracture. Serum hyaluronan concentration may help in defining patients at risk for capsular fibrosis. If treatment with new drugs can be started as a preventive measure, it may be possible to reduce the rate of patients who require surgical intervention.

Adult↗
PubMed2005

Dual-plane implant positioning for capsular contracture of the breast in combination with mastopexy.

OBJECTIVE: This study aims at combined surgical therapy options concerning patients with a clinically relevant and long-established capsular contracture following subglandular breast augmentation in a glandular ptotic breast. METHODS: This is a review of 23 patients with capsular contracture. Three patients had a revision surgery for capsular contracture and implant dislocation before. The mean implant duration in the case of the twenty patients without any previous revision was 96 months. A revision implant has been re-located in a dual-plane position and further corrective surgery was carried out to adapt the glandular ptotic breast. Between 2001 and 2003, a chart review was performed on all patients for capsular contracture and ptotic breast by using the technique presented in this study. RESULTS: In each case, the operation was performed as a one-stage procedure. The procedure included the following steps: Removal of the implant and total capsulectomy, preparation of an inferior de-epithelialised skin pedicle above the inframammary crease, release of the inferior origins of the pectoralis major muscle, creation of a new implant pocket by continuous connection of the inferior muscle border with the cranial edge of the inferior skin pedicle (dual-plane), adaptation of the soft-tissue/skin envelope by closing the cranial V over the implant coverage, preservation of the areola by creating a cranial or cranial medial pedicle. There was a follow-up for a period of up to 48 months, and any complication that occurred was documented. At follow-up period, all patients who had been implanted with a new implant pocket were free of a clinically relevant capsular contracture. CONCLUSIONS: In the cases of a severe capsular contracture and glandular-ptotic breasts, we presented the surgical corrections of the parenchyma/skin envelop as a one-stage procedure following the establishment of a new implant pocket.

Breast↗
PubMed2001

Changes in dorsal horn neuronal responses in an experimental wrist contracture model.

Joint contracture, a major complication after casting, usually makes the therapeutic outcome worse by causing a limited range of motion and related pain. We developed rat models of wrist contracture with fracture of the radius (group A) and wrist contracture without fracture (group B), and investigated whether contracture and fracture changed the characteristics of cervical dorsal horn neuronal responses and the behavior of the animals. After 4 weeks of immobilization, both groups showed wrist contracture and disuse tendencies in the treated forelimb. In an electrophysiological study, the responses of 403 cervical dorsal horn neurons to mechanical stimuli were examined. In normal (control) animals, the neurons had the following distribution: 63% were low-threshold (LT); 15% were high-threshold (HT); and 22% were wide-dynamic-range (WDR). In group A, the distribution of the neurons changed to 51% LT, 16% HT, and 33% WDR. Similar changes were observed for group B. Responses during wrist movement were also examined. Forty-one percent of cells in the control group were responsive to the movements, whereas the number of neurons responding to motion stimulus in both groups A and B was increased, to 77%. The changed population of WDR and LT neurons responding to wrist movement suggests that the characteristics of dorsal horn neurons may undergo plastic changes after contracture.

Animals↗
PubMed1991

The collagen changes of Dupuytren's contracture.

In Dupuytren's contracture there is an increase in the ratio of type III to type I collagen. The objective of this study was to determine if fibroblasts from patients with Dupuytren's contracture have an intrinsic aberration in collagen production or whether local factors govern the collagen changes in Dupuytren's contracture. Using a new collagen micro-method, we found that fibroblasts cultured from palmar fascia affected by Dupuytren's contracture produced similar collagen to fibroblasts derived from the palmar fascia of age- and sex-matched patients with carpal tunnel syndrome. Furthermore, the collagen changes of Dupuytren's contracture could be reproduced in all cell lines by increasing fibroblast density. At high fibroblast density, type I collagen production was inhibited: a finding that could account for the increased types III/I collagen ratio in Dupuytren's contracture. These results suggest that a genetic defect in collagen production is unlikely and that the important phenomenon is an increase in fibroblast density.

Collagen↗
PubMed1993

Prevalence of Dupuytren's contracture and its correlation with degenerative changes of the hands and feet and with criteria of general health.

The prevalence of Dupuytren's contracture and its coincidence with degenerative changes in the hands and feet as well as loss of distal pulses, were studied in 574 55-year-old residents of Malmö, Sweden. Dupuytren's contracture occurred in 6% of the subjects studied, predominantly in men. Dupuytren's contracture was more common in men with degenerative changes in the feet and in men with signs of impaired arterial blood flow in the lower limbs. Men with Dupuytren's contracture had significantly less subcutaneous fat tissue, as measured by a triceps skinfold index, than men without Dupuytren's contracture. Other signs of general health, occupational work load or psychosocial factors did not interact with Dupuytren's contracture in the current study.

Age Factors↗
PubMed1994

Predictors of neurovascular displacement in hands with Dupuytren's contracture.

A prospective study of hands with Dupuytren's contracture was designed to test the association of three variables, the presence of an interdigital soft tissue mass, the presence of flexion contractures at each digital joint, and the duration of contracture, with the formation of spiral nerves. 66 digits in 37 hands affected by Dupuytren's disease were examined intra-operatively. Of the 34 digits (52%) with spiral nerves, 28 had soft tissue masses (42%). The sensitivity of a soft tissue mass alone as a predictor of a spiral nerve was 59% and the specificity 75%. The presence of a flexion contracture at the PIP joint had a sensitivity of 88% and a specificity of 62% for the presence of a spiral nerve. The combination of a soft tissue mass and a PIP joint contracture was a very specific (94%) but not a particularly sensitive (50%) test for spiral nerve formation. The formation of a spiral nerve is progressive, occurring most often in hands with significant PIP joint contractures with or without soft tissue interdigital masses.

Dupuytren Contracture↗
PubMed1991

Postburn contracture of the neck--our experience with a new dynamic extension splint.

Twenty-eight examples of postburn contracture of the neck managed during the last 5 years gave us a better understanding of the problems of anaesthesia, contracture release, skin grafting, splintage and maintenance of the fully release state. The severe contracture should be incised before intubation under a local anaesthetic agent. The release should include the adjoining contractures of mandibular and pectoral regions lest the skin graft is pulled by the existing contracture. Haemostasis should be meticulously secured to avoid graft loss. Splintage should be a static splint for 4-6 weeks followed by a dynamic splint until the applied graft becomes soft, supple and wrinkle free. Ideally, however, contractures should be prevented by nursing the patient with a neck extension in the acute phase and wearing a cervical collar during the subacute phase of wound healing.

Adolescent↗
PubMed2004

Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia.

OBJECTIVE: To determine whether the existence of elbow flexion contractures in persons with C5 or C6 tetraplegia is related to a lack of residual voluntary triceps function and triceps denervation (ie, lower motoneuron damage). DESIGN: A retrospective study of impairment data from 74 arms to identify the incidence of elbow flexion contractures and the contributing factors toward this deformity. SETTING: Five spinal cord injury (SCI) rehabilitation centers in the United States, 1 in England, and 1 in Australia. PARTICIPANTS: Forty-three subjects with motor complete C5 or C6 traumatic SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Active and passive elbow extension, triceps voluntary muscle strength, and triceps response to electric stimulation. RESULTS: Subjects with weak voluntary triceps had significantly fewer and less severe elbow flexion contractures than those with paralyzed triceps ( P =.024). Subjects with completely denervated triceps (ie, no response to electric stimulation) had significantly more elbow flexion contractures than subjects with even a weak response to electric stimulation ( P =.003). Overall, 51% of the arms could not be passively extended to zero. Forty-six percent of the arms classified as C5 lacked full passive elbow extension, compared with 63% of the arms classified as C6 ( P =.302). CONCLUSIONS: A relationship has been found between elbow flexion contractures and lack of residual voluntary triceps and triceps denervation in subjects with C5 or C6 tetraplegia. There should be a greater awareness of the elbow flexion contractures that may develop as a result of this relationship. A better understanding of this deformity and its characteristics can lead to more effective clinical treatment and prevention strategies.

Adolescent↗
PubMed2005

Figure-of-8 sling for prevention of recurrent axillary contracture after release and skin grafting.

The axilla is a frequent site of adduction contracture after deep thermal injury, especially in burns in developing countries where the timely treatment of burns and the prevention of contracture are not possible for lack of appropriate services. Chronic contractures are difficult to treat, as large areas of wounds need to be covered with skin grafts or flaps. However, the most daunting aspect of adduction contracture is the maintenance of release after correction; this is often dealt with using long-term abduction splints, most of which are very uncomfortable. Our purpose here is to analyse our results with a simple figure-of-8 sling. A descriptive study was made covering a period of 10 years, comprising 40 cases of chronic extensive axillary contracture. All the cases were treated with simple release and skin grafting followed by a figure-of-8 sling. Preoperative limb abduction ranged from 0 degrees to 80 degrees; whereas, the postoperative range, at 1 year of follow-up, was from 140 degrees to 180 degrees. Hence, we conclude that the application of a figure-of-8 sling for axillary post-burn contractures is a safe, comfortable, easy and more compliant way of splintage with at least as reliable results as with other abduction splints.

Adolescent↗
PubMed2005

Reconstruction of axillary contractures with thoracodorsal perforator island flap.

The axilla is one of the most frequently sites affected by contractures after severe burns. These contractures often cause cosmetic problems and functional deficiency. A variety of therapeutic methods such as skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been reported for treatment of the contractures. Each has its own advantages and drawbacks. In this clinical study we report 15 cases of post burn axillary contractures treated with thoracodorsal perforator-based cutaneous flaps. The flaps were harvested in range of sizes up to as large as 27 cmx15 cm. All flaps survived completely without even marginal necrosis. The donor sites were closed primarily except in one case who needed a small skin graft. Satisfactory improvement in shoulder abduction was obtained. The range of abduction was on average 46.6+/-19.3 degrees before the operations and 159+/-12.4 degrees after the operations. Cosmetic results were satisfactory from the patient's point of view. The thoracodorsal perforator flap can be safely raised to meet any size required even in the most severe contractures. The donor site scar may be considered as acceptable considering the advantages of the flap. We strongly recommend this flap as the treatment of choice in releasing challenging axillary contractures.

Adult↗