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At least 343 records · Page 19Linked to original sources
PubMed2006

Use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures.

BACKGROUND: Multiple reconstructive methods have been used for the treatment of postburn scar contractures including skin grafting, geometric relaxation techniques, local flaps and free flaps. PURPOSE: In the present study, the authors evaluated efficiency of the use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures. METHODS: Twelve white male with postburn scar contracture were treated using rhomboid and double Z-plasty technique. The cause of burn, duration of contracture, postoperative follow-up period, preoperative and postoperative motion lag of joints and improvement in motion were recorded. CONCLUSIONS: All operations were successful. Severe contracture lines crossing flexion folds can be released effectively by using rhomboid flap and double Z-plasty technique without distorting the specialized flexion areas and with broken scar lines which is essential to avoid from recurrence.

Adult↗
PubMed2006

An algorithm for the release of burn contractures of the extremities.

Burn contractures of the extremities present a clinical challenge. Flexion contractures are more common than extension contractures. The first component of treatment is adequate contracture release. A number of different methods are available for resurfacing the wound and these are reviewed. An algorithm is presented which permits a simple approach to managing burn scar contracture of the extremities.

Algorithms↗
PubMed2006

Uses of scapular island flap in pediatric axillary burn contractures [correction of conractures].

Pediatric axillary post-burn contractures one of the most challenging problems which follow treatment of the upper extremity burns. We preferred to use scapular flaps for surgical treatment of pediatric axillary contractures instead of skin grafting or Z-plasties. In this clinical study we present 13 pediatric cases treated with scapular island flaps. In pediatric scapular flap cases, the technique which we used was to extend the flap's pedicle dissection was continued to the level of bifurcation of subscapular artery. Bypassing the flap triangular space allowed us to cover the anterior part of the axillary contractures. We observed that the scapular flap repairs have many benefits to skin grafting including no recurrence of contracture and stable coverage of the shoulder joint. The other advantages of scapular island flap are that the donor site is closed primarily, and it provides an adequate amount of pliable skin while not compromising the function and range of motion of joints. In conclusion, the island scapular flap is a good choice for reconstruction of various axillary contractures in pediatric population.

Adolescent↗
PubMed2006

A simple and effective procedure for treating burn contractures: releasing incision and quadra Z technique.

Burn contractures particularly involving the joints are challenging problems which might cause severe functional impairments. Many surgical techniques have been described for use, however, an ideal method yet to be found. Releasing incision is the most common and effective way to release the wide and severe contractures but it has some drawbacks. We propose a releasing incision technique combined with four Z plasty incisions to overcome the disadvantages of traditional releasing incision technique. We successfully used our releasing incision and quadra Z technique on seven consecutive patients with burn contractures between 2003 and 2005. We modified the classical releasing incision technique by adding four Z plasties; two of them with a common base on each corner of the incision line. In this technique, limitation of the webbing following the incision is made possible by the transposed flaps and unnecessary lateral extension of the incision and the defect was avoided, i.e. maximum release gain with minimal defect was provided. Satisfactory results were achieved in seven patients treated with this technique due to significant burn contractures between 2003 and 2005 with no significant complication. We propose this technique is suitable in all patients with severe burn contractures who require releasing incision and grafting.

Burns↗
PubMed2004

Abductor digiti minimi involvement in Dupuytren's contracture of the small finger.

PURPOSE: Dupuytren's contracture (DC) is a common, benign, progressive condition. Patterns of involvement of the ulnar side of the hand, specifically the involvement of the abductor digiti minimi (ADM), have received limited attention; therefore, the purpose of this study was to determine the prevalence, patterns of involvement, and surgical outcomes in DC of the small finger. METHODS: A retrospective review was performed on the hands of all patients who had surgery for DC between January 1998 and March 2002 to determine the incidence of ADM involvement. RESULTS: A total of 149 patients had 195 surgeries on 261 digits during this period. Forty-seven percent of cases involved the small finger and 27% of those involved the ADM. Those cases involving the ADM had statistically significantly greater mean preoperative proximal interphalangeal joint (PIPJ) contracture (53 degrees ) as well as postoperative PIPJ contracture (34 degrees ) when compared with those without ADM involvement of the small finger (31 degrees preoperative PIPJ contracture and 15 degrees postoperative PIPJ contracture, respectively). The most common origin pattern of the ADM involvement was found to arise from both the ADM tendon and overlying fascia (77%). The most common insertion pattern was found to be over the middle phalanx (50%). CONCLUSIONS: We conclude that ADM is involved in DC of the small finger in one quarter of cases. Failure to recognize and resect the diseased cord arising from it and its overlying fascia at the time of surgery may account for the poor outcomes seen in DC of the small finger.

Adult↗
PubMed2003

Reoxygenation-induced rigor-type contracture.

The hypothesis tested was that reoxygenation-induced contracture of myocardial cells, a form of reperfusion injury, can be due to a rigor-type mechanism. Isolated adult cardiomyocytes were exposed to 30- or 60-min anoxia (pH 6.4) and reoxygenation (pH 7.4). In cardiomyocytes, cytosolic Ca(2+) and cell length, and in isolated rat hearts left ventricular end-diastolic pressure (LVEDP) were measured. During reoxygenation, cardiomyocytes developed contracture. When energy recovery was slowed down, less Ca(2+) overload was required for contracture: (1) after 30-min anoxia Ca(20) (cytosolic Ca(2+) concentration in cells with 20% cell length reduction) was 1.42 +/- 0.11 micromol/l; (2) after 30-min anoxia with partial mitochondrial inhibition during reoxygenation (NaCN, 0.1 mmol/l) Ca(20) was reduced to 0.69 +/- 0.05 micromol/l; (3) after 60-min anoxia Ca(20) was reduced to 0.78 +/- 0.05 micromol/l and (4) when energy recovery was accelerated (succinate, 0.2 mmol/l), Ca(20) rose to 1.35 +/- 0.05 micromol/l. In isolated hearts, the reperfusion-induced rise in LVEDP was modulated by the same interventions. Slow recovery of energy production favors reoxygenation-induced contracture in cardiomyocytes and hearts. This shows that rigor contracture contributes to reoxygenation-induced cell injury.

Animals↗
PubMed2003

Reconstruction of axillary scar contractures--retrospective study of 124 cases over 25 years.

We present a retrospective study of 134 axillae treated in 124 cases of axillary scar contractures with the use of skin grafts and various flaps over the last 25 years in our department. Free skin grafts were performed in 25 axillae, and local flap transfers including skin elongation procedures such as z-plasty were performed in 76 regions. As regional flap transfers, i.e. pedicled axial local flap transfers, latissimus dorsi flaps, para-scapular flaps, superficial cervical artery flaps (SCA flap) and bilateral combined scapular flaps were used for the reconstruction of 23 severe axillary scar contractures. Free flaps and scarring flaps were also used for five severe contracture cases. The results were generally satisfactory, but five problematic cases and seven cases of recurrence were encountered. In this report, we classify axillary contractures into five types and present our conclusions on the criteria for selecting appropriate surgical methods according to contracture type. Our results suggest there are four key scar features to be considered in the selection of surgical methods for axillary reconstruction: (1) size; (2) depth; (3) location and (4) shape. We also discuss and evaluate the various methods of reconstruction.

Axilla↗
PubMed2002

Burn scar contractures of the feet: efficacy of bilateral simultaneous surgical correction.

Children who sustain large total body surface area (TBSA) burns with involvement of the lower extremities frequently sustain injuries to the dorsum of the feet. Burn scar contractures of the feet can develop as a sequela of the burn injury. Such contractures frequently require surgical correction. Many surgeons proceed with staged unilateral corrections when both feet are equally in need of operative intervention. The purpose of the study is to determine if the morbidity for correction of bilateral dorsal foot contractures is different from that for the correction of unilateral dorsal foot contractures.A retrospective review from January 1994 to July 1999 was undertaken. Forty-five patients with photographic record of burn scar contracture of the feet were identified. Twenty-five patients underwent staged unilateral surgical correction and twenty patients underwent simultaneous bilateral correction of the feet. All patients underwent surgical correction with split thickness skin grafts (STSG). No statistical difference was found in terms of mortality, development of contracture, or number of reconstructive procedures. However, the length of stay revealed the efficacy of the bilateral simultaneous release of the dorsal feet.

Burns↗
PubMed2003

Specifically designed external fixators in treatment of complex postburn hand contractures.

External fixators designed specifically for severe, late postburn contractures of hand and wrist have been used in five patients between 1993 and 1997 with follow up for an average of 30.2 months. The mean age of patients at operation was 16.6 years ranging from 14 to 20 years. They had a number of failed operations. There were fixed joint contractures beside severe soft tissue contractures. There was total loss of hand functions in four patients. After reconstructive operations, at least one hand function was attained. We have found the external fixator method to be helpful in treating severe, fixed and complex postburn contractures of hand where previous surgery had failed. This study indicates the uses and benefits of external fixators as a soft tissue lengthener when correcting progressively complex burn contractures of hand.

Adolescent↗
PubMed1999

Caffeine- or halothane-induced contractures of masseter muscle are similar to those of vastus muscle in normal humans.

BACKGROUND: Skinned fibers from normal human masseter muscle have greater caffeine and calcium sensitivity than skinned fibers from vastus muscle. We examined sensitivity to caffeine and halothane in fresh, cut muscle bundles (non-skinned) from human masseter muscle. METHODS: Masseter bundles (caffeine, n=25, halothane, n=19) excised from 10 humans under general anesthesia had tension measured in 37 degrees C baths during the addition of caffeine (0.5, 1, 2, 4, 8, 32 mM) or 3% halothane. Results were compared to those of our previous studies (1989, 1997, 25 patients) of vastus bundles (caffeine, n=71, halothane, n=63) using the same protocol, technicians, and equipment. RESULTS: Baseline force in the caffeine test was 2.10+/-1.57 for masseter, and 2.02+/-1.68 and 1.82+/-1.29 respectively for vastus muscle. Force at 32 mM caffeine concentration was 11.2+/-9.9 g for masseter, 11.0+/-5.4 and 13.5+/-7.5 g for vastus. Concentration-response curves were virtually identical. In the halothane group, neither baseline values (masseter 1.47+/-1.30, vastus 1.91+/-1.32 and 2.15+/-1.71) nor contractures in response to 3% halothane were different. Most bundles had no contracture in response to 3% halothane; 3 masseter bundles and 2 vastus bundles (1989) developed contractures of less than 0.05 g. Three vastus bundles (1997) developed contractures >0.2 g. CONCLUSION: Contracture responses of intact cut masseter and vastus bundles (non-skinned) do not differ with respect to caffeine and halothane. Responses of skinned fibers might demonstrate greater sensitivity under certain conditions, but they do not reflect those of intact cut bundles.

Aged↗
PubMed2002

Muscle stretching for treatment and prevention of contracture in people with spinal cord injury.

Contracture, or reduced joint mobility, is a common and disabling sequel of spinal cord injury. The primary intervention for the treatment and prevention of contracture is regular stretch to soft tissues. While the rationale for this intervention appears sound, the effectiveness of stretching has not been verified with well designed clinical trials. One recent randomised trial suggests there is no clinically worthwhile effect from a typical stretch protocol applied to spinal cord injured patients. Despite the negative results of this first trial, we argue that therapists should continue administering stretch for the treatment and prevention of contracture until the results of further studies emerge. To maximise the probability of attaining a clinically worthwhile effect, we suggest that therapists stretch soft tissues for long periods (at least 20 min, and perhaps for as long as 12 h a day). Practical suggestions are given on how to readily provide spinal cord injured patients with sustained stretch to key joints and muscle groups. Stretch is most likely to be effective if started before the onset of contracture. Soft tissues most at risk should be targeted, particularly if contracture is likely to impose functionally important limitations.

Contracture↗
PubMed2006

[Histological and immunohistochemical investigations with capsular contracture after breast augmentation with smooth silicone gel implants].

INTRODUCTION: A prospective study was performed to analyse the cellular and molecular composition of fibrous capsules around silicone breast implants. The necessity of an exact histological classification for comparing objectively the different findings of capsular contracture is shown. PATIENTS AND METHODS: The prospective study (investigation time 1/2003 to 6/2005) included 24 female patients (average age: 40+/-12 years) with contracture after bilateral cosmetic breast augmentation with smooth silicone gel implants (Mentor). In each patient the baker score was determined preoperatively. Samples of capsular tissue from all patients were evaluated histologically and immunohistochemically and classified according to the histological classification introduced by Wilflingseder and co-workers. RESULTS: All capsules showed the same basic histological structure with a three-layer composition. For the correlation analysis we had to exclude one patient with repeated implant change. There was no correlation between the patient's age, time of implantation, length of implant period, and capsular contracture. Greater amounts of silicone particles were associated with increased degrees of capsular contracture (Baker: r = 0.687, n = 23, p < or = 0.001; Wilflingseder: r = 0.784, n = 23, p < or = 0.001). High silicone amounts were associated with an increased local inflammation (r = 0.489, n = 23, p , 0.05). A moderate to severe local inflammation was found in 23 patients (95.8%). In summary, there was a positive correlation (r = 0.797, n = 23; p , or = 0.001) between the clinical classification (Baker score I to IV) and the histological classification (Wilflingseder score I to IV). CONCLUSIONS: We demonstrated in our study, in spite of using implants with high gel cohesiveness (fourth generation), the presence of vacuolated macrophages with microcystic structures containing silicone and silicone particles in the capsular tissue. Greater capsular thickness was associated with an increased number of silicone particles ans silicone-loaded macrophages in the peri-implant capsule. The histological classification introduced by Wilflingseder and co-workers takes into consideration this pathogenetic mechanism of inflammatory reaction which seems to be one of the major key factors in the development of capsular contracture.

Adult↗
PubMedDate not supplied

Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study.

PURPOSE: Understanding the relationship between the motor impairments and their impact on physical activity will allow rehabilitation after stroke to be based on scientific principles. The aims of this study were to determine: (i) the relative contribution of weakness and spasticity to contracture, and (ii) the relative contribution of all three impairments to limitations in physical activity during the first 12 months after stroke. METHOD: This longitudinal observational study charted the evolution of weakness (loss of maximal force), spasticity (stretch-evoked EMG) and contracture (loss of joint range) of the elbow flexors and limitations in upper limb activity (Motor Assessment Scale) for a year after stroke in 27 subjects who had suffered a first stroke. Spasticity was measured as abnormal reflex activity, weakness was measured as loss of maximum isometric torque, contracture was measured as the difference in range of motion between the affected and intact side, and limitations in physical activity were measured on a clinical scale. RESULTS: The major independent contributors to contracture were spasticity for the first four months after stroke (p = 0.0001 - 0.10) and weakness thereafter (p = 0.01 - 0.05). However, the major and only independent contributor to limitations in physical activity throughout the year was weakness (p = 0.0001 - 0.05). CONCLUSIONS: For the first time, from a longitudinal study, the findings show that spasticity can cause contracture after stroke, consistent with the prevailing clinical view. However, weakness is the main contributor to activity limitations.

Adult↗
PubMed1993

Accelerated contractures after administration of ryanodine to skeletal muscle of malignant hyperthermia susceptible patients.

A genetic disorder of the calcium releasing ryanodine receptor has recently been postulated in malignant hyperthermia (MH) and ryanodine-induced contractures differ between subjects who are malignant hyperthermia susceptible (MHS) and non-susceptible (MHN). We tested 39 patients from 26 families for MH, using the procedure of the European Malignant Hyperthermia Group. A ryanodine contracture test was performed by both cumulative (0.4-10.0 mumol litre-1 every 3 min) and bolus (10.0 mumol litre-1) application. Contracture with cumulative ryanodine application started significantly earlier in MHS (9.6 (SEM 0.5) min) than in MHN patients (24.6 (1.3) min). A significant difference in start of contracture between MHS (4.8 (0.6) min) and MHN (14.5 (0.6) min) patients occurred also after bolus application of ryanodine. The ryanodine contracture test seems to be a potentially specific in vitro diagnostic test for MH.

Adolescent↗
PubMed1995

Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents.

BACKGROUND AND PURPOSE: The purpose of this study was to do a pilot test of the effectiveness of prolonged stretch (use of splint) in reducing knee flexion contractures more than a traditional program of passive range of motion (PROM) in a group of nursing home residents. SUBJECTS: The subjects were 28 nursing home residents with 10 degrees or more of knee flexion contracture bilaterally. Eighteen subjects completed the study. METHODS: Data were collected prior to the initiation of the intervention and at monthly intervals during the 6 months of treatment. Repeated measurements were made of hip, knee, and ankle range of motion (ROM); the torque required to maintain passive impairment. knee extension; knee pain; several indicators of function; and cognitive impairment. Both legs of each subject received PROM and manual stretching twice a week; in addition, one leg was given a prolonged stretch (use of a splint) five times a week. RESULTS: There were no differences in knee ROM between the side that received prolonged stretching and the side that received only PROM and manual stretching at the beginning of the study. No differences in ROM or torque measurements existed between the side that received prolonged stretching and the side that received only PROM and manual stretching at any interval, nor in ROM or torque over time for either side. Because of the low statistical power of the study, the results should be viewed with caution. CONCLUSION AND DISCUSSION: Physical therapists need to question whether prolonged stretch for nursing home residents with knee flexion contractures greater than 10 degrees is of any greater benefit than PROM and manual stretching. Investigations of other treatment protocols and treatment doses are needed, including work in the area of prevention of knee flexion contractures. For the pilot group of nursing home residents studied, gains in knee extension did not occur with the use of prolonged stretch for 3 hours a day, 5 days per week. [Steffen TM, Mollinger LA. Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents.

Activities of Daily Living↗
PubMed1995

Serial casting of the lower extremity to correct contractures during the acute phase of burn care.

Severe contractures that develop early following a burn may not improve with splinting and exercise treatment. An alternative treatment is serial casting, which has been used to promote increased range of motion, to facilitate patient compliance with positioning, and to prevent the patient from scratching the burned area. This case report describes the use of serial casting for resolution of ankle plantar-flexion contractures that occurred in the acute phase of burn injury. The child described in this case report sustained a 49% total body surface area scald burn and developed contractures within 1 week after injury. The contractures, which were not corrected with thermoplastic splints, improved with casting from 45 degrees of plantar flexion to neutral dorsiflexion over 2 months with biweekly cast changes. The patient had multiple skin grafts and progressed in functional activities. Serial casting is a conservative and effective modality in correcting contractures resulting from burns. Further documentation of the efficacy of this treatment approach is necessary to support its use in burn care throughout various stages of healing.

Acute Disease↗
PubMed1988

Collagen coatings reduce the incidence of capsule contracture around soft silicone rubber implants in animals.

Silicone rubber miniprostheses known to be associated with a high rate of experimental capsule contracture were implanted subcutaneously in rats. Prostheses were coated either with 2 layers of collagen cross-linked with formaldehyde or with 1 layer of collagen cross-linked with glutaraldehyde. Noncoated prostheses were implanted as controls. Contracture was defined as grossly observable distortion of the implant mounds from round to avoid. Capsules were examined histologically at explant at 255 days. In the control group with no coating present capsules formed very early in 100% of the implants. The group with a 2-layer, formaldehyde-treated collagen coat demonstrated the greatest total surface area covered with coating, the least degree of capsule formation, the lowest rate of contracture (7%), and the longest onset. The group with a single layer of collagen treated with glutaraldehyde showed an intermediate coverage of coating, an intermediate degree of capsule formation, an intermediate contracture rate (50%), and an intermediate time of onset. These observations confirm earlier results by showing a correlation between intact collagen coating and absence of capsule formation, and also further demonstrate a significant reduction in the rate of capsule contracture for collagen-coated implants.

Animals↗
PubMed1994

Radiation therapy as a cause of capsular contracture.

The effect of radiation therapy on the final result of breast reconstruction has been debated in the literature. We have had 4 patients with bilateral breast reconstruction who then received unilateral radiation therapy. We noted in all 4 that the irradiated side became contracted, whereas the nonradiated breast reconstruction remained soft. These 4 patients were compared with the bilateral breast reconstruction not receiving radiation therapy. The contracture rate in this control group was 10% (19 of 190 breasts). The difference in contracture rate between these two groups was significant (p = 0.05). A second group of patients was reviewed, unilateral reconstruction patients receiving radiation therapy to the reconstructed breast. This group was compared with bilateral reconstructions not receiving radiation therapy as a control group. The contracture rate in the unilateral reconstruction group receiving radiation therapy was 67% (7 of 11), versus the control of 10%. This difference is also significant (p = 0.001). We conclude that radiation therapy of prosthetic breast reconstruction does increase the rate of capsular contracture. Therefore, we counsel our implant reconstruction patients that the risk of capsular contracture is increased if subsequent radiation therapy is required.

Breast Neoplasms↗