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At least 487 records · Page 27Linked to original sources
PubMed1991

Medial fasciocutaneous flap of thigh for release of post-burn groin contractures.

Post-burn groin contractures, though uncommon, cause some patients distressing symptoms which are difficult to treat. Recurrence of contracture and symptoms is common and multiple operations are often required to control symptoms. We describe the use of the medial thigh fasciocutaneous flap for release of these contractures. Six flaps have been raised in four patients and symptomatic relief has been excellent in three. There have been no contracture recurrences.

Adolescent↗
PubMed1976

Dupuytren's disease--a study of the pattern of distribution and stage of contracture in the hand.

The distribution and stages of contracture in the digits are examined in 901 persons with Dupuytren's disease and collected into an epidemiological study of 15,950 persons in a small Norwegian town. The frequency of contracted digits counted from the total number of affected hands, are for men (women in parentheses): Thumb 3.0% (0.6), Index finger 1.2% (1.7), Middle finger 28.3% (27.9), Ring finger 85.1% (92.3) and Little finger 45.4% (39.5). The most common combination of affected fingers are ring and little fingers. At corresponding ages, the contracture is more severe in men than in women, and more severe in the right than in the left hand. With the exception of the index finger, the degree of contracture increases from the thumb to the little finger, 29% of the men and 12% of the women examined had contracture of such an extent that surgical treatment was advisable. Only 5.7% of the men and 3.1% of the women had been operated on because of the disease, which indicates that operation statistics are based upon very selected patients. Many aspects of this disease can only be properly studied in epidemiological material.

Adolescent↗
PubMed1987

Conservative surgery for Dupuytren's contracture.

The trend towards conservativism in the management of Dupuytren's contracture has resulted in less radical surgery than was previously advocated to release disabling contractures of the fingers. 38 cases of Dupuytren's contracture in the palm have been treated by Z-plasty of skin and underlying contracted band without fasciectomy. Proximal interphalangeal joint contractures were treated by fasciectomy and skin closure with Z-plasties as required. Only one of 16 patients reviewed after two years had evidence of recurrence. Skin compliance has been measured and a return to near-normal levels was found in all but the one patient with a recurrence.

Dupuytren Contracture↗
PubMed1988

Elbow flexion contractures: treatment by anterior release and continuous passive motion.

We treated three elbows with post-traumatic flexion contractures (mean contracture: 41 degrees) by operative release and post-operative continuous passive motion rehabilitation. Each elbow had been resistant to at least six weeks of conservative therapy. All patients complained of the residual deformity and some functional deficit. All patients, after failure of non-operative therapy, desired operative treatment. At follow-up (mean 12 months), there was a mean post-operative contracture of 5 degrees. Continuous passive motion is recommended as an adjunct to anterior release in patients with resistant elbow flexion contractures.

Adult↗
PubMed1987

Treatment of elbow contractures in burns.

Contractures of the elbow after burn injury are frequent and are often connected with other contractions. Surgical correction must take into consideration the topography, the likelihood of possible heterotopic ossification and the condition of the surrounding skin. A study of 66 contractures allowed us to reach the following conclusions: Linear contractures surrounded by normal skin require IC-type local flaps. Widespread contractures can be treated with thoracic flaps if healthy skin remains or else with the 'backwards flap'. Surgery on existing associated heterotopic ossification must be in two stages starting with the cutaneous step.

Adolescent↗
PubMed1994

Management of postburn contracture of the neck.

Five hundred and sixty-two patients with postburn contractures were treated by a plastic surgeon in the Central Hospital of the capital city Lusaka. There were 37 patients with neck contractures of whom 18 were classified as major, all but two were burned by fire and two-thirds were female. Release of contracture and excision of scar tissue followed by surface cover with skin grafting was the mainstay of treatment and was carried out in 31 of 37 patients. Careful perioperative management and the basics of plastic surgery such as skin grafting are within the competence of many general surgeons. Because burn contractures are common in the developing world, it is recommended that plastic surgery be included in the training of general surgeons and that selected cases be managed by them. The more complex cases should be referred to a plastic surgery centre.

Adolescent↗
PubMed1988

Cigarette smoking and Dupuytren's contracture of the hand.

Microvascular occlusion has been implicated as a possible causative factor of Dupuytren's contracture. Cigarette smoking is one of the most significant factors in the development of peripheral vasculopathy. The relationship between smoking and Dupuytren's contracture of the hand is explored in this article. One hundred thirty-two consecutive patients who had a partial fasciectomy for treatment of Dupuytren's contracture from 1980 to 1985, were analyzed retrospectively. There were 111 males and 21 females. Ninety (68.2%) of 132 patients smoked cigarettes compared with 110 (37.2%) of 296 randomized hospitalized control patients (p less than 0.00001). Eighty (72.1%) of 111 men smoked cigarettes compared with 65 (44.2%) of 147 male control patients (p = 0.000015). Cigarette smoking is linked statistically to Dupuytren's disease and may be involved in its pathogenesis by producing microvascular occlusion and subsequent fibrosis and contracture or by some other mechanism.

Adult↗
PubMedDate not supplied

King-Denborough syndrome: contracture testing and literature review.

The King-Denborough syndrome (KDS) is characterized by dysmorphic features, myopathy, and malignant hyperthermia (MH). Physiologic contracture testing for MH susceptibility has not been reported in KDS. A young boy with KDS underwent muscle biopsy evaluation at age 3 years that documented an abnormal contracture response to halothane, indicating MH susceptibility. Histopathology demonstrated small type II fibers associated with type I hypertrophy. Contracture testing of muscle obtained from the patient's mother was positive, while a sibling's test was negative. This case is the first to demonstrate susceptibility to MH with KDS by using physiologic contracture testing. The presence of positive MH results in both the patient and his mother suggest one of the following: (1) KDS may be part of the spectrum of autosomal dominantly inherited MH; (2) the locus for MH and for KDS may be linked closely and inherited concurrently, or; (3) the association of MH and KDS may be coincidental.

Child, Preschool↗
PubMed2005

A new shoulder range of motion screening measurement: its reliability and application in the assessment of the prevalence of shoulder contractures in patients with impaired consciousness caused by severe brain damage.

OBJECTIVES: To determine the reliability of a new shoulder joint range of motion (ROM) measurement for unconscious patients and to assess the prevalence of shoulder joint contractures in such patients. DESIGN: Prospective cohort survey. SETTING: An early rehabilitation center for adult persons with neurologic disorders. PARTICIPANTS: Fifty patients with impaired consciousness caused by severe cerebral damage of various etiologies. In addition, reference values were measured in 60 healthy adults. INTERVENTION: Shoulder ROM was assessed by measuring the distance between the olecranon and underlay while the patient lay supine on a solid surface and the patient's hands were passively positioned behind the neck. Distances between the olecranon and underlay were measured, first, manually by the rater and, second, for control, digitally by a blinded person from a digital photo taken while a constant force was applied to the elbow. MAIN OUTCOME MEASURES: Prevalence of contractures defined as increased distance between the olecranon and underlay or impossibility of positioning the hands passively behind the neck, and intra- and interrater-reliability of the 2 shoulder ROM measurements with the interclass correlation coefficient (ICC). RESULTS: Measurement of shoulder ROM showed high intra-(ICC range, .78-.91) and interrater reliability (ICC range, .77-.90) for manual measurement, high intra- (ICC range, .91-.95) and interrater reliability (ICC range, .90-.94) for the digital analysis, and a high ICC for both methods (ICC=.87). The prevalence of shoulder contractures was 56% in the patients and 50% of all shoulder joints. CONCLUSIONS: The described method provided a reliable measurement for reduced shoulder ROM and appears to be a useful screening method to show the prevalence of shoulder joint contracture in these patients.

Adult↗
PubMed2005

Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: a randomized controlled trial.

OBJECTIVE: To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke. DESIGN: Prospective, parallel-group, randomized controlled trial. SETTING: Four metropolitan mixed rehabilitation units. PARTICIPANTS: A volunteer sample of 36 subjects (minus 5 dropouts), whose mean age was 68 years and had had their first stroke within the past 20 days. INTERVENTIONS: The experimental group received two 30-minute sessions a day, 5 days a week, for 4 weeks, during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion. Both the experimental and control groups received up to 10 minutes of shoulder exercises and standard upper-limb care. MAIN OUTCOME MEASURES: Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side. Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation. RESULTS: The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group, compared with the control group ( P =.03). The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P =.88). CONCLUSIONS: At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm.

Contracture↗
PubMed2006

Effect of heat in increasing the range of knee motion after the development of a joint contracture: an experiment with an animal model.

OBJECTIVE: To compare the effects of 2 different heat modalities, infrared and ultrasonic therapy, on a knee flexion contracture. DESIGN: In vivo, experimental, controlled study involving a rat knee joint contracture model that was immobilized using a ligature in flexion for 40 days. SETTING: Collegiate research laboratory. ANIMALS: Ninety-three adult male Wistar rats. INTERVENTIONS: After remobilization, rats were assigned to 3 treatment groups: stretching only (S), stretching with infrared therapy (S+IR), and stretching with ultrasonic therapy (S+US). Six treatment sessions were given in 2 weeks. MAIN OUTCOME MEASURES: The angle of maximum knee extension, wet-weight of triceps surae muscles, phase lag, and dynamic stiffness as mechanical responses were measured, and histologic study was conducted. RESULTS: Compared with the S group, both the S+IR and S+US groups exhibited a significant increase in range of motion (ROM) (P=.021, P=.008, respectively) and a tendency to decrease the phase lag, but there was no significant difference between the 2 heat-combined groups. There were no differences in the weights of the triceps surae muscles and in dynamic stiffness among the groups. CONCLUSIONS: Six treatment sessions of stretching with infrared or ultrasound were more effective than stretching without heat at increasing the ROM and decreasing the phase lag of a moderately severe joint contracture. The clinical implementation of heat is advocated to regain a normal ROM and mechanical property when experiencing a joint contracture.

Animals↗
PubMed2005

Use of dorsal ulnar neurocutaneous island flap in the treatment of chronic postburn palmar contractures.

In the present study, the authors evaluated efficiency of the "dorsal ulnar neurocutaneous island flap" in the coverage of palmar defects resulting from radical release of selected chronic postburn contractures. Eight white male hands with palmar contracture were treated with this flap between November 2001 and December 2003. The mean follow-up period was 11.6 months. The flap, which was planned on the ulnar aspect of the forearm and the hand, is transferred to the palmar defect. The subcutaneous pedicle of the flap was skin-grafted to avoid tension. All operations were successful. Distal flap necrosis that healed by secondary intention was observed in one of the eight flaps. Seventy-five degrees was the maximum improvement in metacarpophalangeal (MP) joint extension achieved in the little finger. Grasp function of the hand dramatically improved and the bulk of the flap did not interfere with grasping. No recurrent palmar contracture was observed. The authors concluded that the dorsoulnar neurocutaneous island flap can be used effectively in the treatment of postburn palmar contractures. The safety of the flap can be enhanced by grafting the intervening skin between the pivot point of the flap and the palmar defect.

Adult↗
PubMed2005

Versatility of the reverse lateral arm flap in the treatment of post-burn antecubital contractures.

If they are not managed with proper treatment and rehabilitation, full thickness burns involving the cubital fossa may result in severe contractures that may impair upper extremity functions. Later release of these contractures discloses a large soft tissue defect that should be replaced. We used reverse lateral arm flaps for coverage of the cubital fossa in 11 selected cases of antecubital contracture. Ten flaps survived totally while we experienced one distal partial necrosis, which was later treated by skin grafting. We achieved considerable functional improvements in all cases. Although fasciocutaneous flaps offer the advantage of using regional tissue in a single stage, few versatile local flaps relying on the vascular anatomy around the elbow joint are available for cubital fossa coverage. Being a rapid, easy and one-staged procedure with no necessities for sacrifice of a major artery or muscle and for a long-term immobilization of the involved joints, reverse lateral arm flaps appears to be advantageous in comparison to other options for coverage of the cubital fossa defects after the release of antecubital contractures.

Adult↗
PubMed2006

Treatment of wide scar contracture of antecubital fossa with bipedicle flap from scar tissue.

Many surgical techniques exist for reconstruction of burn scar contracture of the antecubital fossa, such as Z plasty, VY plasty, lateral arm flap, and medial arm flap. Another option is direct release of the scar contracture and skin graft of the defect area, which requires prolonged splinting and risk of graft failure. Additionally, in the areas with exposed tendons or vessels, we cannot use grafts. Recurrence of contracture remains another drawback of this treatment, in this article we present a new, simple alternative method for treatment of these cases. In this clinical trial we introduce a new technique of bipedicle flap from scar tissue for coverage of the antecubital fossa with skin grafting of the proximal and distal parts of this bipedicle flap. From July 2002 to July 2005 we used this flap in 12 patients and efficacy and versatility of this flap was studied. Seven patients were female and 5 were male with mean age of 23.7 years. The mean time between burn and our reconstructive operation was 3.2 years. The mean surface area of antecubital burn scar tissue was 77.5%. Mean extension lag before operation was 66.5 degrees , mean extension lag during operation was 4.5 degrees and after operation was 5.4 degrees . Minor complication was observed in two cases with necrosis of the flap margin. Mean follow-up period was 17 months and the appearance of operated site in antecubital fossa was acceptable in all patients. The advantage of this bipedicle flap is its simple surgical technique. The risk of flap necrosis is negligible and it is a reliable flap. Splinting time is short and the risk of recurrence of contracture with this technique is minimal.

Adolescent↗
PubMed2005

The management of web space contractures.

Multiple reconstructive options exist for the web space contracture: skin grafts, local flaps, and distant flaps have all been used to release the contracture and resurface the resultant defect. Local flaps are frequently more suited to web contractures between the fingers, whereas the thumb-index web space is amenable to a broader range of surgical techniques. The authors present a review of the anatomy of the web and options for reconstruction of web space contractures.

Amputation, Surgical↗
PubMed2004

Functional outcome after surgery for Dupuytren's contracture: a prospective study.

PURPOSE: The purpose of this study was to assess the functional outcome after surgery for Dupuytren's contracture and the correlation between the change in the degree of deformity of the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) and the change in hand function. METHODS: Hand function in 30 patients was assessed by Sollerman hand function tests prospectively both before surgery and at 6 and 12 months after surgery. The deformity at the MCPJ and PIPJ was measured in degrees of angulation. The results were analyzed using the Spearman rank correlation test. In patients with multiple finger involvement the data were analyzed twice: first by using the measurements for the finger with the worst deformity and then repeating the analysis after the mean deformity was calculated. RESULTS: The mean preoperative MCPJ and PIPJ deformity was 31 degrees (range, 30 degrees to 76 degrees ) and 35 degrees (range, 30 degrees to 96 degrees ), respectively. The mean correction at the MCPJ and PIPJ was 19.6 degrees and 16 degrees , respectively. The mean preoperative Sollerman score was 72.8, which improved to 77.9 at 12 months after surgery. There was a statistically significant correlation between the total correction, PIPJ correction, and hand function at 6 and 12 months, but not with MCPJ correction. In those patients with multiple finger involvement these correlations remained true regardless of whether the mean or greatest deformity was considered. CONCLUSIONS: We conclude that improvement in deformity in Dupuytren's contracture leads to an improvement in hand function and that an improvement in the PIPJ contracture has a greater correlation with hand function than an improvement in the MCPJ contracture.

Adult↗
PubMed2006

Dupuytren's contracture: an audit of the outcomes of surgery.

This multi-centre postal questionnaire study was conducted by the Audit Committee of the BSSH to assess the outcomes of surgery for Dupuytren's Contracture using subjective data provided by 1177 patients at a mean follow-up of 27 (SD 8) months after surgery. Surgery for Dupuytren's contracture achieved a high rate of full, or almost full, correction in 826 patients (75%) but had a high incidence of post-operative patient-reported complications of 46%. A higher complication rate was seen in those patients with worse initial deformities. The rate of contracture recurrence or persistence was 158 of 1037 (15%). The severity of contracture correlated with the final hand function measured using the PEM score. Recurrence was more common in patients with greater initial deformity. Recurrence was less common if good correction was achieved at surgery. The relevance and limitations of this data are discussed.

Dupuytren Contracture↗
PubMed2004

Muscle MRI findings in patients with limb girdle muscular dystrophy with calpain 3 deficiency (LGMD2A) and early contractures.

Limb girdle muscular dystrophy 2A is a common variant secondary to mutations in the calpain 3 gene. A proportion of patients has early and severe contractures, which can cause diagnostic difficulties with other conditions. We report clinical and muscle magnetic resonance imaging findings in seven limb girdle muscular dystrophy 2A patients (four sporadic and three familial) who had prominent and early contractures. All patients showed a striking involvement of the posterior thigh muscles. The involvement of the other thigh muscles was variable and was related to clinical severity. Young patients with minimal functional motor impairment showed a predominant involvement of the adductors and semimembranosus muscles while patients with restricted ambulation had a more diffuse involvement of the posterolateral muscles of the thigh and of the vastus intermedius with relative sparing of the vastus lateralis, sartorius and gracilis. At calf level all patients showed involvement of the soleus muscle and of the medial head of the gastrocnemius with relative sparing of the lateral head. MRI findings were correlated to those found in two patients with the phenotype of limb girdle muscular dystrophy 2A without early contractures and the pattern observed was quite similar. However, the pattern observed in limb girdle muscular dystrophy 2A is different from that reported in other muscle diseases such as Emery-Dreifuss muscular dystrophy and Bethlem myopathy which have a significant clinical overlap with limb girdle muscular dystrophy 2A once early contractures are present. Our results suggest that muscle MRI may help in recognising patients with limb girdle muscular dystrophy 2A even when the clinical presentation overlaps with other conditions, and may therefore, be used as an additional investigation to target the appropriate biochemical and genetic tests.

Adolescent↗