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At least 811 records · Page 45Linked to original sources
PubMed2006

[Application of integra for reconstruction of burn scar contracture].

OBJECTIVE: Introducing a comprehensive technique to reconstruct burn scar contracture or deformities using integra (artificial dermis) with large epidermal skin grafting or ulth-thin split-skin. METHODS: The wounds following contracture scar or deformities excised or loose were covered with the integra which was flattened and fixed perfectly, after a 2 approximately 4-week period, the out layer was removed then covered with large sheets of epidermal grafts, which was of thickness from 0.0028 inc to 0.0048inc (0.07 approximately 0.12 mm), or ulth-thin split-skin of about 0.006inc (0.15 mm) thickness, harvested using the electric or air power dermatome, the edge of the graft sheet attached together with the borders of wound using nanoparticles-Ag-gauze stripe adding sutures of the 5-0 threads or the skin stapler, dressed with vaseline gauzes in the inner layer and the nano-particles Ag gauze on the outer surfaces. RESULTS: Nineteen sites of 15 cases including 5 sites in trunk and 14 sites in extremities from 1999.8 to 2003.6 were treated using this technique in this study, the wound areas following scar excised was about 10 cm x 25 cm approximately 30 cm x 75 cm, of them 12 cases covered with a large sheet of ultr-thin split-skin (in early time) and 7 cases with a large sheet of epidermal grafting and all of them was survival. The colour and texture of the reconstruction sites were very good and can be compared favorably with normal skin after a half year-four year following up period, because all donor sites healing without scarring, the appearance in the epidermal graft donor is better than that in split-thickness skin donor. CONCLUSIONS: Integra with large sheets of epidermal grafts applied for scar contracture disformities is an effective and useful method, especially the epidermal grafts offered a satisfying result in the donor healing.

Adolescent↗
PubMed1975

[Ischemic contractures of muscle and nerve lesions (author's transl)].

Reporting 14 own cases symptomatology and treatment of the common ischemic syndromes of the extremities (Volkmann's contracture, thumb adduction contracture respectively contracture of the intrinsic hand muscles and anterior tibial syndrome) including the regularly concomitant nerve lesions are discussed. Edema and compression beyond the primary ischemia are essential factors in pathogenesis of nerve and muscle lesions. The electromyographic examination is helpful in diagnosis, prognosis and treatment of the severe sequelae of nerve and muscle. Since late diagnosis yields poor therapeutical results, early recognition of ischemic states and prophylaxis are most important.

Adolescent↗
PubMed1991

The use of the full thickness skin graft in Dupuytren's contracture.

For those hand surgeons who have experienced early complications associated with limited fasciectomies (those who have not, have not done enough limited fasciectomies) and are frustrated by a high rate of recurrence or extension of the disease, incision of the cord and interposition of a full thickness graft is a technique to seriously consider. The procedure is not difficult to perform, but patience and attention to detail are prerequisites for success. That success is measured by complete or near complete release of the contracture with a minimum of morbidity, a nil recurrence rate, and extension rate of less than 10%. This technique is indicated for patients who have one or more elements of the Dupuytren's diathesis. Usually people older than 65 who develop Dupuytren's contracture do not have the diathesis, and their disease can be managed by limited fasciectomy and Z plasty skin lengthening. Finally, Dupuytren's disease presenting with no contracture can be managed effectively and conservatively by a series of intralesional injections of triamcinolone into the nodules and cords, the treatment of choice for all plantar nodules and knuckle pads.

Dupuytren Contracture↗
PubMed1991

[Treatment of cicatricial flexion contractures of the fingers].

The article discusses the results of treatment of 152 patients with cicatrical flexion contractures of the fingers consequent upon mechanical, thermal and gunshot injuries. The authors suggest their own classification of cicatricial contractures of the fingers according to the extent of the cicatricial process and restriction of the volume of movements and impairment of the grasp. Various methods of treatment were applied depending on the type of the pathological process. Analusis of the late-term results showed that the distraction method has advantages over the traditional skin plastics methods in the treatment of stable combined forms of contractures.

Adult↗
PubMed1977

[Dupuytren's contracture and palmar erythema in alcoholic cirrhosis].

Three comparable groups were studied : 100 patients with alcoholic cirrhosis, 100 alcoholics without cirrhosis, and 100 subjects without either alcoholism or cirrhosis. Dupuytren's contracture was noted in 43% of cases in group I, 34% in group 2, and in 14% of group 3. There was no parallel between the frequency of Dupuytren's contracture and the severity of the liver involvement. Palmar erythema was noted in 34% of cases of group 1, 23% of cases of group 2, 12% of cases of group 3. Dupuytren's contracture has a genetic background, but its clinical expression is facilitated by metabolic causes, the most frequent being chronic alcoholism. Palmar erythema appears to be a sign of severe liver disease.

Adult↗
PubMed1991

[The surgical treatment of postburn cicatricial contractures of the knee joint extensors].

In the recent 3 years operations were carried out in 8 patients with postburn extension contractures of the knee joints, which accounted for 12.9% of all cicatricial contractures of this joint. The anatomical essence of the contracture was ascertained. A method of surgical treatment was developed, which consisted in restoration of the cutaneoadipose layer in the region of the knee with a cutaneofascial graft taken from the contralateral leg and subsequent excision of the scars on the thigh, by freeing of the muscles extending the joint, and restoration of the skin surface with a split nonperforated autodermal graft. The operation restores knee joint movement and removes trophic ulcers of pathological postburn scars.

Adult↗
PubMed1990

Preoperative antibiotics and capsular contracture in augmentation mammaplasty.

The main drawback with augmentation mammaplasty using implants is capsular contracture. The cause of this complication is still unknown. Silicone particles, hematoma, and bacterial contamination are some of the etiologic factors discussed. In this randomized, double-blind study on 76 breast-augmented women, 50 percent of the patients had preoperative prophylaxis with benzylpenicillin and dicloxacillin. Bacteria samples were taken intraoperatively. The number of negative cultures increased significantly with antibiotic prophylaxis. In four follow-ups during the first postoperative year, the rate of contractures was evaluated by subjective and objective methods. The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture.

Adult↗
PubMed1990

Polyurethane foam-covered implants and capsular contracture: a laboratory investigation.

Experiments were conducted in rabbits comparing polyurethane foam-covered implants with otherwise identical smooth silicone gel implants. Using five objective methods of measurement of capsular contracture, no significant difference could be identified. The foam-covered implants consistently developed capsular contracture, although in most cases this was of mild degree and would not have been clinically significant. In the two foam-covered implants with hard contractures, there was no evidence of hematoma or separation of the foam.

Animals↗
PubMed1990

[Arthrolysis of the elbow in posttraumatic contracture].

Intra- and periarticular fractures about the elbow joint are treated with open reduction and internal fixation. This allows early functional after-treatment. Nevertheless, the range of motion remains more or less unsatisfactory. In these cases open arthrolysis provides a considerable improvement in joint function. We therefore recommend this operation when the hardware is removed about 9 months after the accident. The reasons for post-traumatic contracture of the elbow could be intrinsic such as interposed fragments, intra-articular adhesions, incongruity of the articular surfaces--or extrinsic--like contractures of the capsule and ligaments, adhesions of different layers, ectopic bone formations. In most cases a combination of both can be found. Important conditions for successful arthrolysis are mostly intact joint surfaces, failure of all conservative efforts to improve the arc of motion, a motivated patient who understands clearly the risks and benefits that could reasonably be expected by the operative procedure and rehabilitation and, last but not least, a skilled, experienced surgeon. The choice of the approach depends on the main location of the post-traumatic changes and on previous incisions. Osteotomy of the radial epicondyle gives a much better view of the joint and should be performed whenever necessary. The exact course of the operation may not be standardized. The main point is to remove scarred adhesions and bony irregularities. An individually modified rehabilitation program is as important as the operative procedure itself to achieve the best results possible. In general, the exercises should not cause pain. In the first few days plaster casts in flexion and extension are used. Physiotherapy is supported by CPM machines as early as possible. Patients must be prepared with the help of drugs and the application of ice bags. Even after months improvement of motion can be obtained. In a retrospective follow-up study, 125 out of 168 patients with arthrolysis of the elbow joint were reviewed. Most patients sustained a fracture of the distal humerus. In 77%, the results were graded as very good, good or satisfactory, i.e., the average relative improvement amounted to at least 40% according to the criteria of W. Blauth. Patients with very severe (preoperative ROM 0-30 degrees) and severe (preoperative ROM 30-60 degrees) contractures profited more (relative improvement 60%) than the others (relative improvement 45%). Overall, the average arc of total motion increased 49 degrees; the relative improvement of motion increased by 58%.

Adult↗
PubMed1990

[The surgical treatment of knee joint extensor muscle contractures].

It is reported about the results after operative mobilization of knee joint in 19 patients with contractures of extension muscles of knee joints. After operative arthrolysis and/or Payr-Plasty the range of motion has increased on average from 23 degrees to 92 degrees (a relative gain of 52%). Patients with traumatic knee contracture of extension muscle achieved an improvement in the range of movement on average by 76 degrees, whereas those with contracture due to infection improved on average by only 43 degrees. The etiology, the duration, and the preoperative loss of movement are important for success of treatment.

Adult↗
PubMed1989

[Corrective possibilities of burn contractures of the large joints].

Major joint movement is frequently limited following full-thickness burns of the extremities due to scar contractures. After operative correction of the contractures physical therapy is absolutely necessary. Skin contractures are treated with Z-plasty, skin graft, local flaps, pedicled flaps and free tissue transfer. The advantages and disadvantages of those procedures are described.

Burns↗
PubMed1989

[Treatment of postburn cicatricial deformations and contractures of the neck].

Postburn cicatrices and contractures of the neck have been corrected in 130 patients by the routine methods (Z plasty, free transplantation of the skin, combined methods). Analysis of the late results has shown that contractures have been eliminated or reduced in 70% of the patients, but a good cosmetic effect has been achieved in only 30%. In 75 patients plasty of the postburn cicatricial deformations of the neck has been made with the use of dermo-fascial flaps of the intact skin of the thoracic wall. This technique developed by the authors has completely removed the contracture, and the shape of the neck has remained unchanged: a full-value natural skin integument has been created on the anterior and lateral surface of the neck. Complications (marginal necrosis of the transplanted flaps), recorded in 10% of the patients, have not much influenced the out-come of surgery.

Burns↗
PubMed1989

Congenital gluteus maximus contracture.

Muscle contractures are infrequent in Israel. This report discusses one case of a congenital contracture associated with a skin dimple treated in Israel. A 3-year-old boy presented with difficulty in running, riding a bicycle, and squatting. Flexion of the right hip in adduction was impossible. The hip could be fully flexed in abduction. Congenital contracture of the right gluteus maximus muscle was successfully treated by surgical release.

Buttocks↗
PubMed1987

Transmural progression of morphologic changes during ischemic contracture and reperfusion in the normal and hypertrophied rat heart.

The purpose of this study was to compare the functional and morphologic changes that occur during ischemic contracture and reperfusion in the normal and hypertrophied heart. Hearts from Sprague-Dawley, spontaneously hypertensive (SHR), and normotensive Wistar-Kyoto rats were evaluated using a modified Langendorff perfusion apparatus. After obtaining control data, hearts were potassium-arrested, made ischemic, and studied at various time points. Regional coronary flow was assessed with the use of radiolabeled microspheres or Microfil dye infusion, and morphologic changes were evaluated by means of light and electron microscopy. Sarcomere length changes and qualitative morphologic changes during global ischemia demonstrate a transmural progression of ischemic damage starting at the endocardium and extending, with time, epicardially. The progression of ischemic changes in hypertrophied hearts of SHRs was similar to that of normal hearts; however, hypertrophied hearts developed ischemic contracture sooner than normal hearts. In addition, the development of contraction band change after ischemic contracture occurred only when hearts were reperfused and was related to the development of no-reflow.

Animals↗
PubMed1988

Spasticity and contracture. Physiologic aspects of formation.

Disruption of the upper motor neuron inhibitory pathways by stroke, brain trauma, or spinal cord injury leads to muscle spasticity. Spasticity is characterized by increased muscle tone, hyperactive reflexes, and possible clonus or rigidity. The increased muscle tone may result in loss of joint motion, leading to contractures. Treatment of established contractures is difficult. Prevention of contractures by joint mobilization is emphasized as a goal in the management of patients with spasticity.

Animals↗
PubMed1987

Dupuytren's contracture studied with monoclonal antibodies to connective tissue differentiation antigens.

Seventeen patients with Dupuytren's contracture underwent partial fasciectomy, and frozen tissue sections from the involved palmar fascia were prepared for binding studies with hybridoma-derived murine monoclonal antibodies (MoAb) recognizing connective tissue differentiation antigens. The two MoAb used were both generated using human sarcomas as immunizing agents, 23H7 known to bind to an antigen shared by selected sarcomas and carcinomas but not normal adult tissues except a subset of granulocytes, and 12C9 shown to recognize a common fibroblastic marker. MoAb 23H7 was discovered to bind to a subset of fibroblasts within the lesions of six of 17 patients with Dupuytren's disease. Occasionally it immunostained a single cell population associated with tissue granulocytes dispersed in the surroundings of the lesions. MoAb 12C9 was found to be expressed in only 12 of 17 specimens prepared from involved lesions from Dupuytren's disease. It is suggested that fibroblasts from selected patients with Dupuytren's contracture express a novel antigen, defined by MoAb 23H7, previously shown to be associated with human sarcomas and other neoplasia. The other fibroblast marker which is defined by MoAb 12C9 and known to be a common connective tissue antigen, is only occasionally expressed in lesions involved with this disease. Though additional markers associated with Dupuytren's contracture remain to be defined, the MoAb, capable of defining connective tissue differentiation markers, reported in this study may serve as new immunological probes for immunodissecting this syndrome into subsets of diseases which may better define the variety of clinical patterns presented by patients.

Adult↗
PubMed1988

Cytogenetic studies in Dupuytren contracture.

Dupuytren contracture is a connective tissue disease mainly confined to Caucasians. It is characterized by nodular growth and proliferation of collagen in the palmar and plantar fascias. Autosomal dominance with variable penetrance is considered the most likely mode of inheritance. The goal of the present study was to examine the cytogenetics of this common benign neoplasia. Chromosome studies were performed on the nodular growth of eight patients with Dupuytren contracture, all of whom showed chromosome abnormalities that included numerical and structural clones, random numerical and structural aberrations, prophasing, and premature centromere separation. Numerical clones of trisomies 7 and/or 8, as well as some random structural aberrations, were considered to represent in vivo abnormalities, whereas most structural clones appeared likely to be the results of rapid and selective in vitro growth of particular cells. The disease process occurring in Dupuytren contracture was found to involve marked chromosome instability, as well as some in vivo clonal formation. Transverse fascial tissue, usually considered to be uninvolved in the disease process, unexpectedly showed all the same types of abnormalities as the nodular tissue. This indicates a more widespread distribution of disease in the tissues than previously suspected. The findings in the present study are similar to those in various malignant and benign types of tumorous growth and suggest the importance of further cytogenetic investigation into other conditions of benign growth.

Aneuploidy↗
PubMed1987

Contractures. A historical perspective.

Orthopedic history vividly documents the continuing battle between restoring tissue stability and preserving functional mobility. Prolonged and uninterrupted rest, popularized by Hilton and Thomas, but promoted by many before them and subsequently continued by Jones, Orr, and others, assures healing. Contractures that permanently limit function are not an uncommon consequence. Hippocrates, Hunter, Lucas-Championniere, and David advocated judicious motion. Timing and the interpretation of the patient's pathologic state have proved to be the critical criteria. Modern antibiotics, antiinflammatory medications, acute surgical repair, and techniques that combine stability and early motion provide today's orthopedic surgeons' great versatility and capability. Despite these advantages the threat of contractures remains. The dictum "rest until healed" persists. Physiologic posturing of inflamed or swollen joints to minimize tissue strain introduces resting positions of 15 degrees plantar flexion at the ankle, and 30 degrees flexion at the knee and hip. These will be perpetuated by contractures if not actively counteracted by timely mobilizing procedures. Each of these joint positions is a serious deterrent to walking without stressful substitutive posturing, and the patient's ability to function is impaired.

Contracture↗