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At least 991 records · Page 55Linked to original sources
PubMed1992

Management of burn contractures of the first web space of the hand.

First web space contractures of the hand affect predominantly the movements at the trapeziometacarpal joint, rendering the thumb ineffective for opposition and thereby destroying the essential elements of grasp and pinch. Adequate release of contractured first web space followed by a local skin flap cover and dynamic abduction splintage for the subsequent 6 weeks gives excellent results. Documenting the first web angle at every follow-up visit can detect early recurrences and the dynamic splintage can be reinstituted to achieve the normal first web space. Secondary surgery in the form of flexor pollicis longus tendon lengthening or opponens-plasty helps to prevent recurrences.

Burns↗
PubMed1995

Use of preputial skin for the release of burn contractures in children.

Contractures are frequent sequelae of burn injuries. Progressive worsening of contractures with limitation of joint movement is common in children. The results of release procedures in 10 male Chinese children using their own preputial skin obtained from circumcision were reviewed. This technique yields reliable results and is well accepted by the parents.

Adolescent↗
PubMed1994

Reconstruction of postburn scar contracture of the neck by expanded skin flaps.

Flexion contracture of the neck after burns can produce severe functional deformity. Excision and split or full thickness skin grafts, local or distant flaps, and free flaps have been used for reconstruction. Recently, tissue expansion has been introduced as an additional reconstructive procedure. We have used tissue expansion for reconstruction of postburn neck contractures. Twelve patients with ages that ranged from 9 to 34 years were treated with expanded fasciocutaneous supraclavicular and shoulder flaps. No flap necrosis has been seen. In two patients, reconstracture occurred between the expanded flap and uninvolved skin. To date we have not seen any problems with nerve neuropraxia and impression on blood vessels.

Adolescent↗
PubMed1996

Use of seven-flap plasty for the treatment of axillary and groin postburn contractures.

Axillary and groin contracture with limitation of abduction of the arm and leg are one of the most common complications of burns. In this paper we report the technique of using seven-flap plasty for treating axillary and groin scar contractures. The advantages of using this technique are that it does not need prolonged splinting and intense and painful physical therapy.

Adolescent↗
PubMed1996

Surgical release for intubation purposes in postburn contractures of the neck.

Postburn contractures of the neck can cause difficult endotracheal intubation when cervical hyperextension and lifting of the mandible are impaired. alternative techniques to direct laryngoscopy may be hampered by the presence of rigid scar tissue which obscures the mandibular and laryngeal anatomy, or by the presence of microstomia following retraction of scar tissue in facial burns. This report describes our experience with a safe and quick surgical neck release to facilitate endotracheal intubation in such cases. Following release, intubation was established at the first attempt in all cases. Patients who have suffered flame burns to the thorax with an ascending involvement of the neck and mandibular region are particularly prone to develop extreme contractures. Problems with intubation should be anticipated in patients with healed burns of the neck, and equipment for aiding intubation should be on hand. Furthermore, the surgeon must be available during the induction of anaesthesia to perform an emergency neck release if necessary.

Adolescent↗
PubMed1991

A three-flap web-plasty for release of short congenital syndactyly and dorsal adduction contracture.

This article describes a technique for interdigital web space deepening, which is applicable to incomplete syndactyly proximal to the proximal interphalangeal joint and to dorsal web space adduction contracture resulting from thermal injury. It consists of a dorsal rectangular flap and two palmar triangular flaps. The flaps are reversed to release dorsal adduction contracture. This procedure provides a broad commissure with a natural slope. A skin graft is avoided. A mathematical model shows that when the length-width ratio of the flaps is 1:1, the surface area of each flap is greater than or equal to the surface area of the defect it covers and the length of every flap edge is equal to or greater than its corresponding defect edge. If a web has a low apex angle and the skin is elastic, the length-width ratio may be as great as 1.5:1. The flaps will still cover the defects and small inequalities between certain flap and defect edges will be accommodated.

Contracture↗
PubMed1992

Soft tissue contractures from melorheostosis involving the upper extremity.

Melorheostosis is a rare disorder characterized by a linear hyperostosis of cortical bone, joint pain, stiffness, deformity, and limited motion. In the hand, the disease is often disabling because of progressive contractures of the joints and soft tissues involved. Two cases of melorheostosis involving the radial side of the hand and upper extremity are reported. Splinting or surgical release did not result in permanent correction of the soft tissue contractures. Retraining patients to use their unaffected hand should be considered early in the course of the disease.

Adult↗
PubMed1993

Total collateral ligament excision for contractures of the proximal interphalangeal joint.

The complete excision of scarred proximal interphalangeal collateral ligaments as the cornerstone of surgical treatment for proximal interphalangeal joint contractures was evaluated. Supplemental palmar plate distal release, extensor tenolysis, and flexor sheath release were performed as needed. Sixteen patients with primary proximal interphalangeal joint contractures treated by this method were reviewed with the use of preoperative data obtained from chart review and postoperative data from direct patient examination. The average range of motion increased from 38 degrees to 78 degrees. No patients had instability of the proximal interphalangeal joints on manual testing and x-ray examination. This radical surgical approach to contracted proximal interphalangeal joints is justified by the improved range of motion without instability.

Adult↗
PubMedDate not supplied

Early-onset benign autosomal-dominant limb-girdle myopathy with contractures (Bethlem myopathy).

We report the first Japanese patients, a mother and son, with early-onset, benign, autosomal-dominant, limb-girdle myopathy with contractures (Bethlem myopathy). The clinical features revealed predominantly proximal muscle weakness--especially in the limb-girdle muscles--joint contractures increasing with age, a benign course, and the absence of cardiac involvement. Muscle histology revealed nonspecific myopathy changes without dystrophic features. Electromyogram revealed a reduced interference pattern with a giant spike suggesting a neurogenic process.

Adult↗
PubMed2005

Contrasting alterations of apposed and unapposed articular cartilage during joint contracture formation.

OBJECTIVE: To quantify histologic articular cartilage alterations after immobilization, distinguishing between apposed and unapposed sites in an animal model of joint contracture. DESIGN: Experimental controlled trial. SETTING: Laboratory, in vivo study. ANIMALS: Adult male Sprague-Dawley rats (N=128). INTERVENTIONS: One hundred seventeen animals had 1 knee internally immobilized or sham-operated for 2, 4, 8, 16, or 32 weeks. One knee in 11 nonoperated animals served as controls. Main outcome measures On standardized sections, we identified femur and tibia cartilage sites that were apposed or that were unapposed. We quantified 4 characteristics: number of chondrocytes in the superficial and deep cartilage; matrix staining intensity to toluidine blue; surface irregularity of articular cartilage; and thickness of cartilage. RESULTS: Immobilized knees harbored fewer chondrocytes in the superficial cartilage at apposed sites and in the deep cartilage at unapposed sites. Matrix staining decreased only at unapposed sites. Cartilage surface became significantly more irregular at both sites but cartilage thickness remained unchanged. Noncartilaginous tissues appeared only at unapposed sites in the superficial and deep cartilage. CONCLUSIONS: Immobilization led to contrasting patterns of cartilage degeneration at apposed sites compared with unapposed sites. These results suggest distinct pathogenetic pathways for cartilage alterations, possibly through absence of mechanical forces (negative mechanotransduction) at unapposed sites and cyclic pressure at apposed sites. Considering the limited potential for cartilage self-repair, these results support the need for early diagnosis and aggressive mobilization of joints that are developing contractures.

Animals↗
PubMed2006

Arthroscopic mobilization for contracture of the wrist.

PURPOSE: We evaluated the clinical efficacy of arthroscopic mobilization of the wrist for release of persistent traumatic contracture. METHODS: We retrospectively reviewed 11 consecutive patients who had undergone arthroscopic mobilization after trauma. Patients included 9 men and 2 women who ranged in age from 16 to 65 years (mean, 40 years). Injuries causing contracture included 8 fractures of the distal radius, 1 Galeazzi fracture, 1 perilunate dislocation, and 1 carpal bone contusion. A single radiocarpal septum extended from the proximal fibrocartilage of the scapholunate ligament to the midradial ridge in all but 1 patient, in whom multiple fibrous bands bridged the radiocarpal joint. RESULTS: Arthroscopy disclosed 3 types of radiocarpal septum-a single fibromembranous structure that completely divided the joint (type A) in 9 cases, a membranous structure with a fenestration that partially divided the joint (type B) in 1 case, and multiple bands that completely divided the joint (type C); the latter situation occurred in the last patient described earlier. Preoperatively, the arc of motion averaged 76 degrees compared with an average of 98 degrees . Postoperatively, a 22 degrees increase was noted. CONCLUSIONS: Arthroscopic release of a radiocarpal septum was effective in improving range of wrist motion in patients with this finding. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adolescent↗
PubMed2006

The 'expansile' supraclavicular artery flap for release of post-burn neck contractures.

UNLABELLED: Soft tissue defects in the cervico-facial region can result from trauma, tumour excision or post-burn scarring. All rungs of the reconstructive ladder offer possible reconstructive options for these defects. The supraclavicular artery based flap is an extremely reliable local flap for this purpose. It offers thin and pliable skin with good colour match and minimal donor site morbidity. An additional advantage, in our experience, is that this skin can stretch postoperatively to allow further improved neck contour and mobility. MATERIALS AND METHODS: Between June 2000 and January 2004, 27 patients underwent reconstruction of neck defects after release of post-burn contractures with the supraclavicular artery based skin flap at our hospital. After discharge the first follow-up visit was on the 10th postoperative day. The patients were advised to wear a custom made Watusi splint for 3 to 4 months. The patients were subsequently followed up at 3 months, 6 months and 1 year. The dimensions of the flap were measured and the patients photographed at the time of discharge and at subsequent visits. RESULTS: All the flaps survived completely. The average operating time for contracture release and flap coverage was 2 h. The hospital stay ranged from 5 to 8 days. Follow-up ranged from 1 to 4 years with an average of 22 months. Complications included epidermolysis (n=2) and delay in donor site healing (n=2). Almost all patients had some widening of the donor site scar. In our experience the width of the flap increased in the postoperative period. At the time of surgery, the width of the flap ranged between 9 and 12 cm. At the 3-month follow-up there was an average increase in width of 24.2%. At 6 months, the average increase in width was 42.8% of the original flap width. At 1 year the average flap expansion was 63% of the original. The length of the flap ranged from 18 to 24 cm and generally remained unaltered during follow-up.

Adolescent↗
PubMed2004

Experience with the seven flap-plasty for the release of burns contractures.

Eighteen patients with burns contracture to the knee 7 (34%), elbow 5 (28%), perineum 4 (22%), and axilla 2 (11%), were treated at our unit between February 1998 to October 2001 using the seven flap-plasty. We chose this method because of its suitability for such contractures, which take the form of a web rather than a straight or linear pattern. Because it involves no donor area, that is no donor site morbidity and therefore less chance for longer hospital stay. The majority of these patients were children 11 (61%). Ten were females (56%) and 8 (44%) were males. Age of patients ranged between 2 and 35 years. The results of the procedure were satisfactory in all patients with good functional recovery of the affected sites.

Adolescent↗
PubMed2004

Paediatric upper limb contracture release following burn injury.

PURPOSE: The aim of this study was to assess the functional outcome in children who had undergone release of upper limb burn contractures at the axilla, elbow and wrist. METHODS: We studied a series of 10 patients reconstructed with local flaps (n = 5), Integra artificial skin (n = 10) and micro-vascular free tissue transfer (n = 5) to release contracted axillae (n = 8), elbows (n = 5) and wrists (n = 7). Follow-up ranged from 6 months to 6 years and outcome was assessed by functional improvement. RESULTS: Full functional release was achieved in all cases at the time of the surgery. Local flaps resulted in good or excellent outcomes in all five cases. Six patients reconstructed with Integra were assessed as having an excellent outcome whereas four had a poor outcome. Free tissue transfer with excellent result was achieved in five children. CONCLUSIONS: This series assessed the three treatment options that we have used for the release of upper limb post-burn contractures. We have shown that local flaps fashioned from burnt skin survive, Integra requires extended post-operative care to prevent recontraction and free tissue transfer is safe in young children. Each method when used appropriately has produced excellent results which have been maintained over the follow-up period.

Adolescent↗
PubMed2004

Bilateral palmar contractures as a paraneoplastic syndrome in primary peritoneal carcinoma.

Primary peritoneal carcinoma, like ovarian cancer, usually causes non-specific abdominal symptoms, and often presents at a late stage. We report a case of primary peritoneal carcinoma where the development of abdominal symptoms was preceded for 6 months by paraneoplastic palmar contractures. This case demonstrates the importance of recognising palmar contractures as a potential sign of neoplastic disease.

Contracture↗
PubMed2006

Factors in the pathogenesis of Dupuytren's contracture.

This article reviews the basic science elements involved in the pathogenesis of Dupuytren's disease. Dupuytren's contracture is effected by a multitude of complex processes at the cellular level and the exact relative contribution of each is unknown. Various investigators have proposed different theories and documented individual findings regarding the pathophysiology of Dupuytren's contracture. The current report attempts to summarize many of these findings together in a schema of pathogenesis.

Algorithms↗
PubMed2005

Pseudosyndactyly and musculoskeletal contractures in inherited epidermolysis bullosa: experience of the National Epidermolysis Bullosa Registry, 1986-2002.

Mitten deformities of the hands and feet occur in nearly every patient with the most severe subtype (Hallopeau-Siemens) of recessive dystrophic epidermolysis bullosa, and in at least 40-50% of all other recessive dystrophic epidermolysis bullosa patients. Smaller numbers of patients with dominant dystrophic, junctional, and simplex types of epidermolysis bullosa are also at risk of this complication. Surgical intervention is commonly performed to correct these deformities, but recurrence and the need for repeated surgery are common. Higher numbers of epidermolysis bullosa patients also develop musculoskeletal contractures in other anatomic sites, further impairing overall function. Lifetable analyses not only better project the cumulative risk of mitten deformities and other contractures but also emphasize the need for early surveillance and intervention, since both of these musculoskeletal complications may occur within the first year of life.

Adolescent↗