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PubMed1997

Day care surgery for advanced Dupuytren's contracture.

Seventy-six consecutive patients suffering from advanced Dupuytren's contracture were analysed in order to evaluate the safety of day care surgery. The complication rates for haematoma, necrosis, infection and reflex sympathetic dystrophy were acceptable, but we found an unacceptably high percentage of nerve lesions. Day care treatment was achieved in all but seven cases. We concluded that advanced Dupuytren's contracture can be treated by day care surgery but the operations should be performed by surgeons who are skilled in hand surgery, and individual selection of patients with recurrence seems advisable.

Ambulatory Surgical Procedures↗
PubMed1997

A historical record of traumatic rupture of Dupuytren's contracture.

Traumatic rupture of Dupuytren's contracture is rare. It has been reported only twice in recent times and only on four previous occasions over the last millenium. These cases are reported and the forces involved in rupturing Dupuytren's contracture are discussed.

Dupuytren Contracture↗
PubMed1998

A clinical grading system for Dupuytren's contracture.

A clinical classification for Dupuytren's contracture of the hand is described. The classification system has been used to sort patients with Dupuytren's contracture into five broad surgical categories and takes into account predisposing factors, risk of recurrence and sympathetic tone in the individual patient. The system has many advantages in determining the approximate operation time and surgical experience required to treat patients. One hundred and four patients graded by this system have been analysed. There was a broad agreement between expected and actual operating times, with no significant difference between them.

Dupuytren Contracture↗
PubMed1998

Correction of soft tissue contractures of the wrist using the Ilizarov technique.

The Ilizarov technique can allow new histiogenesis of soft tissue as well as bone. Three cases of wrist contracture successfully treated by this method are described. One patient had transient superficial pin site infections. There were no other complications. At 2 years follow-up there was no recurrence of contractures.

Adolescent↗
PubMed2000

Medium thickness plantar skin graft for the management of digital and palmar flexion contractures.

The fundamental principle of reconstruction is to replace the lost tissue with similar tissue. Because of the unique similarities in characteristics, plantar skin is an excellent donor area for skin grafting for the palmar aspect of the digits and hand. It provides an ideal color and texture match and long durability with an inconspicuous donor site. However, the use of plantar skin in management of digital and palmar defects is only rarely reported in the literature. Doubts were raised on donor site healing and incidence of recurrence of contracture. There are reports of using full thickness skin graft and dermal grafting from planta in similar cases. We have used medium thickness split grafts from sole of foot in correcting 262 cases of flexion contracture of digits and palms. Thick split skin grafts, full thickness grafts, local flaps and Z plasties were used in numbers of other cases. The technique of plantar skin grafts, application and results with reference to take of graft, quality of skin, donor area healing and recurrence are discussed and compared with available methods and studies.

Adolescent↗
PubMed1999

Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report.

Postburn neck contractures still represent a surgical challenge due to their exposed location; and early operative treatment is necessary for both functional as well as aesthetic reasons. An excellent functional result was obtained by using a supercharged super-thin occipito-cervico-dorsal flap described by Hyakusoku to repair a large defect of the anterior neck following a very wide neck burn contracture release. In this case report, the technique and its advantages among the other reconstructive modalities are discussed briefly.

Adult↗
PubMed1999

Clinical experience in treatment of peri-anal scar contracture in children.

Thirty-nine children suffering from peri-anal scar contracture as a result of burn injury have been treated since 1987. Among them, 25 were boys and 14 girls. Their age ranged from 6 months to 7 years, mean age 3.5 years. In 4 patients, local excision of scar followed by full-thickness skin grafting was done. The result was poor because of movement of the graft, infection and finally necrosis of the graft. In 3 patients, lysis of the scar followed by a transposition of flap, and in 32 local "Z" or "Y-V" plasty were performed with satisfactory results. In our opinion the latter technique should be the treatment of choice, as it is simple, less traumatic, and resulting to high success rate with less tendency to recurrence of contracture. For patients with chronic intestinal obstruction, adequate pre-operative bowel preparation, meticulous post-operative local care are essential. General supportive treatment should not be neglected to ensure a satisfactory operative result.

Anus Diseases↗
PubMed2000

A near closed book contracture of the ear: a case report.

An unusual post-burn ear contracture, involving crus helicis, cymba conchae, tragus and antihelix, with anterior vertical folding of the ear on itself, like a closed book, has been described. The contracture was completely released and the resultant raw area was covered by a full thickness skin graft, harvested from the opposite post-auricular area. The crippled ear cartilage was still folded anteriorly at the level of the concha, regardless of complete release, due to long standing childhood burns. Three months later, concha-mastoid suturing was carried out to give the ear its normal shape and erect, prominent position. Four years of follow up showed, an aesthetically good-looking ear with satisfactory position.

Adolescent↗
PubMed1995

Transforming growth factor-beta: possible roles in Dupuytren's contracture.

Transforming growth factor-beta (TGF-beta) is a multifunctional polypeptide that stimulates extracellular matrix deposition and fibroblast proliferation. Because both these features characterize Dupuytren's contracture, we investigated a possible role for TGF-beta in the etiology of this disorder. We studied receptor expression for TGF-beta, effects of TGF-beta 1 on DNA-synthesis, and in vitro production of TGF-beta 1 and TGF-beta 2 in both normal and Dupuytren-derived fibroblasts. We also studied the effects of epidermal growth factor (EGF) on growth of the different cell types. TGF-beta receptor profiles were different between the two cell types, as were TGF-beta 1 and EGF-induced stimulation of cell growth. Both cell types secreted both active and latent TGF-beta. Our results suggest that growth factors such as TGF-beta and EGF may play a role in Dupuytren's contracture.

Adult↗
PubMed1980

The treatment of contractures of the hand using self-hypnosis.

The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patient's motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

Adult↗
PubMed1983

Extension contracture of the wrist: a case report.

Progressive extension contracture of the wrist of a 19-year-old female patient was noted at operation to be due to shortening of the extensor carpi radialis longus and extensor carpi radialis brevis. Satisfactory wrist motion was restored with Z-plasty tendon lengthening of these two muscles. There was no apparent abnormality of the muscle bellies and no identifiable cause of the muscular contracture. A review of the literature revealed no previously reported cases of this kind.

Adult↗
PubMed1983

The pathogenesis of Dupuytren's contracture: contractile mechanisms of the myofibroblasts.

The role of myofibroblasts in the pathogenesis of Dupuytren's contracture was investigated by light and electron microscopic histochemical methods. Dupuytren's myofibroblasts contain an intracellular contractile mechanism that is driven by the dephosphorylation of adenosine triphosphate. Our study of calcium adenosinetriphosphatase (ATPase) activities verifies that the site of this energy system is on the myofilaments of the myofibroblasts. The degree of ATPase activity, as determined by cell counts, appeared to correlate with the residual contracture as predicted by the Legge and McFarlane Outcome Standard Formula. Further, alcian blue staining on the ultrastructural level indicates that the myofibroblasts are associated with each other and with surrounding collagen by a glycosaminoglycan matrix 300 to 1000 A thick. Collagen fibrils are attached by a similar matrix comprised of 100 A thick fibrils. The dynamic cellular architecture of the multiple adjacent myofibroblasts with their connections to surrounding collagen may be partially responsible for the residual clinical deformities seen in this disease.

Adult↗
PubMed1987

Dermofasciectomy and full-thickness grafts in the treatment of Dupuytren's contracture.

We report a 16-year experience with full-thickness grafts to resurface defects created by releasing contractures of Dupuytren's disease. This technique was used in 68 patients with Dupuytren's contracture from 1970 to 1985. Follow-up of 36 hands of 24 patients averaged 3.9 years postoperatively. There was no recurrent disease in the palms and digits that were covered with the full-thickness grafts. The incidence of extension outside the grafts was 8%. The area of full-thickness grafting covered most of the width of the palm, an extension of Gonzalez's technique, which was presented in 1970.

Dermatologic Surgical Procedures↗
PubMed1987

Possible role of plasminogen activator content of the palmar nodules in recurrence of Dupuytren's contracture.

Increased amounts of plasminogen activator enzymes were found in the large Dupuytren's nodules in the so-called active phase of the disease. A prospective study in 15 patients who had operations investigated possible relationships between fibrinolytic capacity of the palmar nodules (assessed by the fibrin plate method) and the recurrence of contracture. There were substantial analogies and suggestive connections with the results of previous electron microscopic studies. Combined with the presence of myofibroblasts, the high increase of plasminogen activator enzymes in the fascial nodules may be regarded as a predictive marker for possible recurrence after surgical treatment of Dupuytren's contracture.

Adult↗
PubMed1987

Salvage of severe recurrent Dupuytren's contracture of the ring and small fingers.

Severe recurrent digital Dupuytren's contracture, with pseudomotor changes and inadequate palmar tissue, is often treated with amputation. In this study, 11 patients had 14 proximal interphalangeal joint fusions with shortening done for salvage of recurrent Dupuytren's rather than amputation. Indications for operation were pseudomotor changes, severe palmar fibrosis, previous operations, and a flexion contracture of greater than 70 degrees.

Arthrodesis↗
PubMed1996

Correction of severe spastic flexion contractures in the nonfunctional hand.

The superficialis to profundus transfer has been a time-honored treatment of spasticity in nonfunctional hands, but it does not address the many associated problems. Fourteen patients were treated with 15 procedures (1 bilateral) designed to relieve severe flexion contractures of the hand and wrist over a 3-year period with a single-stage comprehensive surgical correction consisting of superficialis to profundus transfer, wrist flexor release, flexor pollicis longus lengthening, wrist arthrodesis, carpal tunnel release, and ulnar motor branch neurectomy or intrinsic release. For all, nonoperative treatment had failed or there were chronic skin problems. The follow-up period averaged 1 year. In 13 of 15 patients, there was wrist fusion after the index procedure, with 1 patient requiring replating and another uniting after prolonged casting. Two patients had a residual claw hand with only partial correction of a thumb-in-palm deformity. All preoperative hygiene problems and infections resolved. The comprehensive protocol allowed correction of severe contractures of the hand and wrist by a single operation with improved care and appearance of the hand.

Arthrodesis↗