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PubMed1983

Management of burn contractures of the perineum.

Burns of the perineum are rare but very disabling. The author's experience in managing six such cases, 3 males and 3 females, age 8 to 17 years, is discussed. These burns occurred following overspilling of kerosene onto trousers while lighting a stove or as a result of a stove explosion. The treatment is aimed at release of the scar contracture and restoration of genitals to their normal position. An attempt is made to provide full-thickness skin cover in front of pubis by wide undermining of lower abdominal skin and advancing it downward. If, however, the abdomen is scarred, the whole of the resultant raw area is covered with thick split-skin graft. Graft contracture is prevented by advising tightly fitting underwear incorporating a wide elastic band sited over the inguinal furrow between the thighs and perineum.

Adolescent↗
PubMed1990

One-stage reconstruction of the postburn nailfold contracture.

Dorsal digital burn contractures cause unsightly eponychial retraction and proximal nail exposure. These areas are subject to breakdown with minor trauma. These deformities are often ignored as trivial. Many surgeons are unaware that simple reconstruction is possible. Correction is a worthwhile undertaking. This report illustrates a new modification: one-stage reconstruction with bilateral proximally based flaps, dorsally transposed and interdigitated. Donor sites are closed primarily. This technique has been successfully applied to 14 affected fingertips in 4 patients with no complications and no revisions. Patients have been gratified by the resultant restoration of the nailfold. Contractures have not recurred.

Burns↗
PubMed1990

Treatment of breast contractures with open capsulotomy and replacement of gel prostheses with polyurethane-covered implants.

Capsular contracture around gel and gel-saline implants is the most common complication following breast augmentation and reconstruction. Thirty-one patients with postaugmentation gel-implant contractures were treated with open capsulotomy and replacement with polyurethane-covered implants. Eighty-seven percent remain soft after a minimum follow-up of 14 months. Results of replacement after subcutaneous mastectomy and reconstruction are more varied and less successful. Results in 14 patients are presented.

Breast↗
PubMed1993

Capsular contracture simulating myocardial infarction on ECG.

A patient is presented with severe bilateral class IV capsular contractures who presented 16 years after prepectoral breast augmentation with a "septal infarct" pattern on ECG. This abnormal ECG proved to be an artifact caused by unavoidable misplacement of the V2 and V3 leads because of the severe capsular contracture. Following open capsulotomy, normal anatomic lead placement was possible, and a normal ECG was produced.

Artifacts↗
PubMed1993

Slow, gradual external fixation distraction for treatment of postburn knee flexion contracture.

Although surgical release and reconstruction have been used extensively to treat severe postburn knee flexion contractures, the degree of correction is sometimes unsatisfactory, and the procedure is not exempt from significant complications. Based on the principle of slow, gradual external fixation distraction, we have designed a triangular articulated frame to be mounted with the ASIF-BM fixator to deal with joint flexion contractures. One successfully treated patient is reported. This is a percutaneous surgery, with very mild aggression to the patient and very low iatrogenic risks. The technique is easy, the degree of correction may be almost complete, and the hospital stay is very short because it is an ambulatory surgery.

Burns↗
PubMed1993

Intracapsular injection of triamcinolone for prevention of contracture.

The use of steroids for the prevention of implant capsular contracture is an attractive concept, but the method has been handicapped by difficulties getting the right amount of drug to the capsule at the right time. Triamcinolone "in the pocket" was found to be ineffective for prevention of capsular contracture. When the drug was injected into the capsule at 4 and 8 weeks postoperatively, it was very effective. The method for percutaneous injection of intracapsular steroid is explained in detail.

Animals↗
PubMed1997

The fasciocutaneous supraclavicular artery island flap for releasing postburn mentosternal contractures.

Mentosternal contractures represent a surgical challenge to the plastic and reconstructive surgeon. We add the supraclavicular artery island flap to the armamentarium of surgical procedures to improve the function and cosmesis of disfigured patients. Since July of 1994, the supraclavicular artery island flap has been used at our institution for releasing postburn mentosternal contractures in eight patients. The flap was planned to be 4 to 10 cm in width and 20 to 30 cm in length with the supraclavicular vessels running axially. All donor defects could be closed primarily without significant postoperative complications in seven of the eight patients. All flaps healed primarily, achieving a good functional result by complete removal of contracting scar tissue for all patients; one donor site healed by secondary intention. We found the supraclavicular artery island flap both reliable and safe for immediate resurfacing after resection of cervical scars. The anatomy, operative procedure, and postoperative results of the supraclavicular artery island flap are outlined in this paper.

Adult↗
PubMed2000

Fist position for skin grafting on the dorsal hand: II. Clinical use in deep burns and burn scar contractures.

The fundamental problem in all types of hand burns is a loss of skin and subsequent deformities. The goal of skin grafting on the dorsal hand is to graft a sufficient amount of skin, as much as the original amount, and to restore normal hand function without secondary deformities. The safe, or Michigan, position commonly has been used for immobilizing the hand. However, this position is to protect hand function rather than to provide for adequate skin grafting. This institution has developed a new hand position (the fist position) for grafting the greatest amount of skin on the dorsal side of the hand. In the fist position, the hand is positioned flexing all joints of the wrist and the fingers and maximally stretching the dorsal surface of the hand before skin grafting. Ten hands with deep second- or third-degree burn (n = 6) and burn scar contracture (n = 4) of the dorsal hand in eight patients were treated with split-thickness skin grafting after immobilizing in the fist position. The burns and contractures involved nearly the total area of the dorsal hand. The hand was kept in the fist position for 7 to 9 days after skin grafting. Excellent functional and cosmetic results were observed in all cases during the follow-up period of 6 months to 2 years. Complications resulting from hand immobilization for a short period did not occur. The fist position may be a proper hand position for skin grafting to reconstruct the dorsal hand.

Adolescent↗
PubMed2002

Use of an adipofascial flap based on the proximal perforators of the ulnar artery to correct contracture of elbow burn scars: an anatomic and clinical approach.

Different techniques can be used to repair contracture of burn scars on the elbow, including local or distant pedicle flaps, muscle or myocutaneous flaps, free flaps, and tissue expanders. Among these, a pedicled adipofascial flap based on the most proximal two to four perforators of the ulnar artery (located 1 to 5 cm from the origin of the artery) can be anastomosed to form a sort of axially patterned blood supply within the fascia and subcutaneous fat. Therefore, no major vessel in the forearm need ever be severed. In addition, use of this type of flap preserves muscle function. The pedicled adipofascial flap described in this article allows for early rehabilitation because the flap is thin and pliable. Additional advantages are the easy and quick dissection and completion of the procedure in one stage. A detailed anatomic dissection of the flap was performed on 16 upper extremities from fresh cadavers; an injection study was also performed to determine the location and dimensions of the pedicle flap and its area of reach around the elbow. In the past 3 years, 14 flaps were used in 13 patients to repair elbow defects after release of burn scar contractures. Flap dimensions ranged from 4 x 7 cm to 6 x 14 cm (mean flap size, 74 cm). The results were very satisfactory.

Adolescent↗
PubMed1976

Correction of extensive neck contractures with local flaps and split- and full-thickness grafts.

A technic of combined split-thickness and full-thickness skin grafts and local flap closure for extensive deep cicatricial neck contractures is presented. The head and neck are mobilized by excision of limiting tissues. The lateral neck skin is mobilized to be rotated anteriorly as flaps, and a full-thickness skin graft is applied to the central neck. Split-thickness skin grafts are placed below the full-thickness graft and flaps, and also above the full-thickness graft over the horizontal part of the neck. The success of this technic relies upon the limited contracture of full-thickness skin grafts, mobilization of lateral neck tissue, and consideration of regional units of the neck. This relatively simple operation results in a dramatic and lasting improvement of the neckline, good range of motion of the head and neck, elimination of multiple operative procedures, and early rehabilitation of the patient.

Cicatrix↗
PubMed1986

Knee flexion contractures in myelodysplasia.

From 1976 to 1982, 12 children with myelodysplasia had surgery at our institution for knee flexion contractures (21 affected knees). Follow-up was a minimum of 18 months and averaged 47 months. Soft tissue lengthening of the hamstring tendons and release of the posterior capsule with or without femoral osteotomy yielded uniformly excellent results; femoral osteotomy alone produced 40% unsatisfactory results. Based on these data, we no longer recommend osteotomy alone as an effective treatment for fixed knee flexion contractures in children with myelodysplasia.

Adolescent↗
PubMed1991

Dupuytren's contracture.

Dupuytren's contracture is a disease of the palmar and digital fascia that results in a flexion deformity of the fingers. Although the first case was reported more than 350 years ago, many questions remain unanswered. With our present state of knowledge, treatment remains empiric and operative intervention is the only successful mode of treatment. Controversies continue over the type of procedure used, as well as its timing. In light of the high rate of recurrence of flexion contractures after apparently successful operations, current research is being directed toward identifying a biochemical or histologic marker to indicate the probability of recurrence.

Dupuytren Contracture↗
PubMedDate not supplied

Axillary burns: extended grafting and early splinting prevents contractures.

The development of contractures is a common complication after burn injuries. Axillary burns often result in limited abduction of the arm and present a major hindrance in rehabilitation. To prevent axillary contractures after burn injury, we perform a special grafting technique. In this study we treated 17 patients with 23 axillary burns using this technique. Patients were splinted early, and an intensive physiotherapy program was started 5 days after splinting. After 12 months, the mean abduction of the successfully treated axillary burns was 152 degrees. A secondary reconstruction was needed in only 5 of the 23 treated axillary burns. For the treatment of axillary burns, we recommend the described grafting technique in combination with early splinting and intensive physiotherapy.

Adolescent↗
PubMedDate not supplied

Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation.

The purpose of this study was to determine recurrence rates of pediatric foot and ankle burn deformities treated with the Ilizarov method. A total of 19 patients with 29 foot and ankle deformities were studied. The most common deformity treated was equinus (23). Rocker-bottom and cavus foot deformities were each treated three times. The average age of the patient at the time of the burn injury was 3.2 years, and the average age at the time of fixation was 9.4 years. Equinus contractures averaged -34 degrees (34 degrees of plantarflexion) before surgery and +7 degrees (7 degrees of dorsiflexion) after treatment with the Ilizarov fixator. The recurrence rate for all 29 ankles and feet was 69% (20/29). The recurrence rate for equinus contractures was 74% (17/23). The average time to recurrence was 17.3 months. Only short-term follow-up was available on four of the six feet and ankles that did not recur. Deformity correction in burned feet and ankles is difficult to obtain by any means. The authors recommend using the Ilizarov method to obtain correction of moderate to severe foot and ankle deformities in pediatric burn patients, but the correction obtained is not stable and deformity will likely recur. Parents and patients should anticipate adjunctive nonoperative and operative procedures to keep their feet plantigrade as they grow. In young children, the possibility of having additional surgeries, including repeat Ilizarov procedures, should be discussed. Even older children should expect additional surgeries to prevent recurrent deformities.

Adolescent↗
PubMed2003

Anterolateral thigh flap in the treatment of postburn flexion contractures of the knee.

The use of the anterolateral thigh fasciocutaneous flap in the reconstruction of soft-tissue defects around the knee among burn patients is described. The anterolateral thigh fasciocutaneous flap was used for eight patients (all male; mean age, 45 years; age range, 32 to 60 years). Flexion contracture was observed for seven patients with unhealed wounds and one patient with a healed burn wound. The anterolateral thigh flap was used as a free flap for six patients and as a distally based island flap for two patients. The flaps ranged from 8 to 17 cm in width and from 12 to 30 cm in length. Seven flaps were based on a musculocutaneous perforator, and two of them were thinned before transfer to the defect. A true septocutaneous perforator was observed in only one case. The mean follow-up period was 12.5 months (range, 3 to 23 months). Only one flap exhibited distal superficial necrosis, which did not compromise the final result. All patients returned to ambulatory status in 15 to 22 days. Extensor splints were applied to prevent mobilization of the skin graft at the flap donor site for only 7 days. The anterolateral thigh flap has many advantages for the reconstruction of postburn flexion contracture of the knee, as follows: (1) very large thin flaps can be elevated, (2) the two-team approach is possible, (3) color and texture matches are good, (4) the donor-site scar can be easily hidden, and (5) the technique allows early mobilization and patients can return to normal daily activity in a short time. Free or distally based anterolateral thigh flaps are a good choice, both aesthetically and functionally, for the reconstruction of soft-tissue defects of the knee region.

Adult↗
PubMed2005

A new skin flap design for the repair of proximal phalanx base defects in flexion contractures of adjacent fingers.

A random-pattern cutaneous flap with its base at the highly vascularized dorsal web space has been designed to decrease donor site deformity and to increase securely flap mobilization in contractures involving more than 1 adjacent proximal phalanx base. Rectangular flaps facing each other on the lateral sides of adjacent fingers have been raised on a single pedicle in the second, third, or fourth web space. The anatomic integrity of the web space was maintained and exposure of the metacarpophalangeal joints was avoided. Flap donor sites were reconstructed with full-thickness skin grafts. Since September 2000, 22 flaps were raised during a single-stage operation in 13 patients with an average age of 11 years at the time of surgery, and a total of 38 fingers have been reconstructed. The follow-up period averaged 24 months. The postoperative course was uneventful for all patients; all the flaps survived and the donor sites healed without complications. This flap, with its wide arc of rotation and minimal donor site morbidity, is easy to perform and is a good alternative in the reconstruction of multiple proximal phalanx base region flexion contractures of adjacent second, third, fourth, or fifth fingers.

Adolescent↗
PubMed1997

Arthrogrypotic joint contracture at the knee and the foot: correction with a circular frame.

The purpose of this study was to investigate the efficacy of an external fixator (Ilizarov apparatus) for the treatment of severe joint contractures in patients with arthrogryposis multiplex congenita. Thirteen knees and 16 feet were treated in 13 patients at an average age of 11.9 years. The knee flexion contractures were corrected from 38.9 degrees preoperatively to a mean of 6.5 degrees postoperatively and to 17.3 degrees at follow-up (34 months). In the foot deformities, the equinus position was corrected from 29.7 degrees to 7.8 degrees on average. This external fixator is an efficient tool for correction of deformities in arthrogryposis.

Adolescent↗
PubMed1982

Latissimus dorsi myocutaneous flap to restore elbow flexion and axillary burn contracture: a report on two pediatric patients.

The transposition of the latissimus dorsi myocutaneous flap is described in 2 pediatric patients: one with complete loss of elbow flexion, and the other with severe axillary burn contracture. A simplified, secure, one-stage reconstruction with the myocutaneous flap resulted in an excellent substitute of biceps function and skin coverage. The axillary reconstruction allowed immediate full over-the-head abduction, without recurrence of the contracture. In any nonforcible shoulder activity, the function of the latissimus dorsi muscle will not be missed, because of the numerous substitute muscles.

Axilla↗