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At least 1,441 records · Page 80Linked to original sources
PubMed1986

Ischaemic contracture of the intrinsic muscles of the hands. A hazard of physical restraint.

A case is described of bilateral ischaemic contracture of the intrinsic muscles of the hands, presenting in a mentally-disturbed patient one year after a reported period of immobilisation in a physical restraint device. Involvement of the deep thenar muscles and the interossei on the radial side of the hand can be explained by consideration of the anatomy of the deep palmar arch. Division of the tendons of the contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the left first web improved hand function. Those who supervise the use of physical restraint devices should be aware of the risk of intrinsic muscle ischaemia and of the need for prompt diagnosis and treatment.

Adult↗
PubMed1990

Elastic band mobilisation after flexor tendon repair; splint design and risk of flexion contracture.

Elastic band mobilisation of repaired flexor tendons in zone 2 may be complicated by flexion contracture of the P.I.P. joint. The mechanics of three types of elastic band mobilisation were analysed from lateral video-recordings of finger movement and the flexion moment at the P.I.P. joint was derived at every 10 degrees of flexion. The conventional forearm attachment of the elastic band produced a steep rise in P.I.P. joint flexion moment during extension; this effect was greatest when the M.P. joint was at 70 degrees and least at 20 degrees. Flexion moments for attachments around the dorsum of the hand or under a palmar pulley were lower, uniform throughout the range of P.I.P. joint motion and independent of the position of the M.P. joint. The effort needed to extend the P.I.P. joint is strongly influenced by the method of elastic band attachment; consideration should be given to both tension and moment arm in application of elastic band mobilisation.

Bandages↗
PubMed1992

Chromosomal abnormalities in Dupuytren's contracture and carpal tunnel syndrome.

The cytogenetics of cell cultures derived from Dupuytren's tissue, adjacent palmar fascia and palmar skin from patients undergoing fasciectomy have been examined and the results compared to cell cultures established from palmar fascia, flexor retinaculum and palmar skin of patients undergoing carpal tunnel decompression. Chromosomal abnormalities were detected in cell cultures from Dupuytren's tissue in eight of the nine patients studied. Clones of cells trisomic for chromosome 8 were found in five of the nine patients. Trisomy 8 was also present in two of five flexor retinaculum cultures from carpal tunnel syndrome cases. These findings in both Dupuytren's contracture and carpal tunnel syndrome suggest the presence of chromosomal instability in the palmar fascia. The significance of the chromosomal abnormalities is however unclear, but they indicate a possible common pathway in the onset of pathological fibrosis.

Adult↗
PubMed1993

The presence of myofibroblasts in the dermis of patients with Dupuytren's contracture. A possible source for recurrence.

Samples of skin and underlying cord obtained at dermofasciectomy for Dupuytren's contracture have been examined for the presence of smooth muscle alpha-actin (SM alpha-actin), a marker for myofibroblasts. 15 of the 20 samples stained positively for SM alpha-actin corresponding with areas of hypercellular Dupuytren's tissue. In 12 of these 15 samples SM alpha-actin-positive hypercellular Dupuytren's tissue extended into the dermis, in three cases reaching the epidermis. In eight samples, diffusely distributed cells positive for SM alpha-actin and resembling fibroblasts were seen in the dermis. These cells appeared to be separate from the Dupuytren's foci. The presence of hypercellular foci and isolated fibroblasts positive for SM alpha-actin within the dermis may explain the high recurrence rate of Dupuytren's disease after fasciectomy.

Actins↗
PubMed1993

Day care surgery for Dupuytren's contracture.

Contrary to standard practice in the United Kingdom, primary surgery for Dupuytren's contracture can be performed safely on a day care basis provided that strict criteria are followed. Although demanding on Consultant surgical time, this policy offers a considerable saving in hospital resources.

Adult↗
PubMed1994

The palmar fascia after treatment by the continuous extension technique for Dupuytren's contracture.

After complete elongation using the continuous extension technique the palmar fascia of four patients with Dupuytren's contracture was examined by light and electron microscopy and compared with non-elongated samples from 20 patients at the same clinical stage of the disease. Nodules and cords were no longer clinically recognizable after extension. The tissue contained collagen fibrils of uniform diameter (about 50 nm), densely packed in fibres parallel to the stretching force. Fine filaments (presumably proteoglycans) formed a network which was intermingled with and periodically bound to the collagen fibrils. Fibroblasts and myofibroblasts with an high biosynthetic activity and oxytalan-like microfibrils were aligned along the collagen fibres. The results show that in Dupuytren's disease the contracted palmar fascia reacts to external forces with neoformation and reorientation of all tissue components by myofibroblasts.

Actin Cytoskeleton↗
PubMed1987

A review of attitudes to splintage in Dupuytren's contracture.

A questionnaire on the use of splintage before and after operations for Dupuytren's contracture has been completed by 45 hand surgeons and ten hand therapists. None considered that preoperative splintage was beneficial, but nearly all used some form of splintage after operation. The types of splint and programmes for using them varied widely, and these are discussed.

Attitude of Health Personnel↗
PubMed1988

A simple inexpensive post-operative management regime following surgery for Dupuytren's contracture.

A simple regime has been devised for the post-operative management of patients following surgery for Dupuytren's contracture; this includes splintage of the hand for two weeks and active and passive mobilisation by the patient according to precise instructions. Selective help was provided by minimal occupational therapy in 5 of 50 patients. The results of the method were assessed prospectively by subjective criteria and objective assessment by measuring the deformity of the finger joints, lateral and tip pinch and grasp and shear forces.

Dupuytren Contracture↗
PubMed1988

The lateral arm free flap in releasing severe contracture of the first web space.

To permanently release severe contracture of the first web space, suitable additional skin must be provided. Local skin is often insufficient and is unable to fill the depths of the space. Pedicle flaps are bulky, require a second operation for division, and frequently demand further procedures for revision. A precisely tailored lateral arm free flap allows unparalleled correction to be achieved with one surgical intervention. The operation can be performed under regional anaesthesia with morbidity restricted to one extremity.

Adult↗
PubMed1986

'Dementia with contractures' as presenting signs of secondary adrenocortical insufficiency.

Report of a 61-year-old man with progressive mental deterioration and flexion contractures of abdominal muscles and legs as initial signs of hypopituitarism. Five years after onset of symptoms, an endocrinologically non-functioning pituitary adenoma was demonstrated. Thyroid replacement therapy had no effect, but administration of hydrocortisone was followed by rapid recovery. The opportunity to treat such cases of curable dementia is easily missed.

Adenoma, Chromophobe↗
PubMed1989

Experience of reverse medial arm flaps in the reconstruction of burned elbow scar contractures.

There are many methods to correct scar contractures in the elbow region after burn injury, including Z-plasty, Y-V or rectangular flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. Among these, the reverse medial arm island flap, based on the recurrent ulnar artery, has proved to be a convenient local fasciocutaneous flap for elbow scar reconstruction. In the past 2 years, 12 reverse medial arm flaps were used in 11 patients. The results are satisfactory. Two complications, one partial flap necrosis, another ulnar nerve compression, were noted. Our clinical experience with this flap encourages us to use it for burn elbow reconstruction in the future. The advantages and disadvantages are discussed.

Adult↗
PubMed1989

Neck contracture as a rare complication of cervical soft tissue expansion.

An unusual complication using an inflatable silicon implant for removing postburn scarred tissue of the neck and face is described. The appearance of a fibrotic band along the inflating tube caused neck contracture. The purpose of this article is to present this uncommon complication and to emphasize the technical error when using the tissue expander in the neck region.

Adult↗
PubMed1990

Fasciocutaneous flaps for burn contractures of the axilla.

Fasciocutaneous flaps do not compromise the function of joints, are less bulky and are easier to dissect. Their use prevents the uncomfortable prolonged splintage of the axilla with the shoulder in abduction which follows split skin grafting. Fasciocutaneous flaps are reliable and failure is minimal, if at all, unlike split skin grafting. Parascapular, lateral thoracic and cervicohumeral fasciocutaneous flaps have been used in 23 patients (aged 8-36 years) with a total of 30 flaps. The mean hospital stay was 12 days and no recurrence of the contracture was observed in the follow-up period of 3-18 months.

Adolescent↗
PubMed1995

Oro-maxillofacial skeletal deformities resulting from burn scar contractures of the face and neck.

The deforming forces of the scar contracture associated with burns of the head and neck region involve primarily the skin and secondarily the facial musculoskeletal structures. A case of severe face and neck burn accompanied by extreme facial skeletal deformity is reported. Best results are obtained in patients treated properly and promptly by a team including plastic and maxillofacial surgeons as well as orthodontists.

Adult↗