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The results of antiinflammatory radiation therapy were analyzed in 17 patients with trigeminal neuralgia and 7 patients with post-neuritic++ contractures of mimetic muscles. The therapy yielded positive results and was adequately tolerated by all patients. In the follow-up, no changes of the patients' general status or hematological indices were detected.
Experience in surgical treatment of 61 outpatients (64 hands) is discussed. The organization of treatment was accomplished stage-by-stage: stage I, detection, selection, examination, preoperative management, stage II, operation in an in-patient operating room, stage III, postoperative management of a patient. Postoperative complications in the form of partial necrosis of the edge of the wound developed in 3 patients. The late-term functional postoperative results were studied in 25 patients; they were good in 17 and satisfactory in 8 patients. Thus, high clinical efficacy was demonstrated in out-patient treatment of Dupuytren's++'s contracture by the method described.
Hemophilic contracture is seen most commonly as an equinus deformity of the ankle, or at the knee or elbow in the form of a flexion deformity. The cause is either fibrosis following intramuscular hematoma, which may be complicated by a peripheral nerve palsy causing muscle imbalance, or is associated with chronic hemophilic arthropathy following recurrent hemarthroses. The introduction of home therapy is an important preventive measure, and treatment is primarily by physiotherapy, splintage, and corrective devices. The late or severe case may require surgical correction in the form of soft tissue procedures. Arthrodesis or total arthroplasty must be carried out with meticulous hemostasis and with replacement of the appropriate blood clotting factors.
Based upon clinical observations of patients, character of pathologico-anatomical alterations of palmar aponeurosis in Dupuytren's contracture the author distinguishes a typical and atypical forms of the disease and proposes a new method of dissection of the medial part of the palmar aponeurosis with altered and not-altered longitudinal bands of the distal part of aponeurosis with keeping intact the transverse fibres at the level of the metacarpophalangeal articulations.
Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.
Thirty adults (17 male and 13 female patients) with spastic disorders were treated by hamstring releases of 46 extremities. The diagnoses were stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, and anoxia. The mean age at surgery was 38.6 years. Three extremities had partial release of the hamstring tendons behind the knee; the remaining 43 extremities had a complete release. The average position of the knee was 61.4 degrees of flexion preoperatively and 6 degrees postoperatively. The follow-up period averaged 21.3 months. Preoperatively, 87% of patients were nonambulatory. Following hamstring release 43% became ambulatory and 17% had gained the ability to transfer. Complications included two stroke patients with severe peripheral vascular disease; one developed a large nonhealing sore of the ankle and the other developed gangrene of the foot. Both patients required amputation. Three other patients developed recurrent flexion contractures that have since been rereleased with good results.
Surgical augmentation of the female breast has become a well-accepted and frequently performed operation since the introduction of the Cronin Silastic mammary prosthesis in 1963. A sleeve of scar tissue (collagenous capsule) consistently develops around every silicone implant. This "reactive bursa" is the normal healing response to this unique foreign body, and should not be referred to as a complication. It actually supports the prosthesis and contours the augmented breast. Operative technique includes precautions to prevent particulate or microbial contamination. Postoperative management involves restriction of motion of and around the mammary implant. (I realize this is a departure from currently accepted techniques. The methods presented, however, are based on physiologic principles of wound healing.) The results for all (private practice) patients who underwent augmentation mammaplasty during the four-year period of 1980 through 1983 were evaluated and codified. They suggest that the incidence of capsular contracture of the augmented breast can be decreased by taking precautions to ameliorate the foreign body reaction to silicone.
Hematoma is one of many complications that can follow surgery for Dupuytren's contracture. In this article, along with a discussion of previously used methods, a technique developed to prevent postoperative palmar hematoma is reviewed. The technique consists of inserting a polyethylene tube into the surgical wound prior to closure and then irrigating the wound with cold Ringer's solution at the rate of approximately 75 cc/hr for 24-36 hours postoperatively. The review involved 101 patients with 124 procedures, 76 of which were performed using the new technique. The incidence of hematoma in the patients without irrigation was 6.3%, while that in the patients with irrigation was 0.0%. No deleterious side effects of this technique were detected.
The authors examined the fine structural alterations of palmar aponeurosis in Dupuytren's contracture. Two types of the fibroblasts can be identified: classic fibroblasts and myofibroblasts. In the Dupuytren's tissue one fourth of all non-inflammatory cells were regarded as myofibroblasts. In the Dupuytren's aponeurosis the orientation of the thin and thick collagen fibers varied. The Paccini corpuscles were hypertrophised and around them compact collagen tissue was increased.
After the description of various possibilities of our operative procedure and post-treatment, the postoperative complications and operation results of 124 patients with Dupuytren's contracture are analysed. In 20% of cases passageric back-hand oedemas and in 2.4% Sudeck's diseases occurred post operation. In 97% of operated patients good and very good functional results could be achieved.
Results of a short series of cases, without statistical pretension, have shown that controlled cicatrisation during treatment of Dupuytren's contracture by open palm method appears to be obtained somewhat more rapidly and to be of better quality using an antiseptic rather than a greasy dressing. Equally, this method has the non-negligible advantage of being less onerous and of very simple management.
An experience with the treatment of 26 patients has shown high efficiency of open mobilization of the knee-joint in extension contractures following fractures of the femoral bone complicated by osteomyelitis. Extended scarry degeneration of certain muscles is not thought to be a contraindication for operation provided the intact muscle heads are sufficiently trained. The aggravation of osteomyelitis in part of the patients at late terms did not deteriorate favorable functional outcome of the mobilizing operation.
The surgical treatment of choice in Dupuytren's contracture is radical aponeurectomy. The clinical and pathological reasons for this are discussed. The authors propose precise indications for operative intervention and describe an original surgical technique. They present a review of 76 comparable cases treated by this method and followed up for an average of 8.5 years. The results obtained were up to the best standards in the most authoritative case reviews, with minimal postoperative complications and minimal time required for functional recovery.
Studies in animals and in children with cerebral palsy (CP) allow precise evaluation of the physiologic and pathophysiologic adaptations in muscle and tendon. In the individual child with CP, clinical evaluation must be much more precise than a routine examination in order to clearly define the nature of the contractures and select the correct therapeutic program.
An epidemiologic study in India showed that 50% of the severely disabled (1.8% of the total population) had locomotor disorders. There is a considerable difference in the incidence of disability and disease in rural and urban populations. The deformities from poliomyelitis are encountered predominantly in the rural areas (53.5%). The incidence in urban areas is only 1%. After poliomyelitis, the pathomechanics of deformity are prominent in the lower limbs. In a developing country, the management of contractures differs considerably from treatment in economically advanced nations. The use of postural exercises with body weight is well illustrated by certain Yoga postures such as paschimottansana or ushtrasana and is a prescribed treatment.
This prospective study was undertaken to assess the prevalence of Dupuytren's contracture (DC) and its relationship with possible causes, especially alcohol consumption and chronic liver disease. Four hundred thirty-two consecutively hospitalized patients were examined for evidence of DC. They were divided into five groups based on the following clinical, biologic, and histologic criteria: alcoholic cirrhosis (89 patients), noncirrhotic alcoholic liver disease (55 patients), chronic alcoholism without liver disease (46 patients), nonalcoholic chronic liver disease (68 patients), and a control group (174 patients). The prevalence of DC in these five groups of patients was 32.5%, 22%, 28%, 6%, and 12%, respectively; the prevalence of DC was higher in patients with cirrhotic or noncirrhotic alcoholic liver disease (25.5%) than it was in patients with nonalcoholic liver disease (6%), but it was not significantly different in alcoholic patients with or without liver disease. The relationship between DC and age, sex, manual labor, previous hand injuries, diabetes mellitus, alcohol consumption, and cigarette smoking was assessed by univariate and logistic regression methods. Nine variables were significantly different in patients with or without DC: age, sex, manual labor, previous hand injuries, diabetes mellitus, daily alcohol consumption, duration of alcohol consumption, total alcohol consumption, and duration of cigarette smoking. In our patients, variables that could explain DC were, in decreasing order, age, total alcohol consumption, sex (male), and previous hand injuries. In alcoholic patients, these variables were age and previous hand injuries; in nonalcoholic patients, these variables were age and cigarette smoking. These results emphasize the high prevalence of DC in alcoholic patients and the absence of a correlation between DC and chronic liver disease. Age and alcohol consumption are the best explanatory variables of DC in hospitalized patients.
Nonprogressive abduction contracture of the shoulder joint in a 32-year-old woman became clinically obvious only when the shoulder became painful following minor trauma. The tether in the deltoid muscle appears to have been present from an early age, but had been well compensated by abnormal scapular posture. No etiological factors could be discovered, but there was an unsubstantiated family history of similar problems. Only one comparable case has been found in the literature, and this unusual presentation seems not to have been described previously. The patient responded well to conservative treatment.
A case is presented which demonstrates the use of a pectoralis major myocutaneous flap for repair in a heavily radiated neck and chest, with neck contracture and a tracheocutaneous fistula.