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[Treatment of burn contractures (author's transl)].

Serious deformation and complete loss of function are not uncommon sequelae of an insufficient treatment of thermic, chemical or electric injuries to the hand. In order to reconstruct the shape or function of the hand once contractures are present, it is necessary to excise the scars completely, and follow with a skin-graft. For this purpose, transposition flaps, free skin grafts and Z-plasty may be considered. Particular importance is attached to an extensive splint therapy, by means of which late results can be improved.

Burns↗

Classification of capsular contracture after prosthetic breast reconstruction.

The Baker classification of capsular contracture remains the most popular and practical method of assessing clinical firmness of the breast after augmentation mammaplasty. This classification system was never intended to describe prosthetic breast reconstruction. A modification of the Baker classification to include classes IA, IB, II, III, and IV has been developed to describe breast reconstruction more accurately. For this modified system, a soft but visible implant (class IB), an implant with mild firmness (class II), and an implant with moderate firmness (class III) could still be considered good or excellent outcomes. Only a class IV classification with an excessively firm and symptomatic breast resulting in a poor aesthetic result would necessarily be considered a poor outcome.

Adult↗

[Flexion contracture of the fingers as a result of digitorum profundus tenodesis at the site of radial metaphyseal fracture].

A case of patient with flexor digitorum profundus tenodesis at the site of metaphyseal fracture of the radius is presented. The open fracture occurred when the patient was 11 years old and was treated elsewhere with plaster of paris. Progressive flexion contracture of the middle, ring and little finger was treated surgically 7 years later. Full extension and good hand function has been achieved.

Adult↗

[Proximal hamstring release for knee flexion contracture treatment in children with childhood cerebral palsy].

A series of 24 children with cerebral palsy has been reviewed to asses proximal hamstrings release for treatment of flexion contracture of the knee. In 22 cases improvement of a various degree has been achieved, in 2 cases no improvement was gained. In 4 children hyperextension of the knee and lumbar hyper-lordosis was found. Observing exact indications for surgery and avoiding hyper-corrections allows for good results of treatment.

Adolescent↗

[Surgical treatment of post-injection contracture of the hip in children].

Abduction contracture of the hip has been treated by two methods; the results of both have been compared. Modified Campbell's procedure has been performed in 5 children (6 hips). In 8 patients (9 hips) gluteal fascia and fibrotic scarring within the gluteal muscles has been transversely dissected. The mean follow-up was 26 months in either group. Dissection of the fascia and the scars resulted in doubled range of adduction and better cosmetic result compared to Campbell's method.

Adolescent↗

Sartorius muscle contracture in a dog.

An adult male German Shepherd dog presented with a chronic non-painful, non-weight bearing lameness of the right hind limb. On clinical examination a contracted sarotorius muscle was palpable. Histopathology of the affected muscle confirmed replacement fibrosis and muscle contracture. Surgical excision of the muscle resulted in complete recovery.

Animals↗

Discordance, in a malignant hyperthermia pedigree, between in vitro contracture-test phenotypes and haplotypes for the MHS1 region on chromosome 19q12-13.2, comprising the C1840T transition in the RYR1 gene.

A point mutation in the gene encoding the skeletal muscle calcium release channel (RYR1) has been proposed as the probable cause of malignant hyperthermia (MH) in swine, where it segregates with the disease in all MH-prone strains investigated. The same C-to-T exchange in nucleotide position 1840 of the human RYR1 cDNA sequence was found in a few human MH pedigrees. We report a German MH pedigree where in vitro contracture test (IVCT) results and haplotypes of markers for the MHS1/RYR1 region including this base transition have yielded several discrepancies. The MH-susceptible phenotype was defined by IVCT performed according to the European standard protocol. Haplotypes were constructed for markers for the MHS1/RYR1 region on chromosome 19 and include the C1840T base exchange. Discussing the probabilities for a number of hypotheses to explain these data, we suggest that our results may challenge the causative role of this mutation--and possibly the role of the RYR1 gene itself--in human MH susceptibility, at least in some cases.

Calcium Channels↗

[The rehabilitation of patients with postneuritic contracture of the mimetic muscles by using locally applied cold action].

A method is proposed for combined modality treatment of patients with postneuritic contracture of the muscles of expression of various genesis utilizing local hypothermia as well as hypo- and hyperthermic methods of treatment. Clinical effectiveness of the proposed method of treatment of patients in the acute phase of the facial nerve neuritis, non-existence of important contraindications which are usual with the medicamentous and electrophysiotherapeutic methods of treatment of this condition, and absence of supposed complications enable it to be recommended for clinical application.

Contracture↗

[Dupuytren contracture--current status in research and clinical practice].

Dupuytren's contracture is a disease of the connective tissue, especially of the palmar side of the hand. Today, by means of electron microscopy and histochemistry, several alternations specific of pathology of the disease can be shown, providing a better understanding. However, a revolutionary change of treatment is far out of reach. Dupuytren's diathesis can be influenced by none of today's known methods, and therapy is still empirical. Operative therapy is only indicated in functional impairment. Treatment should be done by well-trained surgeons and in case of extensive diathesis by carefully planning and longtime follow-up to avoid complications and eruption of the disease.

Dupuytren Contracture↗

Capsulorhexis contracture in phacoemulsification surgery.

We report two cases of capsulorhexis contracture and eventual complete closure after phacoemulsification surgery. The closures significantly decreased vision, but vision improved in both cases following successful Nd:YAG laser treatment.

Adult↗

Infantile spinal amylotrophy Werding-Hoffman disease and congenital contractures.

The authors present a rare case of a male infant aged 5 1/2 months with muscular contractures, hypotonia and areflexia. Two male siblings died with the same clinical picture. The microscopic findings of several spinal cord specimens are typical for Werding-Hoffman amylotrophia spinalis. The microscopical aspects are suggestive for neurogenic atrophy of muscular fibres with interstitial myositic process. It is proposed to include the present case in X-linked form of infantile spinal muscular atrophy.

Contracture↗

[V-Y advancement of volar skin flap in the repair of fingertip defect and cicatricial contracture].

The traditional Kutler and Atasoy V-Y advancement flaps have minimal range of advancement, so it is not satisfactory to repair large skin defect in fingers, hence limited indications. The sensory function of the repaired fingers is impaired because of injury to sensory nerves and scar formation. Since 1985 to 1991, the V-Y advancement flap with bilateral digital arteries and nerves as the pedicle has been used for the reconstruction of 33 fingertip defects and 5 digital volar cicatricial contracture. Satisfactory results were obtained in all these cases. In this paper, the anatomical characteristics and principles of device were recommended, the advantages and key points to success were discussed.

Adolescent↗

[Pathology of muscle contracture caused by injection and activity of phosphochesterase and insulin receptor].

The animal model of muscle contracture caused by injection was set up in the experiment. We used the model for excessive healing studies and researched the changes in its pathology, and activity of phosphochesterase and insulin receptor in this model. The experimental results revealed that the pathologic changes belonged to excessive proliferation of connective tissue (excessive healing). When occurred muscle degeneration, infiltration of inflammatory cells, proliferation of fibroblasts and descending of collagen fibers, the activity level phosphochesterase and insulin receptor became higher. The excessive healing occurrence may have something to do with the changes of phosphochesterase and insulin receptor.

5'-Nucleotidase↗

Effect of "standing" on spasticity, contracture, and osteoporosis in paralyzed males.

The effect of "standing" in a frame on spasticity (clinical assessment and H-reflex), contracture (lower extremity joint range of motion), and osteoporosis (dual photon absorptiometry) was studied in six paralyzed males (mean age 49 yr) who had been confined to wheelchairs for an average of 19 years. Standing time averaged 144 hours over a mean of 135 days. Clinical Assessment measured reflexes, tone, and clonus in the legs. Results revealed no important differences between initial and final scores for clinical assessment and joint range of motion. In three subjects for whom H-reflexes were found, latency and amplitude were not altered by "standing." Bone density was normal in the lumbar spine but significantly reduced in the femoral neck. "Standing" did not modify the bone density in any site. A follow-up interview revealed that 67% of subjects continued to "stand" and felt healthier because of it. In summary, "standing" had no ill effects, did not alter measured variables, and had a positive psychological impact.

Absorptiometry, Photon↗

[Dupuytren's contracture (author's transl)].

The previous treatment, and the open palm and finger technique as described by MacCash and Borden were reviewed. The experience of the author with a case of bilateral recurrent Dupuytren's contracture with severe shrinkage of the skin and an almost total lack of cooperation on the patient's side is added. It is felt that in spite of a crust formation, which seemed at first to interfere with as excellent a result as reported by Borden, the open skin technique encourages further trials, especially in cases with severe shrinkage of the skin combined with psychic disorders, making the cooperation of the patient poor or impossible.

Alcoholism↗

A conformer for the reduction of facial burn contractures: a preliminary report.

Based on the theory and principles of splinting in the reduction of burn contractures, a facial conformer was fabricated with satisfactory results and further surgery was averted. The facial skin softened and regained pliability and function, thus the lower eyelids were restored to their normal position, which allowed full closure and prevented further drying of the cornea and conjunctiva.

Adult↗

Dupuytren's contracture in pensioners at the Royal Hospital Chelsea.

Dupuytren's disease of the hands was present in 55 (13.75%) of the 400 elderly ex-servicemen living at the Royal Hospital Chelsea. Five men (9.1%) reported the condition in either a parent or sibling, but none was aware of an affected child. The prevalence of heavy drinking, non-insulin dependent diabetes or manual occupation was statistically the same in those with or without the condition. Overall, both hands were equally affected, but they differed in severity in 29 men. In milder cases the left hand was the more severely affected (grades 1 and 2); the reverse was true when the difference in severity was greater (grade 3). Since the original description of Dupuytren's disease [1] attempts have been made to link it with a variety of other conditions. These have included trauma, alcoholism and cirrhosis, [2] epilepsy [3] and diabetes mellitus [4]. A genetic link is accepted [5]. The condition is more common in men than women and becomes increasingly common with advancing age [6]. The prevalence in elderly men has been reported as high as 28.9%, rising to 64.3% in surveys of affected families [7]. There are still many physicians who, with a knowing wink when they spot that one of their patients has a Dupuytren's contracture, mentally register that he is an alcoholic. This paper is an attempt to disprove this fairy story. It describes a survey of Dupuytren's disease in a population of elderly men drawn from all parts of the United Kingdom and Ireland.

Aged↗

Management of scar contractures, hypertrophic scars, and keloids.

Aberrant fibrous tissue formation after surgery or trauma still presents a challenge to surgeons. Current research hopes to identify the characteristics of the population of fibroblasts that lead to hypertrophic or keloid scar formation. Surgical procedures and laser therapy followed by intralesional steroid treatments still are the foundation of treatment; but new modalities are being applied. The pathogenesis and management of hypertrophic scars, keloids, and scar contractures are discussed in this article.

Cicatrix↗