Showing 5 results for Contracture
Durga Karki, Narayan Ravi Prakash ,
Volume 6, Issue 3 (7-2017)
Abstract
BACKGROUND
Post-burn contractures are a commonly encountered problem and many techniques have been described in their treatment. Z-plasties are the commonest local flap procedure done for linear bands with adjacent healthy tissue. Our aim was to assess the use of square flap technique in axillary contractures.
METHODS
Ten patients with type I and II axillary contractures underwent release by the square flap technique. All cases were followed up for at least one year and analysed for range of motion and aesthetic outcome.
RESULTS
All cases achieved full range of movement postoperatively with no recurrence during follow up period and a good cosmetic outcome.
CONCLUSION
Square flap was shown to be a reliable technique for mild to moderate axillary contractures of the anterior or posterior axillary folds even when there is significant adjacent scarring of chest wall or back of types I and II.
Muhammad Saaiq,
Volume 9, Issue 2 (4-2020)
Abstract
BACKGROUND
Established Volkmann’s ischemic contractures (VICs) represent the eventuality of neglected acute compartment syndrome (ACS) of the forearm. This study assessed the clinical and demographic presentation of VICs.
METHODS
This study was conducted at Department of Plastic Surgery, National Institute of Rehabilitation Medicine, Islamabad, Pakistan over a period of three years and included all patients of either gender who presented with VICs and analyzed various corrective procedures instituted as surgical remedies.
RESULTS
Among 37 included patients, 83.78% were male and 16.21% were female (mean age: 16.51±9.1 years). The underlying causes of the initial traumatic insults were tight bandages employed by traditional bone setters for treating forearm fractures (83.78%), high voltage electric burns involving hands/forearms (13.51%) and supracondylar fracture with vascular compromise (2.70%). Majority of patients belonged to Holden type 2 (97.29%) and Tsuge type 2 VICs (48.68%). The most common sufferers of VICs were young, illiterate males coming from rural regions. Treatment for forearm fractures by traditional bonesetters constituted the most common underlying cause. Most of the patients were managed with combination of procedures including tendon transfers, excision of the fibrosed muscles, tenolysis and neurolysis of median and ulnar nerves. Tendon transfers were the commonest corrective procedures instituted.
CONCLUSION
This study highlighted the gravity of this largely preventable but neglected catastrophe and there is a need to institute robust preventive measures to address the issue. Emphasis should be on creation of public awareness and robust education of health care providers to ensure correct primary management of upper limb trauma.
Muhammad Saaiq,
Volume 10, Issue 1 (1-2021)
Abstract
BACKGROUND
Burn in developing countries still has high burden of inadequately managed severe burns. This study compared supraclavicular artery flap and skin graft in managing neck post-burn contractures.
METHODS
In National Institute of Rehabilitation Medicine and Pakistan Institute of Medical Sciences, Islamabad, Pakistan, 30 patients with neck post-burn contractures were enrolled. Half of patients randomly underwent supraclavicular artery flap and half received skin graft. The outcome measures including initial improvement in neck extension, patient’s satisfaction with color-texture-match and recurrent contracture formation rate were assessed.
RESULTS
Among patients, 80% were female and 20% were male. Preoperatively, each group had post-burn contractures of grade II among 26.66% of patients, grade III among 60% and grade III among 13.3%. Postoperatively after three months in the two groups, 86.66% improved to grade I and 13.3% improved to grade II. Patient’s satisfaction with color-texture was 84.66% in supraclavicular artery flap group, whereas it was 42.66% for skin graft group. Complications were hypertrophic scar at donor site (13%) and flap tip necrosis (6.66%) in supraclavicular artery flap group. In skin graft group, partial skin graft loss was noticed among 33% of patients and delayed healing of donor site among 20%. The recurrent contracture formation rate at one year was 73.33% in skin graft group, whereas there was no case of recurrent contracture in supraclavicular artery flap group.
CONCLUSION
Supraclavicular artery flap was superior to skin graft in managing post-burn neck contractures. It provided better color-texture match and was associated with no recurrence of contracture formation.
Rafael Dib Possiedi , Lee Seng Khoo , Francesco Mazzarone, Cleber Rafael Viera da Costa, Patricia Stremel ,
Volume 10, Issue 3 (7-2021)
Abstract
BACKGROUND
We aimed to compare inflammatory and intercellular transcription responses induced by surface textured (ST) implants versus foam covered (FC) silicone implants placed on the dorsal aspect of rats.
METHODS
We utilized 80 female rats of the Wistar lineage. The rats were divided into four subgroups of 20 with one type of implant placed in the dorsum per rat. Analysis was carried out on peri-implant capsules at 90 d and at 180 d post-
surgery with microscopic evaluation of inflammatory and immuno-histochemical response of NF-κB-p65 and α-SMA in fibroblasts.
This study was carried out at the Evangelical Faculty of Parana and at the Ivo Pitanguy Institute, Brazil in 2015.
RESULTS
The FC exhibited higher levels of acute and chronic inflammation on evaluation in both time frames. The capsule surrounding the ST implants was significantly thicker with well-organized collagen fibres. NFκB-p65 expression in the capsule surrounding the FC implant was more pronounced. There was higher and more significant α-SMA expression in the capsules of the surface textured (ST) silicone implants compared to the foam-covered (FC) silicone implants.
CONCLUSION
Activation of NFκB-p65 plays a key role in the evolution of capsule formation and maintenance of inflammation by regulating the healing process. Similarly, higher and more prolonged levels of inflammation (increased NF-κB-p65 results in increased inflammation) and lower α-SMA (higher α-SMA is protective against capsular contracture) did not directly translate to a thicker capsule and ultimately, capsular contracture in foam covered silicone implants.
Shahram Jahanabadi, Alireza Bakhshaeekia, Roozbeh Rahbar, Abdoreza Sheikhi, Mahtab Farhadi, Seyedeh-Sara Hashemi,
Volume 12, Issue 2 (5-2023)
Abstract
Background: Treating burn scar contractures remains challenging for reconstructive surgeons; no clear guidelines declare the optimal and most effective technique. We evaluated the efficacy of local flaps in treating patients with post-burn contractures.
Methods: This retrospective study included 243 patients with post-burn contractures referred to Taleghani Hospital (Khuzestan, southwest Iran) for local flap reconstruction from 2011 to 2020. Patients' demographic data, detailed descriptions of scars, surgical procedures, and flap outcomes were assessed. A plastic surgeon conducted all surgical procedures, the goals of which were to release the scar and cover the defect. Joint range of motion (ROM) (according to goniometric measurements), complications, need for second-stage surgery, and patient satisfaction were assessed.
Results: After scar release, 70.4% of joints were covered with a Z-plasty and similar local flaps, 26.1% with a Z-plasty plus skin grafts, and 3.5% with only skin grafts. The outcome after one year revealed a significant improvement in mean ROM (by 45.80% of the normal ROM; P< 0.001). The mean functional and aesthetic satisfaction scores were 9.45 and 7.61 out of 10, respectively. The complication rate was 10.82%: re-contracture occurred in 3.82%, flap tip necrosis in 1.27%, and partial flap necrosis in 0.31%.
Conclusion: Simple local flaps such as the Z-plasty are safe and effective in covering the joint following post-burn contracture release. Due to the feasibility, minimal need for facilities, steep learning curve, acceptable functional and aesthetic outcomes, and low complication rate, we strongly recommend the Z-plasty for reconstructing burn contractures, particularly in LMICs.
