Development Of Contracture Research Articles

SP37. Fortification or Fibrosis? An Evaluation of Immune System Disorders and the Development of Capsular Contracture

PURPOSE: Two-stage implant-based procedures remain the most common approach for women pursuing post-mastectomy reconstruction. Up to 20% of patients develop capsular contracture after surgery, which can lead to poor functional and aesthetic outcomes, cause significant discomfort, and require additional corrective procedures. While the etiology of capsular contracture has not been fully elucidated, most literature attribute the process to a pro-inflammatory response involving the innate immune system. Additionally, some have postulated that peri-operative bacterial colonization of the implant site may lead to fibrosis and contracture formation. Autoimmune disorders, which are linked to abnormal systemic inflammatory responses, and immunosuppression, which can increase susceptibility to a range of infections, are not uncommon in patients diagnosed with breast cancer. Thus, an understanding of the intersectionality between these conditions and post-operative complications could prove useful for surgical planning. The aim of this study is to evaluate the effects of autoimmune disorders and immunodeficiency on rates of capsular contracture among two-stage breast reconstruction patients. METHODS: A dataset consisting of 296 patients (520 samples) who had undergone two-stage breast reconstruction between 2009 - 2021 at a tertiary-care facility was used in the study. An array of patient data, such as demographics, past medical history, and social history were collected. The primary endpoint was contracture development, which was ascertained by reviewing the electronic health record. The secondary outcome of interest was time to contracture formation. The date of contracture development (t_c) is defined as the first mention of capsular contracture based on clinical assessment. The time to event is defined as t_c - t_implant if the subject developed contracture, t_c - t_present if the subject was contracture-free. Univariate logistic regression was used for statistical analysis. RESULTS: Among the cohort, 5% (26/520) and 10.6% (55/520) had concurrent immunosuppression and autoimmune disorders, respectively. The autoimmune disorders examined were rheumatologic and endocrine in origin. The immunosuppressed states included both viral (HIV, Hepatitis A/B/C) and oncological (multiple myeloma, monoclonal gammopathy of undetermined significance, chronic myelogenous leukemia) conditions. On univariate analysis, compared to patients without either conditions, autoimmune disorders (OR 1.15, p-value 0.64) and immunosuppression (OR 1.06, p-value 0.88) were not linked to significantly higher odds or earlier development of capsular contracture (p-value > 0.05). Further stratified analysis examining only patients with immune-based conditions did not reveal statistically significant differences in the timeline (OR 0.14, p-value 0.43) or odds (OR 1.07, p-value 0.878) of contracture formation between the subgroup with immune-overactivation and the subgroup with immunosuppression. CONCLUSION: Comorbid autoimmune disorders and immunosuppression do not appear to significantly affect the odds or timeline of capsular contracture development. When counseling post-mastectomy patients with similar past medical history, surgeons may safely offer the choice of implant-based procedures when presenting the various reconstruction modalities.

117 Allocation of Therapist Time: Mobilization of CFU’s in Hand w/Burn Injury

Abstract Introduction Movement of the hands and digits are used to perform communication and activities for IADL’s and competitive employment. Following a second or third degree to the hand(s), there is a potential for the development of burn scar contracture(s) (BSC), which decreases hand skills creating the potential for decreased quality of life. The ABA data base identifies that 70% of burns are sustained to the upper torso, UE, hands. One ABA verified burn center created a study to identify the time required for the burn therapist to elongate hand CFU’s to pre-burn movement. Methods The one-year retrospective study included unilateral and bilateral hand burns with LOS of 2 days or greater or had an outpatient OT session within one week of the burn. Co-author created the Passive Motion Scoring Grid (PMSG), using a number score with higher number indicating greater passive movement. Education was provided to the OT’s to complete the PMSG at the beginning and end of each hand CFU elongation session. Otherwise, there was no change in the OT burn hand therapy treatment. The study included (5) OT’s with mean of 6 years of experience (3-46). Results There were 50 patients, average age was 48.91 years with majority male and African American. All burns were secondary to thermal with burns of 2nd and 3rd degree. There were 33 unilateral hand burns with an average TBSA of 7.02% and 17 patients sustained bilateral hand burns with an average TBSA of 21.3%. Unilateral hand burns had an average number of CFU’s of 39.4 (11-68) and hand CFU’s accounted for 87.1% of the CFU’s. Average number of CFU’s in bilateral hand burns was 90.3 (8-196) with hand CFU’s accounting of 83.4% of the CFU’s. A total of 539 OT sessions were provided to those with unilateral hand burns with an average of 18 OT sessions (3-36). Bilateral hand burns received a total of 487 OT sessions with average of 24.4 OT sessions (4-67) Therapist time for hand CFU elongation to pre-burn status: unilateral hand burns, 43.5 minutes (SD=24.7) and bilateral hand burns was 53.5 minutes (SD=32.2). The minutes only reflect CFU elongation not the entire therapy time. Conclusions Hand burns result in a small number for TBSA, however it results in a greater number of CFU’s than other body locati8ons. The greater number of CFU’s involved, indicates greater potential for development of BSC. At the completion of the burn OT therapy, no patient exhibited BSC. Providing education and information to funding sources regarding CFU’s in hand burns, equating that to potential BSC development and time required for therapist direct hands-on techniques to obtain pre-burn movement can positively influence authorization for therapy. Applicability of Research to Practice Can assist with allocating therapist time with hand burns. Can positively influence funding authorization for therapy.

D30. Immediate Lymphatic Reconstruction (ILR) with Vascularized Lymph Node Transplant (VLNT)

PURPOSE: Patients undergoing exanteration of axillary/groin lymph nodes and radiation are at risk not only for lymphedema but painful contracture and limited range of motion (ROM). Traditional immediate-lymphatic-reconstruction (ILR) addresses the lymphatic defect but not the soft tissue one. The purpose of this study was to evaluate the safety and efficacy of ILR with a vascularized-omentum-lymphatic-transplant (VOLT) to reduce the risk of both contracture and lymphedema development in patients with extensive disease. METHODS: Patients with an overwhelming risk of developing severe lymphedema and contracture were offered VOLT at the time of axillary/groin dissection at a tertiary-cancer-center between 2016 to 2021. Demographic data, volume-measurements, Quality-of-Life scores, and cellulitis episodes were recorded. RESULTS: A total of eight patients underwent ILR with VOLT at the time of axillary (n=4)/groin (n=4) dissection. No complications were observed (0%). The mean follow-up time was 30.7±12 months. Three patients (37.5%) developed lymphedema. One patient (12.5%) experienced one episode of cellulitis. Limited ROM during abduction was reported by 3 patients (37.5%). The mean Lymphedema-Life-Impact-Scale (LLIS) scores after surgery reflected minimal Quality-of-Life impairment globally (7.6±14.4%), physically (2.6±4.6%), psychologically (1.2±2.8%) and functionally (1.3±2.3%). CONCLUSION: This is the first study to report ILR with VOLT. VOLT is a safe and reliable option for immediate-reconstruction of the highest-risk patient group who are almost certain to develop not only lymphedema but severe contracture and functional disability. While larger studies are required to better determine indications and outcomes, it is preferable to replace soft-tissue prior to radiation to mitigate pain and contracture.

D88. A Friend or Foe? Evaluating Mesh Usage, Implant Location, and the Timeline of Capsular Contracture Development

PURPOSE: Acellular dermal matrix (ADM) and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over surgical techniques in implant-based reconstruction. The aim of this study is to compare no mesh usage to the use of biological matrices (ADM) or synthetic mesh (P4HB) in conjunction with various placement locations (pre-pectoral, retro-pectoral, total sub-muscular), and further examine the respective incidences and timelines of capsular contracture development within each subgroup. METHODS: A dataset consisting of 209 patients (406 samples) who had undergone two-stage reconstruction between 2012-2021 was used in the study. Univariate logistic regression was used for statistical analysis. Kaplan-Meier estimator was used to plot the survival curve for the various conditions. RESULTS: On univariate logistic regression (OR 1.95, p-value 0.004) and survival analysis (p-value 0.0082), P4HB mesh usage was linked to an increased risk of capsular contracture development. Out of the various placement modalities, retro-pectoral with P4HB yielded the highest contracture rate. Pre-pectoral placement with no mesh and retro-pectoral placement with ADM showed similar timelines of capsular contracture development. The lowest incidence of capsular contracture occurred in the pre-pectoral placement and no mesh subgroup (49/161, 30.4%). CONCLUSION: The use of P4HB mesh in two-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Pre-pectoral tissue expander and no mesh led to the lowest rate. There did not appear to be a significant difference in the timeline of contracture formation between retro-pectoral with ADM and pre-pectoral with no mesh usage.

An Evaluation of Native Breast Dimension and Tissue Expander Inflation Rate on the Risk of Capsular Contracture Development in Postmastectomy Reconstruction.

Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk. A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status. Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture. Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.

A comprehensive approach to palliative care in neurological pathology

Palliative care for neurological patients is an approach to patient care and assistance to their families facing chronic, progressive, life-limiting and disabling conditions. The peculiarity of palliative care in neurology is due to the signifi cant duration of the late stages of many neurological diseases and the distinctive features of some diseases (cognitive disorders, mental disorders, speech disorders, pelvic organ dysfunction, paresis, convulsions, contracture development, etc.), as well as the presence of concomitant common symptoms (eating disorders, pain, bedsores, respiratory failure, etc.). The symptoms developing in the advanced stages of neurological diseases requiring palliative care are described. Drug and non-drug methods of treatment are described, measures aimed at improving the quality of life and preventing complications are considered. The features of pharmacotherapy, taking into account their interaction with drugs for the treatment of concomitant pathology, are considered.

Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage.

Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development. A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ 2 , Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis. On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis ( P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups. The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.

Development and prevention of ischemic contracture ("stone heart") in the pig heart.

Stone heart (ischemic contracture) is a rare and serious condition observed in the heart after periods of warm ischemia. The underlying mechanisms are largely unknown and treatment options are lacking. In view of the possibilities for cardiac donation after circulatory death (DCD), introducing risks for ischemic damage, we have investigated stone heart in pigs. Following cessation of ventilation, circulatory death (systolic pressure <8 mmHg) occurred within 13.1 ± 1.2 min; and a stone heart, manifested with asystole, increased left ventricular wall thickness and stiffness, established after a further 17 ± 6 min. Adenosine triphosphate and phosphocreatine levels decreased by about 50% in the stone heart. Electron microscopy showed deteriorated structure with contraction bands, Z-line streaming and swollen mitochondria. Synchrotron based small angle X-ray scattering of trabecular samples from stone hearts revealed attachment of myosin to actin, without volume changes in the sarcomeres. Ca2+ sensitivity, determined in permeabilized muscle, was increased in stone heart samples. An in vitro model for stone heart, using isolated trabecular muscle exposed to hypoxia/zero glucose, exhibited the main characteristics of stone heart in whole animals, with a fall in high-energy phosphates and development of muscle contracture. The stone heart condition in vitro was significantly attenuated by the myosin inhibitor MYK-461 (Mavacamten). In conclusion, the stone heart is a hypercontracted state associated with myosin binding to actin and increased Ca2+ sensitivity. The hypercontractile state, once developed, is poorly reversible. The myosin inhibitor MYK-461, which is clinically approved for other indications, could be a promising venue for prevention.

A multi-targeting bionanomatrix coating to reduce capsular contracture development on silicone implants

BackgroundCapsular contracture is a critical complication of silicone implantation caused by fibrotic tissue formation from excessive foreign body responses. Various approaches have been applied, but targeting the mechanisms of capsule formation has not been completely solved. Myofibroblast differentiation through the transforming growth factor beta (TGF-β)/p-SMADs signaling is one of the key factors for capsular contracture development. In addition, biofilm formation on implants may result chronic inflammation promoting capsular fibrosis formation with subsequent contraction. To date, there have been no approaches targeting multi-facted mechanisms of capsular contracture development.MethodsIn this study, we developed a multi-targeting nitric oxide (NO) releasing bionanomatrix coating to reduce capsular contracture formation by targeting myofibroblast differentiation, inflammatory responses, and infections. First, we characterized the bionanomatrix coating on silicon implants by conducting rheology test, scanning electron microcsopy analysis, nanoindentation analysis, and NO release kinetics evaluation. In addition, differentiated monocyte adhesion and S. epidermidis biofilm formation on bionanomatrix coated silicone implants were evaluated in vitro. Bionanomatrix coated silicone and uncoated silicone groups were subcutaneously implanted into a mouse model for evaluation of capsular contracture development for a month. Fibrosis formation, capsule thickness, TGF-β/SMAD 2/3 signaling cascade, NO production, and inflammatory cytokine production were evaluated using histology, immunofluorescent imaging analysis, and gene and protein expression assays.ResultsThe bionanomatrix coating maintained a uniform and smooth surface on the silicone even after mechanical stress conditions. In addition, the bionanomatrix coating showed sustained NO release for at least one month and reduction of differentiated monocyte adhesion and S. epidermidis biofilm formation on the silicone implants in vitro. In in vivo implantation studies, the bionanomatrix coated groups demonstrated significant reduction of capsule thickness surrounding the implants. This result was due to a decrease of myofibroblast differentiation and fibrous extracellular matrix production through inhibition of the TGF-β/p-SMADs signaling. Also, the bionanomatrix coated groups reduced gene expression of M1 macrophage markers and promoted M2 macrophage markers which indicated the bionanomatrix could reduce inflammation but promote healing process.ConclusionsIn conclusion, the bionanomatrix coating significantly reduced capsular contracture formation and promoted healing process on silicone implants by reducing myfibroblast differentiation, fibrotic tissue formation, and inflammation.Graphical A multi-targeting nitric oxide releasing bionanomatrix coating for silicone implant can reduce capsular contracture and improve healing process. The bionanomatrix coating reduces capsule thickness, α-smooth muscle actin and collagen synthesis, and myofibroblast differentiation through inhibition of TGF-β/SMADs signaling cascades in the subcutaneous mouse models for a month.

Canadian Physicians' Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey.

Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient's activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.

THE ULTRASONOGRAPHY EXAMINATION OF SKELETAL MUSCLES IN TRAUMATIC ISCHEMIA (EXPERIMENTAL STUDY).

The aim: To establish indicators and significance of sonography in the evaluation of muscle necrosis in ischemia of the limb acording to quantitative ultrasonographic indicators and density of collagen by histological method. Materials and methods: In experiments, rabbits modeled with 6-hour limb ischemia by applying an elastic tourniquet. On days 5, 15, and 30, ultrasound and histological studies of the muscles and correlation analysis were performed between the muscles' entropy and the degree of their damage (atrophy, fibrosis and necrosis). Results: The relative amount of structurally altered tissue was estimated morphometrically and compared with entropy. A high correlation of muscle damage with vertical δ-entropy indicates that sonography is highly likely to detect areas of necrosis and, to a lesser extent, fibrosis in the development of ischemic limb contracture in the early stages. Conclusions: Vertical δ-entropy in sonography is a significant indicator of muscle damage after traumatic ischemia and has strong relationship with muscle fibrosis.

ОСОБЕННОСТИ ПРИМЕНЕНИЯ АУТОЖИРА С ЦЕЛЬЮ УВЕЛИЧЕНИЯ МОЛОЧНЫХ ЖЕЛЕЗ У ЖЕНЩИН

The study aims to compare and assess the esthetic results of using autologous fat grafting and silicone implants for breast augmentation in I type ptosis in mammary glands in 29 patients who underwent surgical treatment in the department of rehabilitation surgery of the Republican Scientific Center for Cardiovascular Surgery and the Medical Center for Laser and Plasty Surgery “ORMED” in 2019–2022. The patients included 18 females (I group) who received autologous fat-grafts and 11 females (II group) who received silicone implants, all patients underwent early and long-term ultrasound diagnosis as well as magnetic resonance imaging. In the II group, there were two complications registered in the post-operative period: accumulation of fluid around the implant, which prevented engraftment and formation of the capsule in one woman, and development of capsular contracture detected at the early stage of the onset of the pathological process in the other. Autologous fat grafting demonstrated complete engraftment of transplanted tissues in six patients (75 %). Fat resorption and no effect of surgical intervention were noted in one patient who subsequently received silicone implantation. Further research can help minimize the frequency of adipose tissue lysis, as well as other types of complications that occur following such procedures.

ОПЫТ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ОТКРЫТОГО МНОГООСКОЛЬЧАТОГО ВНУТРИСУСТАВНОГО ЧРЕЗМЫЩЕЛКОВОГО ПЕРЕЛОМА ПЛЕЧА СО СМЕЩЕНИЕМ ОТЛОМКОВ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Complex intra-articular fractures require active patient management tactics and almost always the use of surgical treatment. For intra-articular fractures, it is extremely important to restore the normal anatomical structure, precise reposition and fixation of the fracture, without which it is impossible to restore the full function of the joint and limb. Surgical treatment should be carried out as early as possible in order to prevent the development of contractures. The purpose of this publication is to demonstrate the successful experience of treating a patient with an open comminuted intra-articular transcondylar fracture of humerus with displaced fracture fragments and the validity of the choice of an operative method of treatment of this pathology. Materials and methods : description of a clinical case and a brief analysis of the literature on this issue. Presented case of open reposition of a comminuted intra-articular transcondylar fracture of the shoulder and extra-cortical osteosynthesis with two reconstructive plates is successful. The effectiveness of treatment was evaluated based on the data of X-ray examination methods, as well as assessing the function of the limb and the amplitude of movement in the elbow joint. Results : performed open reposition of a comminuted intra-articular transcondylar fracture of shoulder and extra-cortical osteosynthesis with two reconstructive plates. Complete restoration of limb function and anatomical integrity of the distal metaepiphysis of the humerus has been achieved, the patient’s ability to work has been restored.

CATHETER DIRECTED THROMBOLYSIS IN ACUTE LIMB ISCHEMIA PATIENTS. A SINGLE CENTER’S EXPERIENCE

The aim: This study evaluates catheter-directed thrombolysis (CDT) outcomes in patients with acute lower limb arterial thrombosis and acute limb ischemia. Materials and methods: 53 patients (17 females, 36 males, aged 53-76) were studied. 57% had femoropopliteal and below-the-knee (BTK) thromboocclusion, 43% had BTK thromboocclusion. Symptoms included pain, pallor, edema, and cyanosis. Exclusions criteria: contracture, recent surgeries, bleeding. Results: In 29 (97%) patients regression of lower-limb ischemia rate by 1-2 stages according to the Rutherford classification were observed. One patient (3%) did not exhibit any regression in the degree of lower-limb ischemia, experiencing increasing pain and decreased sensitivity in the lower limb, leading to the development of contracture in the ankle joint and subsequent lower limb amputation over 7 days. Among 12 (40%) patients, after performing follow-up arteriography of the lower limb, angioplasty was performed on the diagnosed steno-occlusive lesions in the revascularized segment with secondary angioplasty. Within a year, one (3%) patient experienced recurrent thrombosis of the lower limb arteries with subsequent revascularization. Conclusions: CDT is recommended for ALI Patients with arterial thrombooclusion.

Risk factors for capsular contracture after breast reconstruction with tissue expanders and silicone implants in nonirradiated patients: A retrospective observational cohort study

Breast reconstruction surgery with tissue expanders and silicone implants is widely performed; however, risk factors for late complications such as capsular contracture have not been fully investigated despite their high prevalence. We investigated the association between expander and implant positions and the development of capsular contracture in patients who underwent breast reconstruction surgery over 10 years previously. In this retrospective observational study, we analyzed 239 patients, among whom 69 (28.9%) had developed capsular contracture of Baker Classification grade II or higher. The position of the expander was classified into six categories based on the inferior margin of the healthy breast. The position of the implant was defined as an upward movement from the position of the expander and was classified into three categories based on the inferior margin of the breast at the time of expander insertion. Using multivariate logistic regression analysis, we assessed whether the misalignment of the expander and silicone implant positions affected capsular contracture development. Both expander and implant positions were significantly different between the groups. The odds ratios, adjusted for confounding variables, were 3.4 and 5.2 for an expander position of 1 and 2 lateral fingers upward, respectively, and 4.8 and 45.4 for a silicone implant position of 2 and 3 lateral fingers upward, respectively. We identified malposition of expanders and silicone implants as risk factors for developing capsular contracture. Correct insertion and adequate dilatation of the expander in the correct position could reduce the risk for capsular contracture.

Keller Funnel Efficacy in "No Touch" Breast Augmentation and Reconstruction: A Systematic Review.

A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected. Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25-0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%). This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.

Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.

Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching of the Plantar Flexors on Ankle Range of Motion and Muscle-Tendon Behavior in Children with Spastic Cerebral Palsy-A Randomized Clinical Trial.

Stretching is considered a clinically effective way to prevent muscle contracture development in children with spastic cerebral palsy (CP). Therefore, in this study, we assessed the effects of a single session of proprioceptive neuromuscular facilitation (PNF) or static stretching (SS) on ankle joint range of motion (RoM) and gastrocnemius muscle-tendon behavior in children with CP. During the SS (n = 8), the ankle joint was held in maximum dorsiflexion (30 s). During the PNF stretching (n = 10), an isometric contraction (3–5 s) was performed, followed by stretching (~25 s). Ten stretches were applied in total. We collected data via dynamometry, 3D motion capture, 2D ultrasound, and electromyography, before and after the stretching sessions. A mixed ANOVA was used for the statistical analysis. Both ankle RoM and maximum dorsiflexion increased over time (F(1,16) = 7.261, p < 0.05, η² = 0.312; and F(1,16) = 4.900, p < 0.05, η² = 0.234, respectively), without any difference between groups. An interaction effect (F(1,12) = 4.768, p = 0.05, η² = 0.284) was observed for muscle-tendon unit elongation (PNF: −8.8%; SS: +14.6%). These findings suggest a positive acute effect of stretching on ankle function. However, SS acutely increased muscle-tendon unit elongation, while this decreased after PNF stretching, indicating different effects on the spastic muscles. Whether PNF stretching has the potential to cause positive alterations in individuals with CP should be elucidated in future studies.

Основні методи фізичної реабілітації хворих на ревматоїдний артрит

Rheumatoid arthritis is a common disease characterized by a high level of disability and disability due to dysfunction of the musculoskeletal system. It is important to combine the basic therapy of rheumatoid arthritis and non-drug methods of recovery and physical rehabilitation of patients. The purpose of the study was to show the main methods of physical rehabilitation of patients with rheumatoid arthritis. Materials and method. Analysis and generalization of scientific literature were used in the study. Results and discussion. The formation of functional insufficiency of the joints in patients requires improving the functioning of the musculoskeletal system and the quality of life of patients through the use of physical rehabilitation methods. The main element of the rehabilitation complex for patients with rheumatoid arthritis is therapeutic physical culture, aimed at increasing the range of motion of the limbs, muscle strength, reducing pain and improving the general physical condition. One of the important methods of rehabilitation of patients with rheumatoid arthritis is orthosis, since the progression of the disease is inevitably associated with the development of joint deformations, especially in the feet. The goals of orthoses prescription are to protect and relieve joint stress, reduce pain and inflammation by creating controlled rest, correct anatomical axes, prevent or slow down the development of contractures, deviations and deformations. Physiotherapy methods in different periods of the disease provide anti-inflammatory and analgesic effects. Restorative treatment and physical rehabilitation of patients with rheumatoid arthritis involves a combination of various methods, among which the most effective are exercise therapy, orthotics, and physical therapy. Conclusion. Rheumatoid arthritis is characterized by a significant limitation of the functions of the musculoskeletal system due to damage to the articular cartilage and bone, which requires, in addition to drug therapy, the use of methods to restore an adequate level of physical activity and physical rehabilitation. The most effective methods of complex rehabilitation of patients with rheumatoid arthritis are physical exercises of therapeutic physical culture, orthotics and physiotherapy methods that reduce the activity of the inflammatory process, progression of deformities, maintain the volume of daily household activities, the ability to self-service, professional work and improvement of quality of life

Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia.

There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.