Repair Of Contractures Research Articles

A 12-Year Review of Clinical Practice Patterns in Dupuytren Contracture Based on Continuous Certification by the American Board of Plastic Surgery.

The American Board of Plastic Surgery collects data on 20 common plastic surgery operations as part of the Continuous Certification process. The goal of this study was to describe clinical trends in Dupuytren contracture repair since 2008 as they relate to evidence-based medicine articles published in this timeframe. Cumulative tracer data for Dupuytren contracture were reviewed for the period from February of 2008 to March of 2020 and compared with evidence-based medicine articles published in Plastic and Reconstructive Surgery . Topics were categorized as (1) pearls, addressed in both the tracer data and evidence-based medicine articles, (2) topics only addressed in tracer data, and (3) topics only addressed in evidence-based medicine articles. As of March of 2020, 230 cases of Dupuytren contracture had been entered. The median age at time of surgery was 65 years (range, 38 to 91 years). Practice patterns from 2008 through 2014 were compared with those between 2015 and 2020. The most common surgical technique was limited fasciectomy (62 percent of cases). Differences in practice between these time periods included decrease in the use of radical fasciectomy (34 percent versus 16 percent, p = 0.002), increase in percutaneous cordotomy (0 percent versus 13 percent), and increase in the use of collagenase injections (0 percent versus 9 percent, p = 0.001). Use of Bier blocks increased (1 percent versus 7 percent), and tourniquet use decreased (97 percent versus 80 percent). Significant changes were also noted in postoperative management. By examining American Board of Plastic Surgery tracer data, the authors have described national trends in presentation and surgical techniques for Dupuytren contracture repair over a 14-year period.

QS10: Clinical Practice Patterns and Evidence-based Medicine in Dupuytren’s Contracture: A Twelve-year Review of Continuous Certification Tracer Data From The American Board of Plastic Surgery

Purpose:Since 2008, The American Board of Plastic Surgery (ABPS) has collected clinical practice data on Dupuytren’s contracture repair as part of their Continuous Certification (CC) process. Submitted twice every ten years by each plastic surgeon, this collection can help describe clinical trends in Dupuyren’s contracture repair as they relate to Evidence-Based Medicine (EBM) articles published in this timeframe.Methods:Cumulative tracer data for Dupuytren’s contracture repair from February, 2008 through December, 2014 were reviewed and compared to data from January, 2015 through March, 2020 with the goal of identifying national practice trends. These trends were then evaluated alongside EBM reviews published in 2010, 2014 and 2017.Results:As of March 2020, 230 cases of Dupuytren’s contracture were included in the tracer. The median age at time of surgery was 65 years (range, 38-91 years), and the average age of disease onset was 47 years. The most common surgical technique was limited fasciectomy, comprising 62% of cases. There were no postoperative adverse events reported in 77% of cases. The most common complications were loss of finger flexion (3%) and skin loss (2%). Topics addressed in EBM articles but not tracer data included adjuvant treatments and non-operative techniques such as tamoxifen administration. The use of minimally invasive procedures such as percutaneous cordotomy (0% vs. 13%) and collagenase injections (0% vs. 9%, p = .001) showed significant increases between the two time periods. More invasive procedures such as radical fasciectomy decreased in popularity (34% vs. 16%, p = .002). Use of Z-plasty also decreased between 2015 and 2020 (67% vs. 45%, p < .001). General anesthesia was the most commonly used form of anesthesia, being employed in 54% of tracer cases. There was an increase in the use of Bier block regional anesthesia (1% vs. 9%, p = 0.029) as well as in the use of epinephrine for hemostasis (0 vs. 8%, p = 0.006). Significant changes were also noted in post-operative management, including a decrease in the employment of formal postoperative hand therapy. This is consistent with evidence showing that it has no significant clinical benefit.Conclusion:The tracer data collected on Dupuytren’s contracture repair over a twelve-year period allow us to describe national trends in presentation and surgical techniques, and can help plastic surgeons evaluate their surgical practice in the context of these trends and EBM.

Neodermis Formation in Full Thickness Wounds Using an Esterified Hyaluronic Acid Matrix.

The role of the dermis is essential for the proper orchestration of all phases of the normal wound healing process. Wounds with seriously damaged or even absent dermis consistently show seriously impaired wound healing and/or long-term complications such as hypertrophic scarring. Replacing a damaged dermis requires a dermal matrix that is compatible with, or even stimulates, the process of wound healing. Hyaluronic acid (HA), in an esterified form, is among the many matrices that are available. HA has been used in a number of indications, such as ulcers (ie, diabetic foot ulcers and venous leg ulcers), trauma, including burns, and for the repair of contractures and hypertrophic scars. The shorter healing time and the decrease of recurring hypertrophy demonstrate the efficiency of HA-derived matrices. Biopsies, taken up to 12 months post-reconstruction show a neodermis that histologically is largely comparable to normal skin, which probably is a function of HA playing such a pivotal role in normal, unwounded skin, as well as in the process of healing.

Orbital Contracture Repair Using the Radial Forearm Free Flap: A Nine and Ten Year Follow-up

Orbital Contracture Repair Using the Radial Forearm Free Flap: A Nine and Ten Year Follow-up

Editorial Comment

Genital burns are bad for you. This has serious implications for the burn patient and their surgeons. When I read a report such as this, I try to absorb all the salient facts, to add them to my “gestalt”. The next time I am facing a genital burn, I know what I am up against. This is what I learned from the report: -Genital burns increase the chance of a hospital-acquired infection by 300% and increase mortality by 50% (see: “genital burns are bad for you”). -Most (90%) patients with genital burns never need urogential surgery, but when required, the mortality rate is a very high 10% (20% mortality in the rare 1% who need “extensive” genital repair) (see: “genital burns are bad for you”). -Surgery, when you decided to do it, can have complications in excess of the high mortality rate: 20% require subsequent genital contracture repair. -Try to treat burns without surgery at first, assuming there are no absolute indications for genital burn surgery (such as mixed necrotizing infection, extensive tissue necrosis mandating tissue removal and coverage, and so forth). This is a tiebreaker for the literature, which advocates both surgical 1 McAninch J.W. Kahn R.I. Jeffrey R.B. et al. Major traumatic and septic genital injuries. J Trauma. 1984 Apr; 24: 291-298 Crossref PubMed Scopus (72) Google Scholar and nonsurgical 2 Peck M.D. Boileau M.A. Grube B.J. Heimbach D.M. The management of burns to the perineum and genitals. J Burn Care Rehabil. 1990 Jan-Feb; 11: 54-56 Crossref PubMed Scopus (36) Google Scholar approaches to most genital burns. (I worked under both senior authors in these opposing-view articles and am grateful to break the deadlock.) -Do not avoid surgery in that special subset of patients with extensive third-degree flame burns or deep electrical burns to the genitals: excise and graft these patients' genital burns as soon as the patients are medically stable – just similar to in any other body area. -Remove Foley catheters early in burn patients. If you cannot because of genital burn injuries, place a suprapubic tube if at all feasible. Genital Burns in the National Burn Repository: Incidence, Etiology, and Impact on Morbidity and MortalityUrologyVol. 83Issue 2PreviewTo better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. Full-Text PDF ReplyUrologyVol. 83Issue 2PreviewGenital burns can be bad indeed. As described in our article and re-emphasized in the editorial by Dr. Santucci, who has surgically summarized the important points of the study, genital burns are also unique, as mortality and infection rates were found to be significantly higher in this population. At our institution, we believe that initial conservative management, with vigilance for early infection identification and early genital grafting, are keys to successful outcomes. In other words, we do not necessarily treat these burns any differently than burns in other areas of the body, simply because of the “sensitive” nature of the anatomy. Full-Text PDF

Central axis flap methods

Extensively burned patients often lack ample healthy skin for autotransplantation. Scar contractures are then frequent. Here, we reconstructed contractures using flaps of remaining healthy skin around the recipient sites. In this report, we present four original scar contracture repair methods using subcutaneous pedicled flaps: (1) Propeller flap, (2) multilobed propeller flap, (3) scar-band rotation flap and (4) pin–wheel flap. The subcutaneous pedicle under the center of these various types of flaps allows these methods to be characterized as “central axis flap methods.” We have employed these flaps to treat mild scar contractures in the axilla and cubital fossa. These methods are easily manipulated to restore function and improve aesthetics of scar contractures.

Malignant hyperthermia during epidural anesthesia

We anesthesized a patient susceptible to malignant hyperthermia (MH) three different times by epidural anesthesia with different types of local anesthetics. His skinned fiber test showed a marked acceleration of calcium (Ca2+)-induced Ca2+ release (CICR). When ester type local anesthetic was used for ankle contracture repair, MH signs appeared following the release of the tourniquet. CICR test is reliable for diagnosing different types of MH.

The technique of split thickness skin grafting in the repair of contractures of burned hands

The technique of split thickness skin grafting in the repair of contractures of burned hands

Repair of contractures of the hand with pedal full-thickness skin grafts

The medial pedal region is a favorable source of hairless skin for full-thickness grafts to the palmar surface of the hand. These transplants have proved to be superior in texture, color match and resilience to other types of full-thickness and split-skin grafts. The principles of skin grafting in general must be followed to achieve satisfactory results in the restoration of normal appearance and function to the hand following injury.

The Repair of Contractures Resulting from Burns

The Repair of Contractures Resulting from Burns

Skin Grafting in the Repair of Contractures Due to Burns

Skin Grafting in the Repair of Contractures Due to Burns