Prevention Of Contracture Research Articles

Prevention of postoperative contracture of the masticatory muscles using a multifunctional gnathic device when removing retinated teeth

Full rehabilitation of patients after atypical extraction of wisdom teeth is not among the priority issues in dentistry, however, the duration and severity of postoperative inflammatory contracture of the masticatory muscles significantly affects the duration of the postoperative period, increasing the patient’s period of disability. Numerous studies indicate the advisability of local effects on tissues in order to improve blood and lymph circulation in the area of inflammation, which enhances the exchange of intercellular fluid and relaxes the masticatory muscles. A method of adaptive myogymnastics for early rehabilitation of patients is proposed and proved the effectiveness of its use.

The incidence and prevalence of Dupuytren’s disease in primary care: results from a text mining approach on registration data

Background The focus of research and management of Dupuytren’s disease (DD) is shifting from relieving symptoms in the later stages of disease towards the prevention of contractures. Treatment services might likewise shift towards primary care. Studying characteristics of DD patients who seek medical care for the first time, may identify a symptomatic target group for early DD treatments. We present the first study that estimates the incidence and prevalence of DD in primary care by applying a text-mining algorithm to registration data. Methods This is a population-based cohort study using electronic health records from Dutch general practices involved in a regional research network. Descriptive statistics were used to describe sex, age, comorbidities and lifestyle factors, the latter two were identified via International Classification of Primary Care (ICPC) codes. Incidence rate was calculated as number of patients with a first contact for DD/1000 person years for the years 2017–2021, point prevalence as the percentage of patients with a contact for DD in 2021. DD contacts were identified using a text-mining algorithm. Results The incidence ranged between 1.41 and 1.72/1000 person years and the overall prevalence was 1.99%. Incidence and prevalence are higher among males and increase with age, peaking between 61 and 80 years. Conclusions Our results of prevalence and incidence of DD in primary care give an insight into the relevant population of patients with symptomatic DD that might be the future target group for potential disease controlling treatments.

Myelodysplasia Rehabilitation in Children: a Review

INTRODUCTION. 1.5 thousand children with myelodysplasia (MD) are born in Russia every year. To improve the quality of life, most of them need lifelong medical supervision and rehabilitation. The topic of medical rehabilitation in MD in children is poorly covered. AIM. To search and analysis published data on the rehabilitation of children with MD identify the most effective methods. MATERIALS AND METHODS. The collection and analysis of publications on this topic from the PubMed and eLibrary databases published from 2014 to 2024 was carried out. Earlier fundamental works on secondary disorders in myelodysplasia and Spina bifida were also included in the review. A total of 512 publications in PubMed and 1096 publications in eLibrary were analyzed, 584 of them were unique. Publications of reviews, systematic reviews and clinical observations were included. RESULTS AND DISCUSSION. Rehabilitation for MD in children is multidisciplinary in nature, a violation of the structure of the nervous system entails, already in utero, the formation of deformities of the musculoskeletal system, combined changes in the functioning of the lower urinary tract and intestines. It is known that rehabilitation started from an early age helps to master motor skills in a timely manner, contributes to the prevention of metabolic syndrome, contractures, pressure sores, urodynamic disorders and constipation. There are different approaches regarding the intensity of physical activity during the day and week, following the recommendations of the World Health Organization (WHO), children should exercise for more than 60 minutes a day. Physical exercises should be carried out from the perspective of the concept of neuroplasticity and enhanced by the influence of magnetic stimulation, low-intensity laser, electromyostimulation, vibration therapy. It will be possible to effectively use acupuncture and massage. In addition, it is important to include urological and orthopedic care in medical rehabilitation from an early age. CONCLUSION. Due to the high disability, there is a question of effective methods for improving rehabilitation potential and improving the standard of living. Among the described methods, physiotherapy is distinguished, including therapeutic exercises, magnetic stimulation, low-intensity laser therapy, electromyostimulation, and ergotherapy. It is necessary to continue to study the effectiveness of the use of various physical factors in children with MD.

Contracture prevention: knowledge, understanding, and skills of community occupational therapists and physiotherapists: a survey

Contracture prevention: knowledge, understanding, and skills of community occupational therapists and physiotherapists: a survey

Treatment of Capsular Contracture in Previously Irradiated Breasts Implants and Expanders with the Use of Porcine Acellular Dermal Matrices: Outcomes and Complications.

Background: Radiation therapy is a crucial component of breast cancer treatment. However, it is well known to increase the risk of unsatisfactory cosmetic outcomes and higher complication rates. The aim of this study is to provide further insight into the use of acellular dermal matrices (ADMs) for the prevention of capsular contracture. Materials and Methods: This single-center, retrospective study analyzed irradiated patients who underwent post-mastectomy, ADM-assisted implant reconstructions. Of the 60 patients included, 26 underwent expander-to-implant substitution after radiotherapy (Group A), while 34 required implant replacement due to capsular contracture following radiotherapy (Group B). The primary objective was to evaluate the effectiveness of ADMs in reducing reconstructive failures, complications, and capsular contracture after breast irradiation. Results: We recorded a total of 15 complications and four implant losses. Reconstructive failures were attributed to implant exposure in two cases, full-thickness skin necrosis in one case, and severe Baker grade IV contracture in one case. Both Group A and Group B showed a significant decrease in postoperative Baker grades. US follow-up was used to demonstrate ADM integration with host tissues over time. Conclusions: Based on our findings, the use of ADM in selected cases appears to be a viable option for treating and preventing capsular contracture in irradiated breasts. This approach is associated with relatively low complication rates, a low rate of reconstructive failure, and satisfactory cosmetic outcomes and can be applied both in breast reconstructed with implants and with expanders.

A Randomized Controlled Trial of Home-Based Virtual Rehabilitation to Improve Adherence to Prescribed Home Therapy after Burn Injury: A Northwest Regional Burn Model System Trial.

Daily rehabilitation after burn injury is vital for prevention of function-limiting contractures. However, adherence to prescribed therapy following acute burn hospitalization has historically been low and not well-studied. Studies involving virtual reality technology have demonstrated an association with improved functional outcomes in burn therapy. We conducted a five-year randomized controlled trial comparing 12 weeks of a home-based virtual rehabilitation (HBVR) system with standard burn therapy. Our primary outcome was adherence to prescribed home therapy, measured by e-diary self-report. Secondary outcomes included steps walked daily and patient-reported outcomes regarding stiffness, upper extremity function, and mobility. We enrolled 50 subjects, of which 48 provided data for analysis (23 HBVR, 25 control). Overall adherence to prescribed home therapy was low, 37.2% in the HBVR group and 60.0% in the control group. Reasons for non-adherence in the HBVR group included lack of time, engagement, and replacement of therapy with other physical activity. However, some subjects enjoyed HBVR and believed it aided their recovery. There was no difference in daily steps walked between the two groups. Daily walking gradually improved from 3,500 steps per day in the first week after baseline and plateaued at 6,000 steps per day at week five. There were no differences in stiffness, upper extremity function, and mobility between the two groups at baseline and 3-, 6-, and 12-month follow-up. Subjects demonstrated improved upper extremity function and mobility in the first year after discharge that coincided with increasing stiffness.

Modification of proximal row carpectomy (PRC) technique for adaptive wrist collapse (pilot study)

Introduction Proximal carpal row resection has been used for many decades as a “salvage procedure” for progressive wrist collapse. Improving the technique of its implementation, as well as introducing various modifications of the technique into practice are an important area for achieving better results of surgical treatment.The purpose of this work was to demonstrate aspects of the modified proximal row carpectomy (PRC) technique and the immediate results of its use.Materials and methods Eight patients aged from 24 to 57 years (seven men and one woman) were treated with the modified PRC technique. Treatment results were assessed using an adapted QuickDASH questionnaire, a visual analogue scale (VAS), based on patient satisfaction and radiographic results.Results The average duration of surgical intervention was (149.0 ± 35.5) minutes. In the postoperative period, six patients (75 %) underwent fixation with an Ilizarov apparatus, the rest with a plaster splint. The average range of motion of flexion and extension was (67.5 ± 18.3)°, range: 40–95°. The patients had an average of (35.6 ± 16.13)° extension, range: 10–65° and (31.87 ± 10.9)° flexion, range: 10–45°. Patients reported decreased grip strength after surgery. Pain syndrome according to VAS at rest was equal to 0–1 points and 3–4 points when the affected limb was loaded. Six patients completed the QuickDASH survey, with a mean score of (14.83 ± 4.25) points. All patients are satisfied with the result of treatment and the absence of pain at rest. Patients returned to their usual work.Discussion Unlike the conventional dorsal approach through the III–IV tendon canals, the use of two mini-approaches provides a better cosmetic effect and makes it easier to restore the integrity of the tendon canals, which are important for the prevention of desmogenic contractures. The use of the Ilizarov apparatus has proven to be the method of choice, providing absolute stability and reduction of pain in the postoperative period. For patients under 45 years of age with increased functional demands, a balanced approach is required when choosing PRC or intercarpal arthrodesis, depending on which functional parameters are more important to the patient.Conclusion The analysis of short-term results of using the modified PRC technique shows that it reduces the invasiveness of the operation, improves its esthetic result, provides pain relief and a satisfactory range of motion and grip strength.

A Comparison of Capsular Contracture Rates after Implant-Based Breast Reconstruction Using ADM Versus Synthetic Mesh

Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics significantly increased the risk for capsular contracture development. Conclusion ADM and synthetic mesh both function as effective tools for reducing the risk of developing capsular contracture after prosthetic breast reconstruction. The rate of capsular contracture with ADM was only 8.0% and the rate with mesh was only 14.8%. Both rates are lower than the 15-30% incidence that has been found in breast reconstruction patients without mesh. None of the patient demographics were significant risk factors for capsular contracture development, so these are unlikely to be confounders. There was no significant difference in rate of capsular contracture between the two groups, suggesting that ADM and mesh are similarly efficacious at preventing capsular contracture in reconstruction patients.

A clinical study on different surgical options for management of post-burn axillary contractures

Background: Post-burn contracture is a common sequele occurring after burn. Upper limb contracture like axilla is also occurring more commonly because it is most mobile part of body and likely to involve in burn. Post-burn contracture of axilla leads to functional deficit as it limits the movement of upper extremity mainly abduction and extension. Patients with axillary contracture are unable to utilize his upper limb because he is unable to take the hand at required site. Aims and Objectives: The objective of this study was to study various operative strategies for patients presenting with post-burn axillary contracture. Materials and Methods: Twenty patients presenting with post-burn axillary contractures were taken in our study. Results: In our study of 20 patients of post-burn axillary contracture, five patients had Grade I (25%), Grade II 05 (25%), Grade III 01 (5%), and Grade IV 09 (45%) contractures. Regarding surgical procedure, Z-plasty was done in 8 patients (40%), release with skin grafting 10 patients (50%), and local flap done in 2 patients (10%). In our study, the mean degree of range of motion achieved after release of axillary contracture was 120°. In our study, 2 patients (10%) developed re-contracture, 1 patient (5%) had a graft failure while 85% of the patients had no complications. Conclusion: In the present study of 20 cases of management of post-burn axillary contracture, it is reasonable to conclude that the prevention of contracture is of utmost importance. The choice of surgical procedure for reconstruction of post-burn axillary contractures can be made according to the pattern of scar contracture and the state of the surrounding skin. The choice of a flap should have priority over the skin graft due to the superior functional and esthetic results of flaps. The results were satisfactory in our study in most cases with regard to quality of life, coverage, and range of motion.

Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review.

This study aimed to systematically review the literature and identify the surgical management strategy for fixed flexion contracture in primary total knee arthroplasty (TKA) surgery, pre-, intra-, and post-operatively. Secondary endpoints were etiologies and factors favoring flexion contracture. Searches were carried out in November 2023 in several databases (Pubmed, Scopus, Cochrane, and Google Scholar) using the following keywords: "flexion contracture AND TKA", "fixed flexion deformity AND TKA", "posterior capsular release AND TKA", "posterior capsulotomy in TKA", "distal femoral resection AND TKA". Study quality was assessed using the STROBE checklist and the Downs and Black score. Data concerning factors or strategies leading to the development or prevention of flexion contracture after TKA were extracted from the text, figures, and tables of the included references. The effect of each predictive factor on flexion contracture after TKA was recorded. Thirty-one studies were identified to meet the inclusion and exclusion criteria. These studies described a variety of preoperative and intraoperative factors that contribute to the development or correction of postoperative flexion contracture. The only clearly identified predictor of postoperative flexion contracture was preoperative flexion contracture. Intraoperative steps described to correct flexion contracture were: soft-tissue balancing (in posterior and medial compartments), distal femoral resection, flexion of the femoral component, and posterior condylar resection. However, no study has investigated these factors in a global model. This review identified various pre-, intra-, and post-operative factors predictive of post-operative flexion contracture. In practice, these factors are likely to interact, and it is therefore crucial to further investigate them in a comprehensive model to develop an algorithm for the management of flexion contracture. IV.

Prevention and Treatment of Burn Scar Contracture: A Practical Review.

Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.

Utilizing a Quality Improvement Approach to Improve Positioning of Acute Burn Patients.

Patient positioning, using "anti-deformity positioning," is a standard practice in burn rehabilitation to assist with edema management, scar contracture prevention, and wound healing. Consistently providing proper positioning requires the combined effort of the multidisciplinary burn team. Our primary goal was to increase the frequency that patients were correctly positioned to over 90%. At a medium-sized, academic burn unit, random audits were conducted by burn lead therapists on the compliance of proper patient positioning over 6 months. Using this data as a trigger, a quality improvement project was designed using the Plan-Do-Study-Act (PDSA) cycle. Surveys were distributed to therapy and nursing staff to identify barriers to proper positioning. Effects on positioning compliance postintervention were monitored. In the 6 months prior to intervention, the average correct positioning was 76%. Surveys identified the following barriers to care: nursing needed more education and the approach was too heavily reliant on nursing efforts alone. To address this, therapists provided education to all nurses, communicated daily about positioning expectations, shifted the project to a multidisciplinary approach, and made changes in therapy workflow. The median compliance improved from 79% to 91% (P < .05). Coordinating efforts of the entire burn team improve consistency for positioning in burn patients. Utilizing the PDSA cycle allowed us to identify areas for improvement and develop appropriate interventions to increase education for nursing staff and workflow improvements for therapists. Following the completion of our interventions, we were able to obtain an immediate improvement in our patient positioning compliance.

Model in Orthesis in Elbow for Rehabilitation in Rigidity Articulate

Introduction: Joint stiffness is the most common complication in elbow injuries and may have several etiologies and pathophysiological mechanisms, affecting treatment and prognosis. The measures for prevention and treatment of joint contracture are based on the cause of stiffness, and early intervention should modify the course of this complication, bringing better results; Such methods may be conservative or surgical, isolated or combined, depending on each individual situation. Objective: To develop a device for use by patients in rehabilitation of elbow injuries. Method: The development of the device was approached through "Design Thinking", divided into four phases: "Discover", "Define", "Develop" and "Deliver". In the “Discover” phase, interviews were conducted with patients with elbow joint stiffness and professionals about the problem. Literature review and search for anteriority data collection was performed. In the “Define” stage, the anomaly to be included in the study was determined. In the stage “Develop”, search was held for ideas and prototypes and models. “Brainstorming” meetings on the topic were scheduled. In the “Deliver” stage, adjustments and refinements and prototype production were performed, as well as testing for improvements and corrections to the project. Results: In the "Discover" phase, collected questionnaire responses from patients. In the "Define" phase, it was established that joint stiffness was the complaint to be treated. In the “Develop” phase, answers were collected from the questionnaires of the professional groups and “brainstorming” was performed among these collaborators. In the "Deliver" phase, creation of the virtual orthotic model ready for three-dimensional printing. Conclusion: A device was developed for individualized use and management, molded to each patient, to be used in the rehabilitation of elbow joint injuries.

Global perspectives on risk factors for major joint burn contractures: A literature review

Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.

Functionalization of breast implants by cyclodextrin in-situ polymerization: a local drug delivery system for augmentation mammaplasty.

Mammaplasty is a widely performed surgical procedure worldwide, utilized for breast reconstruction, in the context of breast cancer treatment, and aesthetic purposes. To enhance post-operative outcomes and reduce risks (hematoma with required evacuation, capsular contracture, implant-associated infection and others), the controlled release of medicaments can be achieved using drug delivery systems based on cyclodextrins (CDs). In this study, our objective was to functionalize commercially available silicone breast implants with smooth and textured surfaces through in-situ polymerization of two CDs: β-CD/citric acid and 2-hydroxypropyl-β-CD/citric acid. This functionalization serves as a local drug delivery system for the controlled release of therapeutic molecules that potentially can be a preventive treatment for post-operative complications in mammaplasty interventions. Initially, we evaluated the pre-treatment of sample surfaces with O2 plasma, followed by chitosan grafting. Subsequently, in-situ polymerization using both types of CDs was performed on implants. The results demonstrated that the proposed pre-treatment significantly increased the polymerization yield. The functionalized samples were characterized using microscopic and physicochemical techniques. To evaluate the efficacy of the proposed system for controlled drug delivery in augmentation mammaplasty, three different molecules were utilized: pirfenidone (PFD) for capsular contracture prevention, Rose Bengal (RB) as anticancer agent, and KR-12 peptide (KR-12) to prevent bacterial infection. The release kinetics of PFD, RB, and KR-12 were analyzed using the Korsmeyer-Peppas and monolithic solution mathematical models to identify the respective delivery mechanisms. The antibacterial effect of KR-12 was assessed against Staphylococcus epidermidis and Pseudomonas aeruginosa, revealing that the antibacterial rate of functionalized samples loaded with KR-12 was dependent on the diffusion coefficients. Finally, due to the immunomodulatory properties of KR-12 peptide on epithelial cells, this type of cells was employed to investigate the cytotoxicity of the functionalized samples. These assays confirmed the superior properties of functionalized samples compared to unprotected implants.

Efforts to Increase The Knowledge of The Initial Management of Burns and Prevention of Contracture Complications At Yayasan Amal Abadi Indonesia

The community service program entitled "Efforts to Increase The Knowledge of the Prevention and Handling of Burn Injuries and the Prevention of Contractures" was held on Sunday, January 22, 2023, at Madina Islamic Primary School owned by Amal Abadi Indonesia Foundation as the partner in this study. This institution is located in Krajan Hamlet, Wedomartani Village, Ngemplak District, Sleman Regency, and it is a densely populated residential area with a population of 3,852 people. This community service program aims to provide knowledge and skills to the community in dealing with burn injuries and preventing long-term complications in the form of contractures. This activity was conducted face-to-face and attended by 40 community representatives in Krajan Hamlet. It was broadcast via Amal Abadi Indonesia Foundation's YouTube channel, watched by more than 1,800 viewers live streaming. A pre-test and post-test using questionnaire were conducted to measure the respondents' knowledge before and after the seminar was held. The pre-test and post-test results were calculated using the correlated T-test method. The results showed an increase in knowledge. Previously, the results of the pre-test showed that most of the respondents had knowledge about the management of burns in the less category for 31 respondents (77.5%) and in the good category for 1 respondent (2.5%). The post-test results of all respondents (100.0%) revealed that they had good knowledge about the management of burns. The correlated T-test yields a p-value of &lt;0.05, so it is concluded that there is an increase in knowledge about the management of burns after the program. The output targets in this community service program are guidebooks for burn management, publication in seminars, and publication of activities in the mass media.

Advances on Capsular Contracture-Prevention and Management Strategies: A Narrative Review of the Literature.

The PubMed database was searched for literature regarding CC prevention and management strategies. Pertinent articles in English, published before December 1, 2022, were compared with selection criteria and eventually included in this review. Through the initial search, 97 articles were identified, of which 38 were included in the final study. Several articles explored different medical and surgical preventive and therapeutic strategies, showing numerous controversies on appropriate CC management. This review provides a clear overview of the complexity of CC. The wide variety of clinical situations in term of patients, implants, and surgical techniques prevent the standardization of CC management strategies. By contrast, a patient-customized approach should be preferred, and different strategies should be considered depending on the specific case. Further research is desirable to better ascertain evidence-based protocols with regard to CC prevention and treatment.

The feasibility of negative pressure wound therapy versus standard dressings in paediatric hand and foot burns protocol: a pilot, single-centre, randomised control trial

IntroductionThe goal of paediatric hand and foot burn management is hypertrophic scar and/or contracture prevention. The risk of scar formation may be minimised by integrating negative pressure wound therapy (NPWT) as an acute care adjunct as it decreases the time to re-epithelialisation. NPWT has known associated therapeutic burden; however, this burden is hypothesised to be outweighed by an increased likelihood of hypertrophic scar prevention. This study will assess the feasibility, acceptability and safety of NPWT in paediatric hand and foot burns with secondary outcomes of time to re-epithelialisation, pain, itch, cost and scar formation.Methods and analysisThis is a single-site, pilot randomised control trial. Participants must be aged ≤ 16 years, otherwise well and managed within 24 h of sustaining either a hand or foot burn. Thirty participants will be randomised to either standard care (Mepitel®—a silicone wound interface contact dressing—and ACTICOAT™—a nanocrystalline silver-impregnated dressing) or standard care plus NPWT. Patients will be reviewed until 3 months post-burn wound re-epithelialisation, with measurements taken at dressing changes to assess primary and secondary outcomes. Surveys, randomisation and data storage will be done via online platforms and physical data storage collated at the Centre for Children’s Health Research, Brisbane, Australia. Analysis will be performed using the Stata statistical software.Ethics and disseminationQueensland Health and Griffith University Human Research ethics approval including a site-specific assessment was obtained. The findings of this study will be disseminated through clinical meetings, conference presentations and peer reviewed journals.Trial registrationRegistered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622000044729, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381890&isReview=true, registered 17/01/2022).

IMPROVING THE METHODOLOGY OF PHYSICAL THERAPY IN ATHLETES WITH INJURIES OF THE KNEE JOINT CONNECTIVE APPARATUS

Description and results of the action developed programs of kinesiotherapy with a combination of kinesiotape to restore impaired locomotor functions of the knee joint and the possibility of continuation playing sports after arthroscopic operations for damage to the ligamentous apparatus.&#x0D; Injuries of the musculoskeletal system (MS) are quite common, especially in athletes. According to statistics, up to 50-70% of all ORA injuries occur in the knee joint. Most often, this type of injury is received by athletes, representatives of complex coordination sports and martial arts. Among injuries to the knee joint, injuries to the ligaments, which later cause post-traumatic instability, take second place after damage to the menisci.&#x0D; 35 patients with injuries of the ligamentous apparatus of the CS (12 women and 23 men) who underwent arthroscopic surgery took part in our study. The patients were active athletes in various sports, in particular game sports. Patients were divided into two groups (the main group and the comparison group) depending on the kind of restorative treatment program. The main group included 23 people whose average age was (24.3±3.0) years. Patients of this group received a rehabilitation program in the conditions of an educational and scientific center Department of Physical Therapy, Occupational Therapy of PNU named after Vasyl Stefanyk. The comparison group (CP) consisted of 12 people, the average age of which was (23.8±3.1) years, who underwent rehabilitation in the polyclinic department of the 1st city polyclinic.&#x0D; The individual program of physical therapy for OG patients included kinesiotherapy and massage muscles of the lower limb, physiotherapeutic procedures and the use of kinesiotape. Kinesiotherapy included therapeutic gymnastics of independent classes, massage for the prevention of contracture of the CS and atrophy of the thigh muscles. Various types of massage were used - classic manual massage with passive movements in the joints, self-massage and hydro massage. Physiotherapy procedures were aimed at reducing swelling and pain, preventing the development of the inflammatory process. Patients were prescribed electrophoresis of painkillers, UV irradiation, and UHF or laser therapy, applications of ozokerite or paraffin. These procedures contribute to the stimulation of lymph and blood circulation, trophic processes in the joints, increasing the amplitude of movements and restoring the strength of the muscles of the limb.&#x0D; In order to objectify the results of the restorative treatment, the functional ability of the lower limb was assessed using the Lovett muscle test (six-point assessment of muscle strength), the amplitude of movements in the knee joint (goniometry) and the visual analog pain scale (VAS) on the 14th day, 1.5 months, 3 and 5 months after the operation. This part of the study showed the advantages of the developed rehabilitation program using elements of kinesiotaping, as only a few patients with functional disorders were found in OG while in the comparison group their number was up to 20%. Improvement of joint function and normalization of muscle strength and goniometry indicators occurred earlier in OG patients by 2 weeks, compared to patients who underwent restorative treatment according to the traditional method of the city polyclinic.&#x0D; A special place in the assessment of results is given to determining the quality of life using the SF-36 questionnaire. The dynamics of quality of life indicators showed a gradual and likely improvement of all components of quality of life at the entire stage of post-hospital rehabilitation. We proved that the proposed rehabilitation program is more effective compared to the traditional methods of restorative treatment of a medical institution and allows achieving better results in restoring the functions of the knee joint in the shortest possible time after the injury and can be recommended for wide use.

Prevention of Postoperative Complications by Prepectoral versus Subpectoral Breast Reconstruction: A Systematic Review and Meta-Analysis.

Implant-based breast reconstruction has evolved over time. However, the effects of prepectoral breast reconstruction (PBR) compared with those of subpectoral breast reconstruction (SBR) have not been clearly defined. Therefore, this study aimed to compare the occurrence of surgical complications between PBR and SBR to determine the procedure that is effective and relatively safe. The PubMed, Cochrane Library, and EMBASE databases were searched for studies published until April of 2021 comparing PBR and SBR following mastectomy. Two authors independently assessed the risk of bias. General information on the studies and surgical outcomes were extracted. Among 857 studies, 34 and 29 were included in the systematic review and meta-analysis, respectively. Subgroup analysis was performed to clearly compare the results of patients who underwent postmastectomy radiation therapy. Pooled results showed that prevention of capsular contracture (OR, 0.57; 95% CI, 0.41 to 0.79) and infection control (OR, 0.73; 95% CI, 0.58 to 0.92) were better with PBR than with SBR. Rates of hematoma, implant loss, seroma, skin-flap necrosis, and wound dehiscence were not significantly different between PBR and SBR. PBR considerably improved postoperative pain, BREAST-Q score, and upper arm function compared with SBR. Among postmastectomy radiation therapy patients, the incidence rates of capsular contracture were significantly lower in the PBR group than in the SBR group (OR, 0.14; 95% CI, 0.05 to 0.35). The results showed that PBR had fewer postoperative complications than SBR. The authors' meta-analysis suggests that PBR could be used as an alternative technique for breast reconstruction in appropriate patients.