Contracture Release Research Articles

Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.

Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy. Two raters measured the coronal positions of the scapula, thoracic spine, and humeral shaft bilaterally on coronal images, correcting trigonometrically for scapular protraction on axial images. Supraspinatus, deltoid, and latissimus dorsi muscle atrophy was assessed, blinded to other measures. Correlations between glenohumeral abduction contracture and glenoid version, humeral head subluxation, passive external rotation, and Mallet shoulder function before and after surgery were performed. MRI measurements were highly reliable between raters. Glenohumeral abduction contractures were present in twenty-five of twenty-eight patients, averaging 33° (range, 10° to 65°). Among those patients, abductor atrophy was present in twenty-three of twenty-five, with adductor atrophy in twelve of twenty-five. Preoperatively, greater abduction contracture severity correlated with greater Mallet global abduction and hand-to-neck function. Abduction contracture severity did not correlate preoperatively with axial measurements of glenohumeral dysplasia, but greater glenoid retroversion was associated with worse abduction contractures postoperatively. Surgery improved passive external rotation, active abduction, and hand-to-neck function, but did not change the abduction contracture. A majority of patients with persistent shoulder weakness following neonatal brachial plexus palsy have glenohumeral abduction deformities, with contractures as severe as 65°. The abduction contracture occurs with abductor atrophy, with or without associated adductor atrophy. This contracture may improve global shoulder abduction by positioning the glenohumeral joint in abduction. Glenohumeral and scapulothoracic kinematics and muscle pathology must be further elucidated to advance an understanding of the etiology and the prevention and treatment of the complex shoulder deformity following neonatal brachial plexus palsy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Post burn digital contracture our way: The pains, The gains

Background: Post burn digital contractures account for 30% of new outpatient clinic visits but 25% of elective surgery load in our practice. There is a lot of backlog and pressure to operate particularly in the pediatric age group. We were able to demonstrate in this series that irrespective of the duration, uncomplicated post burn contractures are usually not complicated by ankylosis and a single stage complete release is possible. Aims and Objectives: 1. To determine if multiplicity of joint involvement and duration between burn and corrective surgery affect outcome. 2. To determine the range of complications after post burn digital contracture release. 3. To determine if preoperative plain radiographs are necessary in uncomplicated post burn digital contractures. Materials and Methods: Retrospective analysis of the records of 33 patients. Data collected included socio demographic and disease characteristics, etiology of burns, duration of burns before corrective surgery, complications after corrective surgery. Data was analyzed using SPSS version 16.0. All patients with contractures in other joint other than digits and from other causes other than burns, or burns associated with mechanical trauma were excluded. Results: Mean age 8 yrs, nearly equal sex distribution. Scald 48.5%, flame 21.2%, contact burn 9.1%, others 21.2%. Mean duration between burn and contracture release 40months. Overall, 172 joints were involved in 33 patients, 69.7% had incision ,+ FTSG, 3% had incision+ STSG, 6.1% had Z plasty only and 21.2% had Z plasty + FTSG. In 32 patients (97%) complete intra op contracture release was achieved. Twenty patients (60.6%) healed without complications, recorded complications post op were wound infection (30%), graft shift and digital tip gangrence. Conclusion: Prolonged duration between burn and eventual contracture release does not affect achieving complete contracture release, neither does multiplicity of joint involvement.

Anesthetic management of post-burn contracture chest with microstomia: Regional nerve blocks to aid in intubation

This case report exemplifies the anesthetic technique of blocking bilateral infraorbital and mental nerves for release of contractures of mouth. A 30 year old female patient of post-acid burn contractures of chest wall and mouth was scheduled for contracture release and skin grafting. Airway assessment revealed severe restriction of mouth opening with limited restriction of neck movements. Contracture release of mouth conducted by blocking bilateral infraorbital and mental nerves, which facilitated intubation easily. This case report highlights the practical advantage of nerve blocks for release of contracture mouth, in case of anticipated difficult airway, over other conventional methods.

Different surgical modalities for management of postburn flexion contracture of the elbow

Objective A study evaluating the outcomes of different surgical modalities for management of the postburn elbow contracture. Background The incidence of the postburn contracture is unkown, but it is inversely propotional to the standards of the initial management. Methods This is a prospective study included 20 patients suffering from different degrees and forms of postburn elbow contracture. All patients had scar contracture release and then were managed according to the forms of the contractures and the availability of adjacent healthy unscarred tissues. Results Different techniques had been used in this study, seven cases had skin graft representing 35% of all cases, there was partial loss in one case and one case had recontracture later on. Five cases representing 25% of cases had z-plasty flap, only one case had tip necrosis. Two cases had five z-plasty technique representing 10% of cases and there was no complications including infection, dehiscence, hematoma, tip necrosis or recontracture. Three cases representing 15% of cases had reversed lateral arm flap and there was no complications. Three cases representing 15% of cases had proximally based lateral forearm flap and also there was no complications. Conclusion Flaps are better for resurfacing the defects after post-burn contractures release. Flaps do not need rigorous post-operative physiotherapy or splintage, no recurrence of contracture and grow with age especially in children.

Study on Surgical Management of Post Burn Hand Deformities.

Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. It's a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.

Repairing post burn scar contractures with a rare form of Z-plasty.

Although many precautions have been introduced into early burn management, post burn contractures are still significant problems in burn patients. In this study, a form of Z-plasty in combination with relaxing incision was used for the correction of contractures. Preoperatively, a Z-advancement rotation flap combined with a relaxing incision was drawn on the contracture line. Relaxing incision created a skin defect like a rhomboid. Afterwards, both limbs of the Z flap were incised. After preparation of the flaps, advancement and rotation were made in order to cover the rhomboid defect. Besides subcutaneous tissue, skin edges were closely approximated with sutures. This study included sixteen patients treated successfully with this flap. It was used without encountering any major complications such as infection, hematoma, flap loss, suture dehiscence or flap necrosis. All rotated and advanced flaps healed uneventfully. In all but one patient, effective contracture release was achieved by means of using one or two Z-plasty. In one patient suffering severe left upper extremity contracture, a little residual contracture remained due to inadequate release. When dealing with this type of Z-plasty for mild contractures, it offers a new option for the correction of post burn contractures, which is safe, simple and effective.

A systematic review on burn scar contracture treatment: searching for evidence.

Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

Manual Kirschner-Wire Insertion through the Soft Tissue for Finger Immobilization after Scar Contracture Release

The fingers are immobilized in full extension for finger stability in skin graft or flap operation on the volar aspect of the finger or the palm. A common method for finger immobilization is Kirschner wire (K-wire) pinning from the distal phalangeal bone to the proximal phalangeal or metacarpal bone through the medullar cavity. However, this method requires a drilling device to insert a pin into the bone, and minor joint or tendon injury by the high-speed rotating wire Manual Kirschner-Wire Insertion through the Soft Tissue for Finger Immobilization after Scar Contracture Release

Elbow arthroscopy: indications, techniques, outcomes, and complications.

Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. Contraindications, technical considerations, and favorable outcomes following treatment with elbow arthroscopy require careful patient evaluation, a thorough understanding of anatomic principles, and proper patient positioning and portal selection to guide preoperative planning and overall patient care. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

Primary intranasal lining injury cause, deformities, and treatment plan.

Nasal membranes may be injured by immune disease, infection, trauma, or cocaine. Destruction of the septum, vault and floor lining, external skin, upper lip, and adjacent structures follows. Lining injuries caused by cocaine, Wegener granulomatosis, primary syphilis, leishmaniasis, septorhinoplasty, septal cancer excision and irradiation, corrosive inhalation, and foreign body and iatrogenic intubation injury were reviewed. The site and degree of injury were correlated with presentation and anatomical and functional abnormality. Damage may be isolated to the septum, creating a septal fistula with loss of dorsal and tip support and modest collapse of the dorsum and tip with columellar retraction, or the injury may extend onto the vaults and floor, leading to circumferential scar contracture and severe nasal shortening and lip retraction. Progressive disease, infection, or iatrogenic injury increases soft-tissue damage, causing external skin contraction or full-thickness necrosis. Repair is determined by site, depth of injury, and clinical deformity--not cause. Lining necrosis and subsequent scar contraction, rather than structural compromise of the septum, are the primary causes of the severe deformity. If vault and floor lining injury is minimal, central support alone will restore dorsal and tip projection. Extensive loss requires release of scar contracture and replacement of the vault and floor lining with composite grafts, a microvascular flap, or hinge-over lining flaps, depending on the site and extent of injury. If the external skin is destroyed by scar or a full-thickness loss, a staged forehead flap will be required to resurface the nose.

Axillary Fistula and Scar Contracture due to Uncontrolled Chronic Infection after Trans-Axillary Augmentation Mammaplasty.

Axillary Fistula and Scar Contracture due to Uncontrolled Chronic Infection after Trans-Axillary Augmentation Mammaplasty.

Protocol of surgical indications for scar contracture release before childbirth: Women with severe abdominal scars after burn injuries

It is difficult to determine if women with severe abdominal burn scar contractures can have uneventful pregnancies and births. There are few reports involving the relationship between severe abdominal scar contractures and pregnancy/childbirth. Furthermore, all of these reports are based on retrospective studies. The present study focused on women with severe abdominal burn scar contractures with desired fertility. This study investigated whether or not normal childbirth is possible, the necessity of scar contracture release, and the delivery method. In addition, a protocol developed by this hospital was prospectively evaluated. Surgery was indicated in women with scars covering ≥75% of the total abdominal area. The scarred area in the upper abdomen, superior to the navel, was considered particularly important. The protocol of this study serves merely as a reference, and future studies are needed with an increased number of cases.

Incarcerated Medial Epicondyle Fracture Following Pediatric Elbow Dislocation: 11 Cases

To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up. Average follow-up was 14 months (range, 4-56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness. Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy. Therapeutic IV.

Delayed-Onset Ulnar Neuritis After Release of Elbow Contractures

Background: Little information exists regarding delayed-onset ulnar neuritis (DOUN) after arthroscopic release of elbow contractures. Purpose: To describe, in a large cohort of patients, the clinical presentation of and risk factors for developing DOUN after arthroscopic release of elbow contractures. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective study of 565 consecutive arthroscopic releases of elbow contractures was conducted. Essentially, DOUN was defined as ulnar neuritis or neuropathy, or worsening of pre-existing ulnar nerve symptoms, that developed postoperatively in patients with normal neurological examination findings immediately after surgery. After inclusion and exclusion criteria were met, 235 contracture releases in patients who had not undergone any ulnar nerve surgery remained and were used for the analysis of risk factors with a multivariate logistic regression analysis. Results: Twenty-six patients (11%) developed DOUN. The patients fell into 1 of 3 distinct groups. Fifteen (58%) presented with rapidly progressive DOUN, characterized by rapidly progressive sensorimotor ulnar neuropathy, increasing pain at the cubital tunnel during end-range flexion and/or extension, and rapidly deteriorating range of motion within the first week after surgery. Urgent ulnar subcutaneous nerve transposition was performed within 1 or 2 days of diagnosis. Eight (31%) presented with nonprogressive DOUN, characterized by mild sensory ulnar neuropathy, neither motor weakness nor substantial pain at the cubital tunnel, or loss of motion. Three (12%) presented with slowly progressive DOUN, characterized by the insidious onset of mild ulnar neuropathy. Significant risk factors for DOUN included a diagnosis of heterotopic ossification (odds ratio, 31; 95% CI, 5-191; P < .001), preoperative neurological symptoms (odds ratio, 6; 95% CI, 2-19; P = .001), and preoperative arc of motion (odds ratio, 0.97 per degree of motion; 95% CI, 0.96-0.99; P = .02). Conclusion: Delayed-onset ulnar neuritis is an important complication of arthroscopic release of elbow contractures. We recommend a high index of suspicion and monitoring patients with progressive loss of elbow motion and end-range pain for evidence of subclinical ulnar neuritis.

Delayed-Onset Ulnar Neuritis After Release of Elbow Contracture: Preventive Strategies Derived From a Study of 563 Cases

The purposes of this study were to determine whether delayed-onset ulnar neuritis (DOUN) after elbow contracture release can be prevented and to compare the efficacy of ulnar nerve decompression versus subcutaneous transposition. A retrospective study of 563 consecutive arthroscopic elbow contracture releases was conducted. The prophylactic efficacy of (1) subcutaneous transposition, (2) ulnar nerve decompression, (3) limited ulnar nerve decompression (7 to 8 cm), and (4) mini-decompression (4 to 6 cm) was assessed prospectively. The efficacy of prophylactic strategies (transposition, decompression, limited decompression, or mini-decompression) in preventing DOUN was compared by univariate survival analysis. Patients who underwent a subcutaneous transposition were matched with patients who underwent a standard open decompression or a limited decompression, according to gender, age (±10 years), diagnosis, and preoperative motion. This analysis was repeated after we excluded the patients who underwent associated open procedures (e.g., hardware removal). DOUN occurred in 26 of 235 patients (11%) who did not undergo any prophylactic procedure versus 8 of 295 patients (3%) who underwent a prophylactic ulnar nerve decompression or transposition at the time of contracture release (P < .001). The neurologic impairment was significantly less severe after prophylactic decompression compared with patients without any prophylactic intervention (grade on Neuropathy Grading Scale, 2 vs. 4; P = .03). Ulnar nerve transposition and decompression were equally protective. The decompression length was the only factor significantly related to the failure of the prophylactic intervention (odds ratio, 0.19; P = .02). A mini-decompression was not as effective as a prophylactic procedure, whereas a limited decompression was equal to a standard decompression. The case-control analysis showed that the decompression and transposition had equal preventive effects but the transposition was associated with a higher rate of wound complications (19% vs. 4%, P = .03). DOUN is a complication of arthroscopic elbow contracture release. Its incidence and severity can be reduced by limited open ulnar nerve decompression or transposition. Level II, prospective comparative study with retrospective analysis.

Outcome of Split Thickness Skin Grafting and Multiple Z-Plasties in Postburn Contractures of Groin and Perineum: A 15-Year Experience

Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum. Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were managed by physiotherapy and partial recurrence of the contracture in 4 (8.16%) patients required secondary surgery. Conclusion. We conclude that postburn contractures of the groin and perineum can be successfully treated with release of contracture followed by STSG with satisfactory functional and cosmetic results. Long term measures like regular physiotherapy, use of pressure garments, and messaging with emollient creams should not be neglected and should be instituted postoperatively to prevent secondary contractures of the graft and recurrence of the contracture.

The management of elbow instability using an internal joint stabilizer: preliminary results.

BackgroundNonsurgical and surgical treatments such as immobilization, transarticular pinning, and hinged or nonhinged external fixation have been used to treat unstable elbows. These methods all have drawbacks. We thought that a bent Steinmann pin introduced through the axis of ulnohumeral rotation and attached to the ulna could provide an improved method of treatment and that this could result in the development of a proper internal joint fixator that may have widespread application.Questions/purposesDoes a fully internal hinged fixator crafted intraoperatively by the surgeon from a Steinmann pin for patients undergoing surgery for severe elbow instability result in restoration of range of motion and elbow stability? Does it result in new complications?MethodsWe reviewed the first 10 patients treated with the method for elbow instability. Diagnoses included fracture-dislocations of the elbow that remain unstable after fracture repair and unstable elbows that result from release of contracture or ulnohumeral synostosis. During that time, all patients meeting these criteria who underwent surgery by this surgeon (JLO) were treated with this approach. Charts, radiographs, and therapy notes were assessed at a minimum of 14 months (mean, 32 months; range, 14–59 months); no patients were lost to followup. Data recorded included age, sex, and elbow and forearm range of motion as well as any complications and reoperations that occurred. The absence of elbow instability was determined initially by radiographically observing concentric reduction of the ulnohumeral and radiocapitellar joints and later by radiography plus the absence of clinical signs and symptoms of elbow instability.ResultsMean range of motion at latest followup was flexion 134°, extension −19°, pronation 75°, and supination 64°. All elbows were clinically and radiographically stable. Complications resulting in additional procedures occurred in four patients, including one recurrent deep infection in a patient with a remote history of sepsis, one wound hematoma that resolved after a drainage procedure performed in the office, one prominent implant treated by partial removal, and one patient with heterotopic ossification treated with excision of the heterotopic bone.ConclusionsThis technique restores elbow stability and permits motion without the use of transcutaneous pins. It seems promising for the treatment of patients with severe elbow instability but requires a second procedure for removal. Further investigation is needed to understand its place in the surgeon’s toolbox and what drawbacks it may have.Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Three-dimensional Reconstruction of Scar Contracture-bearing Axilla and Digital Webs Using the Square Flap Method.

Background:Joint scar contractures are characterized by tight bands of soft tissue that bridge the 2 ends of the joint like a web. Classical treatment methods such as Z-plasties are mainly based on 2-dimensional designs. Our square flap method is an alternative surgical method that restores the span of the web in a stereometric fashion, thereby reconstructing joint function.Methods:In total, 20 Japanese patients with joint scar contractures on the axillary (n = 10) or first digital web (n = 10) underwent square flap surgery. The maximum range of motion and commissure length were measured before and after surgery. A theoretical stereometric geometrical model of the square flap was established to compare it to the classical single (60 degree), 4-flap (45 degree), and 5-flap (60 degree) Z-plasties in terms of theoretical web reconstruction efficacy.Results:All cases achieved 100% contracture release. The maximum range of motion and web space improved after square flap surgery (P = 0.001). Stereometric geometrical modeling revealed that the standard square flap (α = 45 degree; β = 90 degree) yields a larger flap area, length/width ratio, and postsurgical commissure length than the Z-plasties. It can also be adapted by varying angles α and β, although certain angle thresholds must be met to obtain the stereometric advantages of this method.Conclusions:When used to treat joint scar contractures, the square flap method can fully span the web space in a stereometric manner, thus yielding a close-to-original shape and function. Compared with the classical Z-plasties, it also provides sufficient anatomical blood supply while imposing the least physiological tension on the adjacent skin.

Various Methods of Reconstruction of Axillary Burn Contracture

Post burn contracture is a burn sequel, which was not properly treated in initial burn management. Deep partial and full thickness burn of axillary region can result in scar contracture which limits shoulder abduction and extension. The axillary contracture has functional morbidity along with aesthetic disfigurement. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. The goal of the surgical correction of axillary scar contractures is to provide a maximum release with minimum or no local anatomic distortion. 42 patients with post burn contracture of the axillas were operated in the Department of Burn and Plastic Surgery Unit, Dhaka Medical College Hospital and in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka in the period between November 2007 &amp; December 2011. Among them 26(61.9%) were males and 16(38.1%) were females. Age ranged from 6 to 38 years with a mean age 14.7 years. Unilateral axilla were involved in 34 patients(81%) and bilateral axilla was involved in 8 patients(19%). 18 cases (42.8%) had contracture of anterior axillary fold, 12 cases (28.5%) cases had contracture of posterior axillary fold, 8 cases (19%) had contracture of both folds and 4 cases (9.5%) had contracture involving axillary dome. Pre operative X-ray of shoulder joints of affected axilla revealed normal joint spaces. The operative procedure was chosen according to the pattern of scar and state of surrounding skin. Surgical procedures included release of post burn axillary contracture by recontructive procedures single Z plasties were done in 2 cases(4.7%), multiple Z plasties were done in 12 cases(28.6%), five flap plasty was done in 1 case (2.4%), local fascio cuteneous flaps were done in 25 cases(59.5%), parascapular flap was done in 1case (2.4%) and split thickness skin grafting was done in 1 case (2.4%). Axilla was immobilized with plaster cast for two weeks. The rate of complication was 9.5%. All of them were minor. Functional improvement was quite satisfactory, except for one case of skin grafting which had re-contracture. Choice of surgical procedure for reconstruction of post burn axillary contracture can be made according to the pattern of scar contracture and the state of surrounding skin. The choice of a flap should have priority to skin graft because of the superior functional and cosmetic results of flaps. Long term splinting and physical therapy are mandatory to prevent re contracture. Proper pre-operative planning, appropriate surgical method, post operative immobilization, physiotherapy and follow up can make good outcome of post burn axillary contracture reconstruction. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18686 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 16-19

Current indications for and the technique of wrist arthroscopy.

Since its introduction more than 30 years ago, wrist arthroscopy has become an essential diagnostic and therapeutic tool in hand surgery. This procedure minimizes exposures and allows access to otherwise remotely located anatomic regions with minimal morbidity. Advances in anatomic understanding and wrist scope technology have standardized the procedure and expanded indications. Current applications are diagnostic staging of various wrist pathologies where arthroscopy allows for a direct, magnified, and tactile-assisted examination. This includes injuries to the triangular fibrocartilage complex (TFCC), osteochondral lesion of the carpus, and dynamic assessment of carpal instability and radiocarpal arthritis. Therapeutic applications have continued to expand and include arthroscopic-assisted fracture reductions, treatment of radiocarpal synovitis and arthritis, TFCC repairs, and arthroscopic management of soft tissue pathologies such as ganglion excisions and release of contractures.