Total Contracture Research Articles

Minimally invasive burn reconstruction with subcutaneous scar contracture release

BackgroundScar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. MethodsPatients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. ResultsForty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6–68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were “satisfied” or “very satisfied”. 95% reported improved mobility. No significant adverse events occurred. ConclusionThis MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.

Preventive effect and possible mechanisms of ultrashort wave diathermy on myogenic contracture in a rabbit model.

The purpose of this study was to determine the preventive effect of ultrashort wave diathermy on immobilization-induced myogenic contracture and to explore its underlying mechanisms. Forty-two rabbits were randomly assigned into control (Group C), immobilization (Group I, which was further divided into one week, Group I-1; two weeks, Group I-2; and four weeks, Group I-4, subgroups by the length of immobilization) and ultrashort wave prevention (Group U, which was further divided into one week, Group U-1; two weeks, Group U-2; and four weeks, Group U-4, by time of treatment) groups. Intervention effects were assessed by evaluating rectus femoris cross-sectional area (CSA), knee range of motion, and the protein levels for myogenic differentiation (MyoD) and muscle atrophy F-box (MAFbx-1) in the rectus femoris. Compared with those of Group C, in Groups I and U, total contracture, myogenic contracture, MyoD and MAFbx-1 levels were significantly elevated, and CSA was significantly smaller (p < 0.05). Compared with those of Group I at each time point, MyoD levels were significantly elevated, MAFbx-1 levels were significantly lower, CSA was significantly larger, and myogenic contracture was significantly alleviated in Group U (p < 0.05). In the early stages of contracture, ultrashort wave diathermy reduces muscle atrophy and delays the process of myogenic contracture during joint immobilization; the mechanism of this may be explained as increased expression of MyoD triggered by suppression of the MAFbx-1-mediated ubiquitin-proteasome pathway.

A comparison of the antidotal effects of three oximes against an organophosphate on chick skeletal muscle

Background: One of the most toxic effects of organophosphorus poisoning (OP) is the paralysis of skeletal muscles. The oximes are a group of available antidotes. This study investigated the effects of different concentrations of paraoxon on the function of skeletal muscle and reversal or prevention of these effects by three different oximes (i.e., pralidoxime, obidoxime, and HI-6). Materials and Methods: This study was conducted based on the chicken biventer cervices (CBC) nerve-muscle preparation and the use of twitch tension recording technique. The twitches of the CBC were evoked by stimulating the motor nerve at 0.1 Hz with pulses of 0.2 msec duration and a voltage greater than that required to produce the maximum response. Moreover, twitches and contractures were recorded isotonically using Grass Biosystems. Results: Paraoxon at 0.1 µM induced a significant increase (more than 100%) in the twitch amplitude, while higher concentrations (0.3 and 1µM) induced partial or total contracture. Therefore, paraoxon at a concentration of 0.1 µ M was used to examine the capability of oximes to prevent or reverse its effects. Pralidoxime, obidoxime, and HI-6 dose-dependently prevented (when it was used as pre-treatment, 20 min before or at the same time of administration of the toxin) and reversed (when it was used as post-treatment, 20 min after the administration of the toxin) the effect of paraoxon. Conclusion: In conclusion, these results revealed that oximes were very useful in the prevention and reversal of the OP toxic effects on the skeletal muscle. Moreover, it was suggested that oximes were more effective when used as pre-treatment. Pralidoxime was more potent than obidoxime and HI-6. The HI-6, which is a newer oxime, was unexpectedly less effective than the other two.

A Comparison between Neuromuscular Effects of Parathion and Paraoxon on Chick Biventer Cervicis Nerve-Muscle and the Reversal of their Effects by Pralidoxime

Background: It is generally believed that the anticholinesterase effect is induced by the organophosphate insecticide parathion only through its bioactive metabolite (i.e., paraoxon) that is created in the liver. Objectives: This study aimed to evaluate the intrinsic anticholinesterase effect of parathion, compared to its main metabolite. Methods: This study has been conducted to prepare the isolated chick biventer cervicis nerve-muscle using the twitch tension recording method. Results: According to the results, paraoxon (0.1 µM) induced a highly significant increase (more than 100%) in the twitch height, while higher concentrations (0.3 and 1 µM) induced partial or total contractures. Furthermore, parathion induced almost the same percentage of increase in the twitch height at 1 µM and partial or total contractures at 3 and 10 µM. It should be noted that pralidoxime (2-PAM), at 300 µM, reversed the effects of paraoxon and its parent (i.e., parathion). Conclusion: These results demonstrate that both parathion and its metabolite inhibit the acetylcholinesterase enzyme which can be reactivated by pralidoxime, whereas parathion is about 10 times less potent, compared to its metabolite. Therefore, the intrinsic toxic effects of parathion, regardless of its metabolite, should be considered in future studies.

Effect of ultrashort wave treatment on joint dysfunction and muscle atrophy in a rabbit model of extending knee joint contracture: Enhanced expression of myogenic differentiation

ObjectiveTo investigate the effects of ultrashort wave treatment on joint dysfunction and muscle atrophy in a rabbit model of extending knee joint contracture. MethodsForty rabbits were randomly divided into eight groups. In group C, the left knee joint was not fixed. In group I-8, the left knee joint was only fixed for eight weeks. In groups R-1, R-2, and R-4, the left knee joint was fixed for eight weeks before the rabbits underwent one, two, and four weeks of self-recovery, respectively. In groups T-1, T-2, and T-4, the left knee joint was fixed for eight weeks before the rabbits underwent one, two, and four weeks of ultrashort wave treatment, respectively. The degree of total contracture and myogenic contracture were measured, the cross-sectional area (CSA) and protein levels for myogenic differentiation (MyoD) of the rectus femoris were evaluated. ResultsThere was a tendency toward a reduced degree of total and myogenic contracture, and also a tendency toward an increased CSA of the rectus femoris and increased protein levels for MyoD after both self-recovery and ultrashort wave treatment. The ultrashort wave was more effective than self-recovery in reducing the total and myogenic contracture, and increasing the CSA and MyoD protein levels of the rectus femoris. ConclusionsUltrashort wave treatment may ameliorate joint dysfunction and muscle atrophy by upregulating the expression of MyoD protein in a rabbit model of extending knee joint contracture.

Low-Level Laser Therapy Prevents Treadmill Exercise-Induced Progression of Arthrogenic Joint Contracture Via Attenuation of Inflammation and Fibrosis in Remobilized Rat Knees.

We investigated whether the combination of exercise and anti-inflammatory/anti-fibrotic treatment using low-level laser therapy (LLLT) promotes recovery from joint contracture without arthrogenic contracture progression. Rat knees were immobilized for 3weeks in a flexed position. After fixator removal, rats were divided into no intervention (RM), daily treadmill walking (WALK), and daily treadmill walking and LLLT (W + L) groups. Total and arthrogenic contractures were assessed by restrictions of passive range of motion (ROM) before (m-ROM) and after myotomy (a-ROM), respectively. After 7days of remobilization, m-ROM restriction decreased equally in all groups. Conversely, a-ROM restriction further increased after remobilization in the RM and WALK groups. Furthermore, this restriction was significantly larger in the WALK group compared with the RM group. In the W + L group, however, progression of a-ROM restriction during remobilization was prevented. After 1 or 7days of remobilization, inflammatory and fibrotic reactions in the joint capsule were induced in the RM group and were more pronounced in the WALK group, but these reactions were milder in the W + L group than in the WALK group. m-ROM restriction representing total contracture initially established by immobilization was partially improved by remobilization. Additional LLLT and exercise intervention did not further reduce total contracture, but LLLT suppressed the progression of arthrogenic contracture caused by ambulation and treadmill exercise. Therefore, exercise with LLLT in the early phase of remobilization would be one possible adjunct therapy to prevent further progression of arthrogenic contracture.

Variation in Treatment Recommendations for Dupuytren Disease.

To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. Little agreement exists on treatment recommendations for common presentations of DD in this sample. Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations.

Study about the Effectiveness of Serial Stretching in Post Burn Elbow and Knee Flexion Contracture

Study about the Effectiveness of Serial Stretching in Post Burn Elbow and Knee Flexion Contracture

Shoulder adduction contracture after burn: Anatomy and treatment with quadrangular local scar subcutaneous pedicled flap, a new approach

BackgroundAxillary adduction contracture is caused by scars that tightly surround the shoulder joint impairing the function of the upper limb. Due to severe scar surface deficiency, contracture release presents a challenge for surgeons since a method of release is transfer of tissue in the form of a large pedicled or free flap(s). Thus, development of simpler, less traumatic techniques, using local tissues, persists. MethodsAnatomic studies of shoulder adduction contractures after burn (pre-operative, during surgery, post-reconstruction) were done in 346 pediatric and adult patients. All were divided into three groups according to contracture types: with edge contractures (80%), medial (6%) and total (14%). Anatomical study covered peculiarities of total contractures and possibilities for their treatment using local scarred tissue. ResultsTotal contractures (48 patients) were caused by scars tightly surrounding the joint on three sides: anterior, posterior, and axillary. There were two specific forms of contracture: (a) shoulder close to the chest wall (22 of 48 patients) which was treated with thoracic pedicled or free flaps; (b) in 26 out of 48 patients a flat scar and skin graft surface laid along the shoulder and chest wall, in axillary projection, which were used for contracture release in the form of a subcutaneous pedicled quadrangular flap. The flap was mobilized only peripherally, descending to the apex of the axilla, forming the central axillary zone, and suspension of the axilla on a normal level. Wounds aside the flaps were covered with skin graft. Acceptable functional and cosmetic results were achieved in all 26 patients. ConclusionTotal shoulder adduction contractures have two forms: (a) shoulder close/fused with the chest wall; and (b) along the chest wall and shoulder there is a flat surface, the tissue of which can be used for reconstruction in a form of scar subcutaneous pedicled quadrangular flap. Based on this flap, a new technique is described which is relatively easy to perform.

Ankle dorsiflexion postburn scar contractures: Anatomy and reconstructive techniques

BackgroundPostburn ankle scar contractures cause functional limitations of all lower extremities and create a serious cosmetic defect, not allowing patients to use normal foot wear, and, therefore, needing surgical reconstruction. The anatomic features of ankle dorsiflexion contractures and their treatment have been covered in the literature far less than other joint contractures, and their treatment is still a challenge for many surgeons. A common treatment method is incisional release of the contracture and defect resurfacing with skin graft. Rarely, distally based sural or free flaps and Ilizarov fixator are used. MethodsAnatomy of postburn ankle scar contractures in 55 patients was studied and contractures were surgically treated using a specific approach and technique. Follow-up results were observed from 6months to 16years. ResultsAccording to the anatomic features, dorsiflexion scar contractures were divided into three types: edge, medial, and total. Edge contractures were caused by burns and scars located on the lateral or medial ankle surface and were characterized by the presence of the fold along the anterior edge ankle; the skin of the anterior ankle surface was not injured. Medial contractures were caused by scars located on the anterior ankle surface and were characterized by the presence of the fold along the medial ankle line. Total contractures were caused by scars tightly surrounding the ankle. In fold's sheets of edge and medial contractures there is a trapeze-shaped surface deficit in length (cause of contracture) and a surface surplus in width which allows contracture release with local trapezoid flaps. For total contractures, wide scar excision and skin grafting were indicated. ConclusionThree anatomic types of ankle dorsiflexion scar contractures were identified: edge, medial, and total. An anatomically justified technique for edge and medial contractures is trapeze-flap plasty; total contractures are effectively eliminated with scar excision and skin grafting.

Praoxon-induced changes in the function of chicken biventer cervices nerve-muscle preparation and the reversal of such changes by pralidoxime

One of the most toxic effects of organophosphate (OP) poisoning has been the paralysis of skeletal muscles that can lead to paralysis of respiratory muscles and death. However, oximes are the only antidotes available to reverse or prevent such toxic effects of OP insecticides and nerve chemical warfare agents. In the present research work, the effect of different concentrations of paraoxon (as an OP) on the function of skeletal muscle and reversal or prevention of these effects by an oxime (pralidoxime, 2-PAM) were studied in chicken biventer cervices nerve-muscle preparation using twitch tension recording technique. For this purpose, twitches of the biventer cervices were evoked by stimulating the motor nerve at 0.1 Hz with pulses of 0.2 msec duration and a voltage of greater than that required to produce the maximum response. Twitches and contractures were recorded isotonically using Narco Biosystems. The results showed that paraoxon (10 nM) induces a significant increase (more than 100%) in the twitch amplitude, while higher concentrations (30 and 100 nM) could induce partial or total contractures. In this study, paraoxon at a concentration of 10 nM was used to examine the capability of pralidoxime to reverse or prevent its effects. Pralidoxime at doses of 300 and 100 µM almost fully reverse (when it was used as post treatment) or prevent (when it was used as pretreatment or at the same time as toxin) the effect of paraoxon. While oxime at doses of 30 and 10 µM could only reverse or reduce this effect to about 25 and 70% respectively, pralidoxime alone had no significant effect on the function of the muscle. These results suggest that this applied method is of high value in studying the functional effects of OPs on skeletal muscle tissues and the reversal effects of antidotes, and pralidoxime by itself may fully reverse such effects.

First web space post-burn contracture types: Contracture elimination methods

First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Effective hand reconstruction usually considers anatomy as its foundation. Based on the experience of over 500 web space contracture elimination cases, three anatomical types of thumb adduction contractures were identified: edge, medial and total. Edge contractures (80% of all thumb adduction contractures) are caused by a fold in which only one sheet is scarred, either the palmar or dorsal surface. The contraction is caused by a trapeze-shaped length deficiency of the scar sheet, which has a surface surplus in width. Reconstruction consists of surface deficiency compensation with trapezoid flap prepared from the non-scarred side and skin–fat tissues of the web space. In most cases, the small scar–fat trapezoid flaps should be prepared from the non-scarred side to cover the donor wounds on both sides of the main flap. Medial contractures (10% of thumb adduction contractures) are caused by the fold, both sheets of which are scarred and have trapeze-shaped surface deficiency in length and surplus in width. Both fold sheets are converted into one or several pairs of trapezoid scar–fat flaps by radial incisions. The oppositely located flaps are transposed towards each other. As a result of the counter flaps transposition, the contracture is eliminated; the web space's shape and depth are restored by the use of flaps alone or in combination with skin grafting. The trapeze-flap plasty is very simple and effective with the length gain of up to 100–200%. Neither flap loss nor re-contracture occurs. Total contractures (about 10% of all) have no fold. Reconstruction consists of the creation of the central zone of the first web space depth with the rectangular subdermal pedicle flap; the wounds on both sides of the flap are skin grafted. The flap sustains normal web depth and prevents the contracture recurrence and skin graft shrinkage.

The Basic Types of Scar Contractures after Burns and Methods of Eliminating Them with Trapezeplasty Flaps

The study of postburn scar contractures in various locations has revealed four contracture variables: edge, medial, strip, and total. Following the surgical treatment of more than 2000 patients with such contractures, a trapezeplasty flap method has been worked out and applied since 1979. This method allows one to make up for deficient scar tissue of the same shape. Flaps are cut out of sheets of a fold with the maximum use of undamaged skin in adjacent sections. They move toward each other and merge with adjacent sides into a state of tension. This surgery is based on use of the reserve on the width of the surface of a fold and the high tension of skin with pressure on underlying tissue. The extended skin grows quickly, the tension disappears, and the scars dissolve. For each contracture type, there are trapeze-flap variables either in pure form or in combination with the transposition of split-thickness skin with a flap to create a flexible joint zone. The trapezeplasty flap method can be used to treat all edge, medial, strip, and total contractures of joints whose natural position is adduction, the shoulder joint, and contractures between fingers. Skin-fat or skin-fascia trapeze flaps prevent the relapse of contracture and make the weakened scars softer, which, as a rule, ensures a good functional and aesthetic result.