Treatment Of Scar Contractures Research Articles

Management of Scar Contractures of the Hand-Our Therapeutic Strategy and Challenges.

The essence of treating scar contractures lies in covering the skin deficit after releasing the contractures, typically using flaps or skin grafts. However, the specific characteristics of scar contractures, such as their location, shape, and size, vary among patients, which makes surgical planning challenging. To achieve excellent outcomes in the treatment of scar contractures, we have developed a dimensional classification system for these contractures. This system categorizes them into four types: type 1 (superficial linear), type 2-d (deep linear), type 2-s (planar scar contractures confined to the superficial layer), and type 3 (planar scar contractures that reach the deep layer, i.e., three-dimensional scar contractures). Additionally, three factors should be considered when determining surgical approaches: the size of the defect, the availability of healthy skin around the defect, and the blood circulation in the defect bed. Type 1 and type 2-d are linear scars; thus, the scar is excised and sutured in a straight line, and the contracture is released using z-plasty or its modified methods. For type 2-s, after releasing the scar contracture band, local flaps are indicated for small defects, pedicled perforator flaps for medium defects, and free flaps and distant flaps for large defects. Type 2-s has good blood circulation in the defect bed, so full-thickness skin grafting is also a suitable option regardless of the defect's size. In type 3, releasing the deep scar contracture will expose important structures with poor blood circulation, such as tendons, joints, and bones. Thus, a surgical plan using flaps, rather than skin grafts, is recommended. A severity classification and treatment strategy for scar contractures have not yet been established. By objectively classifying and quantifying scar contractures, we believe that better treatment outcomes can be achieved.

Treatment of Scar Contracture with Intralesional Jet-Assisted Injection of Hyaluronic acid

The liquid jet permits an easy and tolerable penetration of hyaluronic acid into firm scar tissue. Biomolecular effect of HA and pressure impact of the jet synergistically contributes to reverse formation of scar tissue. Our approach was effective and safe for relief of the burn scar contractures in a few treatment sessions.

Evaluation of Clinical Efficacy of Combination of Surgery and Rehabilitation for Treatment of Scar Contracture after Hand Burn

Objective: To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn. METHODS: Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019. The subjects were divided into regular group and combined group according to random number table method. The regular group (n=33) received surgical treatment alone. The combined group (n=33) patients were given surgery combined with rehabilitation. Recovery of hand function, efficacy of clinical treatment, hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn. RESULTS: Efficacy, recovery of hand function (finger, finger flexion and extension, palm and finger adduction or abduction, daily activity, wrist rotation, wrist flexion and extension, appearance and sensory function) and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn. P <0.05, the indicator data showed statistical significance. Conclusion: Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.

Use of Tissue Expansion and Serial Z-plasty for Release of Neck Postburn Scar Contracture.

Z-plasty is widely employed in plastic surgery and its mainly functions include elongation along the axis of the scar, dispersal, and realigning the scar within the lines of minimal tension. It is especially useful to release linear-scar contracture, yet difficult for wide scars. Here, we described a technique of tissue expansion followed by serial Z-plasty for several cases of severe postburn scar contracture. In this procedure, first, full expansion should be achieved in the tissues adjacent to the contracture by tissue expansion. Then, the serial Z-plasty technique with precise trimming and adjustment is performed with adequate tension-free skin to release the contracture. Over a period of 2 years from 2015 to 2017, this technique was employed in moderate or severe postburn scar contracture in four patients (1 male and 3 females) aged 14 to 40 years old. The size of contracture ranged from 5 to 27 cm in diameter. Improved appearance and excellent skin match was observed in our four patients. All patients healed uneventfully without any complications and no patient required revision surgery. The range of motion, short form-36 health survey and Vancouver Scar Scale indicated that this technique offered a durable skin coverage with satisfying appearance in these patients. Through the outcomes of our patients, tissue expansion followed by serial Z-plasty has a great potential to be a useful alternative for the treatment of scar contracture especially for contracture adjacent to cervical joints.

Correction of Cord Like Scars Using Running Opposing Y-V Plasty

Linear scars are a common problem in the plastic surgerypractice. Release is the first step in surgical treatment. Skingrafts, Z-plasty, local, regional or free flaps are used tolengthen the scar. In this article, we will use running y-v flapsfor scar lengthening. From January 2016 to April 2017, 20linear burn contractures of 15 patients were corrected usingmultiple Opposing Y-V plasty. Patients were followed-up fora period of 6 months at least. All scar contractures werecorrected successfully in all cases. One partial flap necrosiswas observed and managed successfully with dressing changes.During the follow up period, only one case showed recurrenceof contracture and required release and local advancementflap. linear scar contracture treatment modalities vary largely.Options for reconstruction include skin grafts, Z plasty andY-V flaps. Skin grafts carry the risks of recurrence of contractures.Z plasty should include flap undermining before flaptransposition which carries the risks of flap necrosis especiallyin burned skin. Multiple Y-V flaps carry the advantages oflow rate of scar recurrence and secondary contractures andhave the merits of being a safe technique with low incidenceof flap necrosis. Running Opposing Y-V-plasty is an optionfor correction of linear cord-like burn scar contractures. Ithas the advantages of being a safe and effective method withlaw morbidity.

Effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand

Objective: To observe the effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand. Methods: Forty-six patients with scar contracture after deep partial-thickness or full-thickness burn injury of dorsal hand hospitalized in our department from March 2013 to February 2015 were divided into routine training group (RT, n=18) and comprehensive training group (CT, n=28) according to their willingness. Two weeks after the wounds were healed, patients in group RT were treated with functional training of hands and self-made pressure gloves, while patients in group CT were treated with self-made hand flexing training band (consisting of nylon strap, flexing band, and velcro) on the basis of those in group RT. All patients were treated for 3 months. Before and after treatment, scar condition of affected hands was assessed with Vancouver Scar Scale (VSS). The range of motion of joints of affected hands was measured by Total Active Movement (TAM) Scale. The function of affected hands was evaluated by Carroll Upper Extremity Function Test. Data were processed with t test, chi-square test, and Mann-Whitney U test. Results: (1) The score of VSS in patients of group RT was (10.0±1.9) points before treatment and (4.4±1.4) points after treatment, with the improved score of (5.6±1.0) points. The score of VSS in patients of group CT was (10.5±1.8) points before treatment and (4.6±1.4) points after treatment, with the improved score of (5.9±1.2) points. There was no statistically significant difference in the improved score of patients between the two groups (t=0.834, P>0.05). The score of VSS in patients of groups RT and CT after treatment was significantly lower than that before treatment (with t values respectively 14.014 and 10.003, P values below 0.01). (2) Before treatment, the ratios of excellent and good results according to TAM were 2/9 in patients of group RT and 3/14 in group CT, with no statistical differences between them (χ(2)=2.140, P>0.05). After treatment, the ratio of excellent and good results according to TAM in patients of group CT (6/7) was higher than that in group RT (5/9, χ(2)=0.023, P=0.038). The ratios of excellent and good results according to TAM in patients of groups RT and CT after treatment were significantly higher than those before treatment (with Z values respectively -2.023 and -4.780, P values below 0.05). (3) The improved score of hand function in patients of group CT was (26±12) points, which was higher than (15±7) points in group RT (t=3.278, P=0.002). The score of hand function in patients of groups RT and CT after treatment was significantly higher than that before treatment (with t values respectively 2.628 and 6.125, P values below 0.05). There were no significant differences in grades of hand function of patients between the two groups before treatment (Z=-0.286, P>0.05). After treatment, the grade of hand function in patients of group CT was higher than that in group RT(Z=-1.993, P=0.046). The grades of hand function in patients of groups RT and CT after treatment were significantly higher than those before treatment (with Z values respectively -2.717 and -4.998, P values below 0.01). Conclusions: For patients with scar contracture after burn injury of dorsal hand, early functional training combined with hand flexing training band can improve the range of motion of hand joints and functional recovery of hand, and the result was better than functional training alone.

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.

Ablative fractional photothermolysis in the treatment of scar contractures of the wrists and forearms: A retrospective data analysis

Ablative fractional photothermolysis in the treatment of scar contractures of the wrists and forearms: A retrospective data analysis

Treating Burn-Associated Joint Contracture

The prevention and treatment of scar contracture is critical after significant burn injuries to avoid functional impairment. However, descriptions of specific contracture treatment interventions and outcomes are limited. Our objective is to provide detailed information and range of motion outcomes regarding the use of an intensive stretching protocol for burn-associated contracture. As part of a quality improvement measure, all patients admitted to inpatient rehabilitation with burn injury were treated with at least 1 hour of daily stretching by experienced therapists and were tracked with standardized range of motion measurements. Eighty-eight joint contractures were treated across nine patients for up to 4 weeks. The average weekly improvement in range of motion was 8.2 degrees (95% confidence interval [CI], 6.5-9.9). The largest gains were seen in the first week of treatment with an average improvement of 11.2 degrees (95% CI, 8.7-13.6). Eighteen digit contractures were treated across four patients. The average weekly improvement in flexion was 7.2 mm (95% CI, 5.2-9.1) again with larger gains in the first week of treatment-12.8 mm (95% CI, 10.3-15.4). Thumb opposition improved across five patients in the first week with an average improvement of 1.4 on the opposition scale (95% CI, 0.4-2.5). Intensive stretching by experienced therapists yielded significant improvements in joint range of motion for patients with burn-associated joint contracture. Defining specific burn contracture interventions remains a key goal in advancing burn rehabilitation in the future.

Uso de matriz dérmica associado ao curativo por pressão negativa na abordagem da contratura em pacientes queimados

INTRODUÇÃO: O aperfeiçoamento no tratamento inicial do paciente queimado, por meio da reposição volêmica e, principalmente, com excisão e enxertia precoce das lesões, resultou em profundo impacto na evolução dos indivíduos queimados, ocorrendo aumento da taxa de sobrevida. Com a maior sobrevida desses pacientes surgiu um novo desafio para a cirurgia reparadora, o tratamento das sequelas de queimaduras, principalmente compostas pelas contraturas. O objetivo deste estudo é demonstrar o uso da matriz dérmica artificial associado a terapia por pressão negativa no tratamento de sequelas de queimaduras. MÉTODO: Foram selecionados 10 pacientes com contratura por queimadura. Os pacientes selecionados foram submetidos a liberação da contratura cicatricial e colocação de matriz dérmica artificial (Integra®), conforme técnica padrão, e curativo por pressão negativa para cobertura. A cada 5 dias, foram realizadas trocas do curativo até completar período de 3 semanas a 4 semanas. Após esse período, o leito foi submetido a enxertia de pele. Os pacientes foram questionados, no pré e pós-operatório, quanto a sua satisfação com os aspectos estético e funcional da região abordada. RESULTADOS: Houve integração de cerca de 98% da matriz de regeneração dérmica na área em que a contratura foi ressecada. Também ocorreu integração de aproximadamente 85% dos enxertos utilizados. Todos os pacientes abordados referiram significativa melhora estética e, principalmente, funcional da região abordada. CONCLUSÕES: O uso da matriz de regeneração dérmica associado a terapia por pressão negativa promove maior taxa de sucesso na abordagem da contratura cicatricial, proporcionando melhor resultado tanto funcional como estético nos pacientes com sequelas graves de queimadura.

Release within Scar Using the Needle-Scalpel for Treatment of Scar Contracture of the Neck

Release within Scar Using the Needle-Scalpel for Treatment of Scar Contracture of the Neck

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty

A medial flexion elbow contracture is characterized by the presence of a fold which has a semi-lunar shape, the sheets of which are scars. The shortage in skin length and the excess in width occurs in the sheets. To estimate the size and form of length deficiency in the fold is the section from the top of the fold to the rotation axis of the joint. As a rule, the wound receives a trapeze form. To convert the sheets of the fold into trapeze-shaped flaps, several radial cross-sections from the tops of the fold to joint rotation axis are used. The flaps are mobilized with the full fat layer, and then transposed toward one another causing tension, therefore, covering the wound on the flexion surface of the joint. Flaps and the adjacent skin, displaced forward from lateral and back surfaces of the joint, participate in wound coverage. Trapezoid flaps have a wide end, stable blood circulation; they do not undergo rotation, therefore, do not undergo necrosis. Contractures are eliminated in full without relapse. As a rule, in all 35 patients the functional outcome was perfect.

パレスチナ難民の顔面熱傷後搬痕拘縮の治療例

我々はパレスチナ難民の顔面熱傷後搬痕拘縮症例を治療する機会を得た.症例は23歳女性.幼少時期に顔面に火焔熱傷を負い保存的治療で上皮化した.ボランティアの援助により治療目的にて来日した,患者は顔面全体に癩痕拘縮を認め閉瞼障害による眼球の充血と開口障害を認めた.本症例に対して,esthetic unitを考慮した遊離植皮術を用いて再建を行ない,術後も十分な圧迫療法を行った.採皮部の選択には難渋し,コミュニケーシヨンの困難さも存在したが一年という限られた治療期間で一定の改善をみることが出來たので反省点を含めて報告する.

CONTROL OF WOUND CONTRACTION

Although a substantial amount of molecular and cellular data have been generated in an effort to understand the process of wound contraction and scar contracture formation, questions remain. What seems apparent is that the myofibroblast is not the only cell that generates contractile forces within wounds, but it does appear to be intrinsically linked to the development of hypertrophic scars. The supposition that the formation of scar contractures is solely the result of a continuation of wound contraction is an oversimplification. Figure 4 provides a model of the possible evolution of contractile forces during the wound healing process and their role in the development of scar contractures. Migration of fibroblasts into and through the extracellular matrix during the initial phase of wound healing, prior to the expression of alpha-SMA, appears to be a fundamental component of wound contraction. During this migration, the pulling of collagen fibrils into a streamlined pattern in their wake, and the associated production of collagenase, may facilitate a more normal arrangement of collagen. Once the wound has been repopulated and the chemotactic gradient that was established by inflammatory cells is decreased, fibroblast migration will cease. It is at this point that myofibroblasts appear and play a key role in the production of hypertrophic scars, given that their prolonged presence and over-representation are hallmarks of this pathology. One of the pivotal differences between wounds that proceed to normal scar compared with those that develop hypertrophic scars and scar contractures may be a lack (or late induction) of myofibroblast apoptotic cell death. The combined contribution of fibroblasts and myofibroblasts to abnormal extracellular matrix protein production results in an excessive and rigid scar. The isometric application of contractile forces by myofibroblasts probably contributes to the formation of the whorls, nodules, and scar contractures characteristic of hypertrophic scars. Because the prolonged presence of myofibroblasts, producing an imbalance in extracellular matrix proteins and proteases, probably exacerbates hypertrophic scars and wound contraction, accelerating the rate of apoptotic cell death to reduce the cell number to that seen in normal scar may be a useful strategy for providing effective and efficient treatment of scar contracture.

A simple finger tourniquet

BY using metacarpal block anaesthesia many surgical procedures on the finger, such as suture of cut wounds, tip injuries, reconstruction of nail deformities, excision of benign tumours and treatment of scar contractures, may be performed. The application of this simple tourniquet provides the desired bloodless field. After the hand has been cleaned and a sterile operating field obtained, local anaesthetic is injected. The patient’s hand is covered with a sterile rubber glove, and the glove tip of the finger to be operated on is snipped off. By rolling back the glove finger to its base (Fig. I) the finger itself is progressively compressed from tip to base proximally and becomes exsanguinated (Fig. 2). The rolled rubber band acts as a tourniquet throughout the operation and is cut transversely at the end of the procedure. The pressure of the rubber band does not appear to jeopardise the neurovascular bundles, as some 200 routine operations have proven. The technique is contra-indicated in the event of infection of the finger as the squeezing of the blood proximally may cause spread of the infection. The same applies to malignant tumours.

Plastic surgical treatment of scar contractures of the hand

Plastic surgical treatment of scar contractures of the hand

Surgical treatment of scar contractures of the hand and fingers following burns

Surgical treatment of scar contractures of the hand and fingers following burns

Local plasty with opposing triangular flaps in the treatment of scar contractures of the skin after burns

Local plasty with opposing triangular flaps in the treatment of scar contractures of the skin after burns