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1.
J Pediatr Orthop ; 43(2): 91-98, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607920

RESUMO

BACKGROUND: Tendo Achilles lengthening (TAL) for the management of equinus contractures in ambulatory children with cerebral palsy (CP) is generally not recommended due to concerns of over-lengthening, resulting in weakness and plantar flexor insufficiency. However, in some cases, surgical correction of severe equinus deformities can only be achieved by TAL. The goal of this study is to assess the outcomes following TAL in these cases. METHODS: A retrospective cohort study of children with CP with severe equinus contractures (ankle dorsiflexion with the knee extended of -20 degrees or worse) who underwent TAL as part of a single event multilevel surgery, with preoperative and postoperative gait analysis studies. Continuous data were analyzed by paired t test, and categorical data by McNemar Test. RESULTS: There were 60 subjects: 42 unilateral, 18 bilateral CP; 41 GMFCS II, 17 GMFCS I; mean age at surgery was 10.6 years, mean follow-up was 1.3 years. Ankle dorsiflexion with the knee extended improved from -28 to 5 degrees (P<0.001). The ankle Gait Variable Score improved from 34.4 to 8.6 (P<0.001). The ankle moment in terminal stance improved from 0.43 to 0.97 Nm/kg (P<0.001). Significant improvements (P<0.001) were seen in radiographic measures of foot alignment following surgery. There were few significant differences in the outcome parameters between subjects with unilateral versus bilateral CP (eg, only the bilateral group showed improved but persistent increased knee flexion in mid-stance). CONCLUSIONS: The outcomes following TAL for the management of severe equinus deformity in ambulatory children with CP were favorable 1 year after surgery, with significant improvements in all domains measured. SIGNIFICANCE: This study does not advocate for the widespread use of TAL to correct equinus deformity in children with CP. However, it does show that good short-term outcomes following TAL are possible in properly selected subjects with severe contractures when the dosing of the surgery is optimal (correction of contracture to between 0 and 5 degrees of dorsiflexion with the knee extended) and the procedure is performed in the setting of single event multilevel surgery with subsequent proper orthotic management and rehabilitation.


Assuntos
Paralisia Cerebral , Contratura , Pé Equino , Humanos , Criança , Pé Equino/etiologia , Pé Equino/cirurgia , Estudos Retrospectivos , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Tenotomia/métodos , Marcha
2.
J Pediatr Orthop ; 43(2): e163-e167, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607927

RESUMO

BACKGROUND: Collagen VI-related myopathies with pathologic COL6A1, COL6A2, and COL6A3 variants manifest as a phenotypic continuum of rare disorders, including Bethlem myopathy (BM), characterized by early onset muscle weakness, proximal joint contractures, and distal joint laxity. Herein we discuss the concomitant orthopedic manifestations of BM, potential management strategies, and patient outcomes. METHODS: An IRB-approved retrospective cohort study (n=23) from 2 pediatric institutions with a confirmed diagnosis of BM. Charts were reviewed for demographic data, age of disease presentation and diagnosis, COL6 genotype, diagnosis method, ambulation status, need for assistance, musculoskeletal abnormalities, other systemic comorbidities, advanced imaging and screening diagnostics, previous surgical interventions, and progression of the disease. RESULTS: The mean age was 11.65 years (range 3 to 19 y). Mean age at initial presentation with symptoms was 4.18 years old, whereas diagnosis was delayed until 8.22 years old on average. Muscle weakness was the most common presenting symptom (65.2%), and 73.9% of patients required some use of assistive or mobility devices. Overall, 30.4% of patients were diagnosed with scoliosis; 57.1% required operative intervention for their scoliosis; 43.5% of patients had acetabular dysplasia; 10% required open reduction of a dislocated hip; 10% required closed reduction with hip spica application; 10% required bilateral periacetabular osteotomies for instability; 91.3% of patients developed foot and ankle deformities; 33.3% of patients underwent posteromedial-lateral equinovarus releases; 28.6% required an Achilles tendon lengthening, and 86.9% of patients had muscle tendon contractures, the most common locations being the ankle (55%) and elbow (40%). CONCLUSION: Although often less severe than other more common neuropathies and myopathies like Charcot-Marie-Tooth disease and Duchenne muscular dystrophy, BM does lead to progressive musculoskeletal deformity and disability. Its relative rarity makes it less familiar to providers and likely contributes to delays in diagnosis. Scoliosis, hip dysplasia, and equinus and varus ankle deformities are the most common musculoskeletal deformities. Physicians and surgeons should appropriately counsel patients and families about the clinical course of this disorder and the potential need for mobility assistance or surgical procedures. LEVEL OF EVIDENCE: III, Prognostic. study.


Assuntos
Contratura , Distrofia Muscular de Duchenne , Escoliose , Humanos , Criança , Pré-Escolar , Adolescente , Adulto Jovem , Adulto , Estudos Retrospectivos , Mutação , Colágeno Tipo VI/genética , Contratura/etiologia , Contratura/cirurgia , Debilidade Muscular , Progressão da Doença
4.
Science ; 379(6628): 137-138, 2023 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-36634168

RESUMO

Dysfunction of a mechanosensor in sensory neurons causes joint contracture.


Assuntos
Contratura , Humanos , Contratura/etiologia
5.
Science ; 379(6628): 201-206, 2023 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-36634173

RESUMO

Distal arthrogryposis (DA) is a collection of rare disorders that are characterized by congenital joint contractures. Most DA mutations are in muscle- and joint-related genes, and the anatomical defects originate cell-autonomously within the musculoskeletal system. However, gain-of-function mutations in PIEZO2, a principal mechanosensor in somatosensation, cause DA subtype 5 (DA5) through unknown mechanisms. We show that expression of a gain-of-function PIEZO2 mutation in proprioceptive sensory neurons that mainly innervate muscle spindles and tendons is sufficient to induce DA5-like phenotypes in mice. Overactive PIEZO2 causes anatomical defects through increased activity within the peripheral nervous system during postnatal development. Furthermore, botulinum toxin (Botox) and a dietary fatty acid that modulates PIEZO2 activity reduce DA5-like deficits. This reveals a role for somatosensory neurons: Excessive mechanosensation within these neurons disrupts musculoskeletal development.


Assuntos
Artrogripose , Contratura , Camundongos , Animais , Mecanotransdução Celular , Artrogripose/genética , Contratura/genética , Células Receptoras Sensoriais , Mutação
6.
Pediatr Rheumatol Online J ; 21(1): 8, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36694203

RESUMO

BACKGROUND: Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome, caused by biallelic pathogenic mutations in the proteoglycan 4 (PRG4) gene, is characterized by early-onset camptodactyly, noninflammatory arthropathy, coxa vara deformity, and rarely, pericardial effusion. This syndrome can mimic juvenile idiopathic arthritis. CACP syndrome is caused by mutations in the proteoglycan 4 (PRG4) gene. To date, only 36 pathogenic mutations have been reported in this gene, but none have been reported from Azerbaijan. CASE PRESENTATION: Herein, we report two siblings presented with chronic polyarthritis, had a prior diagnosis of juvenile idiopathic arthritis, but was subsequently diagnosed as CACP syndrome with novel mutation in the PRG4 gene. CONCLUSION: Our report expands the knowledge of PRG4 mutations, which will aid in CACP patient counseling.


Assuntos
Artrite Juvenil , Contratura , Coxa Vara , Artropatias , Proteoglicanas , Feminino , Humanos , Artrite Juvenil/genética , Contratura/genética , Coxa Vara/diagnóstico por imagem , Coxa Vara/genética , Artropatias/genética , Mutação/genética , Proteoglicanas/genética , Irmãos
7.
BMC Musculoskelet Disord ; 24(1): 33, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650507

RESUMO

BACKGROUND: The digital artery-based V-Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V-Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery. METHODS: According to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V-Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method. RESULTS: The middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V-Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V-Y flap design for the 120 fingers. CONCLUSIONS: Our flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V-Y advancement flap.


Assuntos
Contratura , Traumatismos dos Dedos , Humanos , Traumatismos dos Dedos/cirurgia , Resultado do Tratamento , Contratura/cirurgia , Dedos , Articulações dos Dedos/cirurgia , Artéria Ulnar
8.
Ann Plast Surg ; 90(1): 33-40, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36534098

RESUMO

BACKGROUND: Oncoplastic techniques, in conjunction with lumpectomy and adjuvant radiotherapy, have been demonstrated to achieve good aesthetic results and cancer outcomes in the treatment of patients with macromastia or significant ptosis. This study evaluated a series of patients undergoing breast conservation with concomitant oncoplastic-augmentation-mastopexy and a contralateral augmentation-mastopexy. METHODS: Patients undergoing lumpectomy for breast conservation were identified via a retrospective chart review. Inclusion criteria included patients with ptosis and preexisting breast implants or insufficient breast volume undergoing oncoplastic implant placement/exchange and mastopexy. Demographic characteristics, operative details, and complications were assessed. RESULTS: Thirty-four consecutive patients (64 breasts, 4 unilateral procedures) were included in the study. Average age was 51.4 years, average body mass index was 27, and 38.2% were smokers/former smokers. The average operative time was 2.5 hours. Furthermore, 38.2% of patients received chemotherapy, and 82.4% of patients received breast adjuvant radiotherapy. The average length of follow-up was 11.7 months. In the sample that received radiation, the capsular contracture rate was 25%, with a 7.1% contracture revision rate. For the entire group, a total of 8 patients (23.5%) underwent revisions for either positive margins (8.8%), capsular contracture (8.8%), implant loss (2.9%), or cosmetic concerns (2.9%). One patient developed a pulmonary embolism. CONCLUSIONS: Oncoplastic-augmentation-mastopexy is a safe technique with acceptable complication rates. This technique is best used for breast cancer patients with breast ptosis and a paucity of breast volume or preexisting implants who wish to pursue breast-conserving therapy. The revision rates are acceptable compared with single-stage cosmetic augmentation procedures as well as other oncoplastic techniques described in the literature, but patients must be clearly counseled on contracture risk.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Humanos , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Mastectomia Segmentar/efeitos adversos , Mamoplastia/métodos , Implantes de Mama/efeitos adversos , Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/cirurgia , Contratura/cirurgia
9.
J Am Acad Orthop Surg ; 31(1): 49-56, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36548153

RESUMO

INTRODUCTION: Progressive collapsing foot deformity (PCFD) is frequently associated with a gastrocnemius contracture. Surgical treatment of PCFD often includes a gastrocnemius recession in addition to other corrective procedures, which typically requires a period of restricted weight bearing postoperatively. Isolated gastrocnemius recession may allow passive correction of the deformity, improve orthotic fit, and obviate the need for full reconstruction and restricted weight bearing. The goal of this study was to evaluate patient-reported outcomes after an isolated gastrocnemius recession for flexible PCFD in patients anticipated to have difficulty with postoperative restricted weight bearing. METHODS: A total of 47 patients met the inclusion criteria: isolated gastrocnemius recession for flexible PCFD, no previous ipsilateral surgery, and more than 6 months of follow-up. Of 47 eligible patients, 29 (31 feet) participated. Available preoperative and postoperative patient-reported outcomes were gathered, including the Foot and Ankle Ability Measure Activities of Daily Living, visual analog scale, and the Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a. In addition, patients were asked about satisfaction, willingness to undergo the procedure again, and whether orthotics provided better relief. RESULTS: At a mean of 5.1 (range, 0.6 to 9.0) years postoperatively, median Foot and Ankle Ability Measure Activities of Daily Living was 82.1, mean Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a was 44.2, and median visual analog scale was 10 (of 100). Sixty-nine percent of patients were either satisfied or very satisfied, 69% would undergo the procedure again, and 62% reported improved relief with use of orthotics postoperatively. Among the 47 eligible patients, there were 5 (11%) subsequent flatfoot reconstructions. CONCLUSIONS: Isolated gastrocnemius recession for the management of flexible PCFD can be effective as this procedure demonstrated good outcomes scores with high procedural satisfaction and 11% of patients proceeding to subsequent flatfoot reconstruction. This alternative approach may be of particular value for patients anticipated to have difficulty with postoperative weight-bearing restrictions. LEVEL OF EVIDENCE: :IV.


Assuntos
Contratura , Pé Chato , Humanos , Pé Chato/cirurgia , Atividades Cotidianas , Músculo Esquelético/cirurgia , Contratura/cirurgia , Articulação do Tornozelo/cirurgia
10.
Pract Neurol ; 23(1): 23-34, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36522175

RESUMO

Muscle cramps are painful, sudden, involuntary muscle contractions that are generally self-limiting. They are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes. Cramps are only infrequently due to progressive systemic or neuromuscular diseases. Contractures can mimic cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally, and are generally myogenic. General practitioners and neurologists frequently encounter patients with muscle cramps but more rarely those with contractures. The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? We consider these questions and present a practical approach to muscle cramps and contractures, including their causes, pathophysiology and treatment options.


Assuntos
Contratura , Cãibra Muscular , Humanos , Cãibra Muscular/etiologia , Cãibra Muscular/terapia , Cãibra Muscular/diagnóstico , Contratura/terapia , Contratura/complicações
11.
Tissue Cell ; 80: 101999, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36527787

RESUMO

BACKGROUND: Capsular contracture may occur after rhinoplasty due to rejection of silicone implants by the immune system. Our previous high-throughput sequencing of RNA in nasal capsular contracture tissue revealed that FPR3 was significantly increased in grade IV capsular contracture tissue, compared with grade II. OBJECTIVE: This study aimed to elucidate the effect and specific mechanism of FPR3 on capsular formation and contracture following rhinoplasty. METHODS: Using the GeneMANIA Database, the genes involved with FPR3 expression were searched, and the Gene Ontology analysis was performed to annotate the biological functions of the aforementioned genes. The mRNA and protein expressions of related genes in fibroblasts and capsular contracture tissues were analyzed using quantitative real-time PCR, western blot, and immunohistochemical staining. CCK-8 was used to determine the viability of cells. The migration capacity of fibroblasts was assessed using a wound healing assay. ELISA was used to detect levels of IL-1ß, TNF-α, and IL-6. RESULTS: After rhinoplasty, the expression of FPR3 in the capsular tissue increased in proportion to the degree of contracture. By activating the PKA/Rap1/ERK1/2 axis, overexpression of FPR3 can significantly increase the cell viability of fibroblasts and promote their transformation into myofibroblasts. Moreover, FPR3 phosphorylates IκB to decrease NF-κB inhibition, thereby promoting the synthesis and release of the inflammatory cytokines IL-1ß, TNF-α, and IL-6. CONCLUSION: FPR3 is a crucial molecule that causes capsular development and contracture following rhinoplasty. In the future, local suppression of FPR3 may be an effective treatment for relieving capsular contracture.


Assuntos
Implantes de Mama , Contratura , Rinoplastia , Humanos , Implantes de Mama/efeitos adversos , NF-kappa B , Fator de Necrose Tumoral alfa/genética , Rinoplastia/efeitos adversos , Interleucina-6 , Sistema de Sinalização das MAP Quinases , Fibroblastos , Contratura/etiologia , Contratura/cirurgia
12.
J Vis Exp ; (189)2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36468711

RESUMO

Skin shortages and scar contractures are common complications following penile trauma and tumor surgery, resulting in significant pain and erectile dysfunction. Currently, skin grafts and scrotal flaps are widely used to reconstruct skin shortages. However, various limitations still exist; for instance, the skin graft may cause severe scarring in patients, and the traditional scrotal flap usually requires a two-stage procedure due to the large skin defect. To treat the shortage of foreskin, a modified bilateral scrotal pedicled flap is used. In this procedure, flaps located on each side of the midline of the scrotum, which was pedicled from the anterior scrotal artery, are harvested. Subsequently, these bilateral scrotal flaps, like a butterfly, can successfully cover the foreskin defect. In this study, seven patients underwent this procedure, and satisfactory outcomes were obtained. Only two patients developed necrosis in some small areas of the flaps, which were recovered after wound care. Postoperative penile length significantly increased compared to the preoperative status in both flaccid and erectile states. We believe that modified bilateral scrotal flaps are a simple and effective solution to penile skin shortages and scar contractures.


Assuntos
Contratura , Transplante de Pele , Masculino , Humanos , Cicatriz , Pênis/cirurgia , Retalhos Cirúrgicos
13.
Acta Orthop Traumatol Turc ; 56(6): 366-371, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36567538

RESUMO

OBJECTIVE: The aim of this study was to evaluate the results of 2-stage treatment of upper and lower extremity deformities in patients with thrombocytopenia absent radius syndrome. METHODS: Four patients (3 female, 1 male) with a mean age of 1.8 years (range 1-4) were included in the study. The patients were followed up for an average of 5.5 years. All 4 patients had bilateral radial longitudinal deficiency, whereas only 2 patients had bilateral fixed knee contractures. A 2-stage surgical procedure was implemented. The surgical procedure performed for radial longitudinal deficiency consisted of distraction with an Ilizarov frame in the first stage, followed by centralization performed in the second stage. Knee contractures were first treated using an Ilizarov frame, followed by a hamstring tendon transfer in the second procedure. Radiological evaluation of the radial longitudinal deficiency was done by measuring hand-forearm angle, hand-forearm position, and ulnar bowing preoperatively and at postoperative follow-ups. Knee contracture was evaluated by measuring the angle preoperatively and at postoperative follow-ups. RESULTS: The mean hand-forearm angle values of patients at preoperative assessment, early postoperative period, and at the last follow-ups were 82.60, 5,80, and 11.10, respectively (P < .001). The hand-forearm position values were -14.25 mm, +11, and +7.1 mm, respectively (P < .001). The ulnar bowing values were 7.3°, 4.5°, and 2.9°, respectively (P < .001). Recurrence of the radial longitudinal deficiency deformity requiring surgery occurred in 1 patient. In the other 3 patients, some deformity recurred but did not require surgical intervention. In addition, 1 patient with knee flexion contracture had a recurrence of the contracture that did not require surgical intervention. There was no circulatory disorder or skin necrosis in the lower or upper extremities of the patients. CONCLUSION: This study has shown us that two-stage treatment is a reliable method for lower and upper extremity deformities accompanying thrombocytopenia absent radius syndrome. However, recurrence is still a major problem. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Contratura , Luxações Articulares , Deformidades Congênitas das Extremidades Superiores , Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Resultado do Tratamento , Deformidades Congênitas das Extremidades Superiores/complicações , Deformidades Congênitas das Extremidades Superiores/cirurgia , Antebraço , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Rádio (Anatomia)/anormalidades , Luxações Articulares/cirurgia , Contratura/etiologia , Contratura/cirurgia
14.
Plast Reconstr Surg ; 150(6): 1326e-1339e, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36445760

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the cardinal principles in the management of postburn deformities in the face and neck. 2. Understand reconstruction of specific subsites in the face and neck affected by burn contracture. 3. Acquire knowledge about the various techniques of burn reconstruction of the face and neck. 4. Grasp technical nuances and select appropriate surgical options for individual cases. SUMMARY: Postburn contractures in the face and neck region are multifactorial in origin and difficult to prevent in extensive burns. Facial burns lead to distortion of anatomical landmarks, causing aesthetic, functional, and psychological problems. Each subunit of the face is unique in structure; thus, the surgeon needs to adjust the timing of surgery and the technique according to region and the severity of contracture. Contracture of one unit, especially that of the neck and forehead, can exaggerate the contracture in neighboring subunits. The role of these extrinsic influences must be considered while sequencing surgical procedures. The burn surgeon must be adept in all reconstructive surgery techniques from skin grafting to tissue expanders to microsurgery to obtain the best outcomes. Surgery must be followed up with long-term physical therapy and psychological rehabilitation to help burn survivors with head and neck contractures to integrate back into society.


Assuntos
Contratura , Traumatismos Faciais , Humanos , Pescoço/cirurgia , Contratura/etiologia , Contratura/cirurgia , Transplante de Pele , Traumatismos Faciais/complicações , Traumatismos Faciais/cirurgia , Testa
15.
JBJS Case Connect ; 12(4)2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36399614

RESUMO

CASE: A 7-year-old girl presented with a recurrent hammertoe deformity causing pain with shoe wearing after a prior corrective surgery. Surgical revision required a unique approach that included a staged corrective osteotomy of the proximal phalanx because of hypoperfusion management and the application of a rotational skin flap previously described for camptodactyly correction in the hand to avoid harvesting a skin graft. CONCLUSION: Revision surgery for recurrent pediatric hammertoe deformity requires a heightened awareness of the risk for toe hypoperfusion and subsequent wound closure challenges.


Assuntos
Contratura , Síndrome do Dedo do Pé em Martelo , Feminino , Humanos , Criança , Seguimentos , Síndrome do Dedo do Pé em Martelo/cirurgia , Osteotomia/métodos , Retalhos Cirúrgicos
16.
Ann Plast Surg ; 89(6): 694-702, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416706

RESUMO

OBJECTIVE: The aim of the study is to determine rates of overall complications and failure of prepectoral breast reconstruction between various types of acellular dermal matrices (ADMs). BACKGROUND: Implant-based breast reconstruction is the most common reconstructive technique after mastectomy in the United States. Traditionally, the reconstruction has been performed in the subpectoral plane; however, there has been an emerging interest in prepectoral reconstruction using ADM. Human (hADM), porcine (pADM), and bovine (bADM) ADMs are available for use, but little is known about the benefits and complication profiles of each for prepectoral breast reconstruction. METHODS: Studies examining complications after the use of ADM for prepectoral breast reconstruction were identified using MEDLINE, Embase, the Cochrane Library, LILACS, and the Web of Science from January 2010 to August 2021. Titles and abstracts of 1838 studies were screened, followed by full-text screening of 355 articles. Thirty-three studies were found to meet inclusion criteria. RESULTS: From the 33 studies, 6046 prepectoral reconstructions were examined. Implant loss was comparable across the different types of ADM (pADM, 4.0%; hADM, 4.0%; bADM, 3.7%). Bovine ADM had the highest rate of capsular contracture (6.1%), infection (9.0%), skin flap necrosis (8.3%), dehiscence (5.4%), and hematoma (6.1%) when compared with both hADM and pADM. Human ADM had the highest rate of postoperative seroma (5.3%), followed by pADM (4.6%) and bADM (4.5%). CONCLUSIONS: Among the prepectoral breast reconstruction studies using hADM, pADM, or bADM included in our analysis, complication profiles were similar. Bovine ADM had the highest proportion of breast complications in the following categories: capsular contracture, infection rate, skin flap necrosis, dehiscence, and hematoma. Implant loss was comparable across the cohorts. Overall, prepectoral breast reconstruction using ADM leads to relatively low complication rates with the highest rates within the bADM cohort.


Assuntos
Derme Acelular , Implantes de Mama , Neoplasias da Mama , Contratura , Mamoplastia , Humanos , Bovinos , Animais , Suínos , Estados Unidos , Feminino , Mastectomia/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Hematoma , Necrose
18.
Orphanet J Rare Dis ; 17(1): 406, 2022 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-36345025

RESUMO

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Epidermolysis bullosa (EB) causes blistering and scarring of the hands resulting in contractures fused web spaces and altered function. Surgery is needed to release contractures and web spaces and hand therapy is essential to maintain results, approaches for both differ. WHAT DOES THIS STUDY ADD?: These guidelines aim to provide information on the surgical and conservative therapeutic hand management of children and adults diagnosed with EB. They are based on available evidence and expert consensus to assist hand surgeons and therapists in decision making, planning and treatment. They highlight the importance of a holistic multidisciplinary team (MDT) approach, where patient priorities are paramount.


Assuntos
Contratura , Epidermólise Bolhosa Distrófica , Epidermólise Bolhosa , Criança , Adulto , Humanos , Mãos/cirurgia , Epidermólise Bolhosa/cirurgia , Epidermólise Bolhosa/complicações , Contratura/cirurgia , Consenso
19.
Am J Occup Ther ; 76(6)2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36332198

RESUMO

IMPORTANCE: Critically ill neonates can be vulnerable to positional deformities and joint contractures. Early splints, along with dynamic exercise, may lead to long-term functional improvement. Making splints to perfectly contour neonates' small joints and bodies is challenging. An ill-fitted splint can lead to skin ulcers, nerve damage, poor compliance, and discomfort. Three-dimensional (3D) printing has been applied to create customized, cost-effective, and lightweight orthoses that may be promising for neonates. OBJECTIVE: To explore the feasibility of scanning, designing, and printing 3D splints for neonates. SETTING: A large neonatal intensive care unit (NICU) in a university teaching hospital. METHOD: Case series of three neonates in a NICU who had deformities or joint contractures that would benefit from early static splints. We created customized splints for neonates using 3D scanning, digital design software, and 3D printing technology. We monitored the neonates' comfort and clinical improvement. RESULTS: One neonate with a congenital neck deformity had a neck splint created from 3D body-scanned images. Another neonate with a hand deformity was measured and had 3D digitally designed hand splints made. The same hand splint design was modified to fit a third neonate's hand with new measurements. All splints were 3D printed using specialized lightweight materials. The neonates tolerated the splints well. CONCLUSIONS AND RELEVANCE: 3D printing technology is feasible for and applicable to NICU neonates. Advancing 3D technology should focus on upgrading scanning quality, improving splint design, and speeding up printing. Further research to evaluate the long-term benefits of early splinting is needed. What This Article Adds: This is the first published article to discuss the feasibility of using 3D printing technology to create customized splints for fragile neonates. Neonates, especially critically ill ones with congenital defects, may benefit from early splinting to preserve function and development. Neonates are the most challenging patients to make a perfect-fit splint for, and 3D printing may offer a potential solution.


Assuntos
Contratura , Contenções , Recém-Nascido , Humanos , Unidades de Terapia Intensiva Neonatal , Estado Terminal , Impressão Tridimensional
20.
Plast Aesthet Nurs (Phila) ; 42(1): 39-42, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36450074

RESUMO

In this article, we describe reconstruction of a McCauley's Grade I postburn anterior neck contracture with extensive scarring in a 34-year-old woman using a free thin anterolateral thigh (ALT) flap. To our knowledge, this is the first case of reconstruction of Grade I neck contracture using a thin ALT flap that has been reported. By selecting the correct patient, adhering to recommended standards of microvascular technique, and implementing appropriate postoperative nursing care, we achieved a near-normal neck contour in this patient in a single-staged procedure.


Assuntos
Contratura , Retalhos de Tecido Biológico , Linfoma Folicular , Torcicolo , Feminino , Humanos , Adulto , Coxa da Perna/cirurgia , Contratura/etiologia , Pescoço/cirurgia
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