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1.
Am J Case Rep ; 22: e931857, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648481

RESUMO

BACKGROUND Chronic posterior knee dislocation after total knee arthroplasty (TKA) is a rare but serious complication, especially when it coexists with septic implant loosening, flexion contracture, and extensive comorbidities. Although the severity is comparable to that in the native knee dislocation, there are few reports in the literature. When TKA dislocation is complicated with infection, bone defect, and patient's comorbidity, treatment becomes even more difficult. For these complex complications, in order to provide stable and mobile knees, constrained total knee prostheses are used. CASE REPORT We present the case of a 63-year-old, non-ambulatory man, with mental retardation and multiple comorbidities, who had a 9-year history of neglected posterior TKA dislocation, which later became complicated with septic loosening and productive fistula for 4 years. The patient required use of a wheel-chair for several years, was obese with a body mass index (BMI) of 34.3, and the affected knee was in a prolonged flexion contracture at 90°. The posterior TKA dislocation was later infected by Staphylococcus hominis and Staphylococcus epidermidis. He was successfully treated with two-stage revision surgery and managed to become ambulatory after 6 years of requiring use of a wheel-chair. CONCLUSIONS Neglected posterior dislocation of TKA is a rare and potentially limp-causing complication, especially when accompanied with chronic infection, implant loosening, severe bone loss, flexion contracture, and extensive comorbidities. A multidisciplinary approach with careful preoperative planning, exceptional surgical technique, and prolonged supervised physiotherapy are the keystones for a successful outcome.


Assuntos
Artroplastia do Joelho , Contratura , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Contratura/etiologia , Contratura/cirurgia , Humanos , Articulação do Joelho , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Resultado do Tratamento
2.
Am J Case Rep ; 22: e933907, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34663779

RESUMO

BACKGROUND First web space contracture affects thumb function and grasping capacity. This pathology alters normal anatomy and results in decreased ability to use the hand. Appropriate release and resurfacing are needed to restore normal hand function. Principles of successful treatment also include providing healthy compliant skin for a tension-free closure and a smooth healing period. The Manta Ray skin flaps are utilized in children, allowing the position of as much local skin as possible with minimal dorsal scarring. The technique has potential use in adults who have less skin plasticity and pliability. CASE REPORT We present the case of a 36-year-old patient with a severe first web space contracture of the dominant hand. Primary concerns of the patient were loss of hand mobility, limited grasping ability, and an inability to "give a proper handshake". Medical history suggests a gunshot wound in early childhood treated operatively by a mild web release after the point of trauma, with insufficient outcomes. We proceeded with the Manta Ray flap technique using 3 dorsally-based flaps and 4 palmar-based flaps, with excellent results. CONCLUSIONS Although the Manta Ray flap procedure was developed for moderate web space contractures in children, it combines advantages of several flap techniques. It ensures sufficient web space lengthening and may be applicable in older patients if enough healthy unscarred skin is available. These unique properties and potential led us to use the method for this challenging case.


Assuntos
Contratura , Traumatismos da Mão , Ferimentos por Arma de Fogo , Adulto , Idoso , Criança , Pré-Escolar , Contratura/etiologia , Contratura/cirurgia , Mãos , Traumatismos da Mão/cirurgia , Humanos , Retalhos Cirúrgicos
3.
Shanghai Kou Qiang Yi Xue ; 30(3): 332-336, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34476456

RESUMO

PURPOSE: To explore the feasibility of applying bilateral free expanded scapular flaps to treat extensive cervicomandibular scar in children and adolescents. METHODS: This study reviewed 7 children and adolescent patients who received bilateral expanded scapular flaps to treat extensive cervicomandibular scars in the Pediatric Plastic Surgery Ward from August 2018 to December 2020. The scars in all patients involved neck, mandible, and anterior chest. The cervical scars involved the anterior neck and one or both sides of the lateral neck, and there were varying degrees of cervical dysfunction and mandibular dysplasia. The operation was completed into two stages. In the first stage, the expanded circumflex scapular artery perforator flaps were designed on both sides of the back and soft tissue expanders were implanted. The expansion process lasted for 6-14 months. In the second stage, the scar tissue was removed and contracture was released, and the expanded flaps were harvested. The cervical wound was repaired with free flap transplantation by anastomosing the facial artery and vein with the circumflex scapular artery and vein. The donor sites were closed directly. RESULTS: In this series of 7 patients, one patient had poorly healed incision after the expander was implanted. One expanded flap ruptured before the second-stage surgery, which was successfully treated by secondary surgery. One patient had expansion problem due to the blockage of the internally placed injection bottle, which was treated by placing the injection bottle externally. One patient developed a small area of ischemic necrosis at the distal end of the flap after transplantation, which was treated conservatively with dressing change. The postoperative follow-up was 6 months to 2 years. The cervico-mandibular angle restored to normal range, the cervical extension, flexion, and rotation were significantly improved. Two patients underwent flap thinning and scar releasing. CONCLUSIONS: The route of the circumflex scapular artery is constant. Bilateral expanded scapular flap transplantation can be used to repair extensive cervicomandibular scar in children and adolescent patients. The flap donor site is concealed and secondary damage is minimal.


Assuntos
Contratura , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Criança , Cicatriz/cirurgia , Contratura/cirurgia , Humanos , Transplante de Pele , Resultado do Tratamento
4.
J Hand Surg Asian Pac Vol ; 26(3): 451-454, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380396

RESUMO

Most of the lateral dislocations reported in previous literatures occurred to healthy patients by accident. However, our patient had limping gait, flexion contracture of the elbow, and spasticity in an affected arm due to a traumatic brain lesion 20 years ago. He fell down while taking a walk and presented with a lateral elbow dislocation accompanying tingling sense in ulnar nerve territory of his hand. Open reduction was performed. The torn MCL was reattached and the ulnar nerve was released. In postoperative six months, the range of motion was regained and the neurologic symptoms were resolved. This case shows that flexion contracture of elbow joint and a brain lesion causing motor disturbance of upper extremity could be the specific condition causing lateral elbow dislocation. Open reduction including repair of MCL and decompression of ulnar nerve, seems quite reasonable for the treatment of the lateral elbow dislocation.


Assuntos
Contratura , Luxações Articulares , Braço , Encéfalo , Contratura/complicações , Contratura/diagnóstico , Contratura/cirurgia , Cotovelo/cirurgia , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Luxações Articulares/diagnóstico por imagem , Masculino
5.
J Hand Surg Asian Pac Vol ; 26(3): 432-439, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380412

RESUMO

Background: This is a retrospective case series investigating the outcomes using a dynamic external fixator (DEF) for treatment on severe flexion contractures at the proximal interphalangeal (PIP) joint. Severe flexion contractures of the PIP joint occurring after multiple operations and neglected over a long period of time are difficult to treat. The recurrence of contracture, even after successful treatment, is inevitable in patients with severe cases. In this study, we defined the severity of PIP joint contracture based on the active range of motion (ROM), soft tissue condition, and duration of the contracture. We also illustrated the strategy, results, and complications of using a DEF with rubber bands in these severe cases. Methods: We studied 11 fingers of 10 patients with PIP joint contracture treated by DEF. These were fixed at a small arc and neglected for an average 4.1 years (range, 1-9 years). The temporal Kirshner wire (K-wire) fixation after achieving an extension via DEF was maintained for 9.1 weeks on average. We retrospectively reviewed the results of these patients with an average 2-year follow-up. Results: Our method yielded favorable results upon retrospective evaluation. The average active ROM of the affected PIP joint improved from 90/96° to 34/83° with a functional arc and good patient satisfaction. The elastic force induced by strong rubber bands was safe and effective. The first step of joint space widening was the key to obtaining a successful joint extension afterwards. Serious progression of osteoarthritis at the PIP joint and pin-site fracture were a complication in each one case. Conclusions: In this study, we evaluate the surgical strategy of using DEFs powered by elastic torque from rubber bands to treat severe cases of flexion contractures of fingers. We first created extension contracture intentionally, followed by promoting flexion movement during follow-up in this group of patients.


Assuntos
Contratura , Fixadores Externos , Articulações dos Dedos , Contratura/etiologia , Contratura/cirurgia , Articulações dos Dedos/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
6.
J Pediatr Orthop ; 41(9): 559-565, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34387232

RESUMO

BACKGROUND: We examined the clinical and functional outcomes of the simultaneous anterior distal femoral 8-plate hemiepiphysiodesis (ADF8PH) and hamstring release, for fixed knee flexion deformity in children with neuromuscular disease. To our knowledge, no published evidence is available that reports the outcomes of this combined techniques. METHODS: Electronic medical records were retrospectively reviewed for 19 consecutive children who underwent bilateral ADF8PH and concomitant hamstrings release in our institution from 2012 to 2019. Relevant demographics, Gross Motor Functional Classification Score and preoperative and postoperative knee flexion contractures and popliteal angles were documented. RESULTS: The average age at the time of operation was 12±2.1 years. There were 15 males and 4 females. Diagnoses included cerebral palsy (n=16), Cornelia de Lange syndrome (n=1), hereditary spastic paraplegia type 56 (n=1) and fructose-1,6 bisphosphonate aldose B deficiency (n=1). Mean length of follow-up was 3.8 years (range: 1.5 to 7 y). Mean fixed knee flexion deformity improved from 28.9 to 13.4 degrees (P<0.001) at an average correction rate of 0.94 degrees per month. Mean popliteal angle improved from 81.8 to 44.4 degrees (P<0.001) in the early postoperative phase and to 51.8 degrees (P<0.001) in latest clinic review. Mean time to correction was 18.9 months. The agreed treatment goals of maintaining or promoting the use of standing frame and spinal/postural symmetry was attained in 18 patients (94.7%). Postoperative knee pain was reported in 2 cases (10.5%). We report 2 complications; 1 case of neurapraxia and 1 case of sepsis because of respiratory infection. CONCLUSION: Simultaneous bilateral ADF8PH with hamstrings release is a promising effective technique for correction of knee flexion contractures in skeletally immature individuals with neuromuscular disabilities. Our findings demonstrate improvement in clinical outcomes and maintaining functional outcomes, indicating the validity of this approach as a satisfactory, less invasive alternative in the management of this deformity. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Paralisia Cerebral , Contratura , Doenças Neuromusculares , Adolescente , Criança , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Doenças Neuromusculares/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
7.
Zhonghua Shao Shang Za Zhi ; 37(8): 711-717, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34404161

RESUMO

Objective: To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars. Methods: A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test. Results: Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions: The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Contratura , Lasers de Gás , Dióxido de Carbono , China , Cicatriz/cirurgia , Cicatriz Hipertrófica/patologia , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Ann Plast Surg ; 87(3): 253-259, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397514

RESUMO

BACKGROUND: Although external circular frame (ECF) has been widely used for the correction of knee and ankle deformities, few studies reported the use of ECF for the treatment of severe postburn elbow contracture and stiffness (SPECS). The purpose of this retrospective study was to investigate the effectiveness and safety of the distraction using ECF in treating SPECS. METHODS: After institutional review board approval, we implemented a retrospective single-center case series study composed of consecutive patients treated for SPECS at Chinese PLA General Hospital between January 2010 and January 2018. After scar release and skin grafting, distraction with ECF was performed for 4 to 6 weeks, and the frame was retained for 2 more weeks before removal. Four weeks of splinting and at least 1 year of rehabilitation were recommended. Patient demographics, active and passive range of motion (ROM) of the elbow at different time points (preoperative, postdistraction, and final follow-up), and complications were collected from the electronic medical record. The primary outcome was the long-term improvement of the ROM. Other outcomes included complications and recurrence. RESULTS: The ECF was used to treat SPECS in 6 patients (3 males and 3 females, average age of 11.7 ± 2.6 years). Scar release and distraction with ECF significantly increased both active (from 3° preoperative to 38.7° postdistraction) and passive (from 3.5° preoperative to 48.3° postdistraction) ROM over an average distraction duration of 5.2 weeks. The long-term improvement of active and passive ROM was 38° ± 13.4° and 46° ± 14.7°, respectively, over a median follow-up of 4.1 years. Pin-tract infection occurred in 2 patients and were treated with local wound care and oral antibiotics. A tendon readhesion developed in 1 of the 6 patients because of noncompliance with splinting and physiotherapy, and was treated with revision surgery. CONCLUSIONS: The 3C strategy (i.e., contracture release, coverage of the defect with skin grafting, and correction of articular angle with gradual distraction using the ECF) is able to increase the ROM with minor complications. We recommend distraction with ECF as part of the treatment arsenal, particularly for severe contractures in which 1-stage correction is unfeasible because of considerable soft tissue shortening.


Assuntos
Contratura , Articulação do Cotovelo , Adolescente , Criança , Contratura/etiologia , Contratura/cirurgia , Cotovelo , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
9.
Ann Plast Surg ; 86(6S Suppl 5): S487-S490, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100804

RESUMO

ABSTRACT: Adipose fat grafting (AFG) is a popular technique used to add volume in the face, breasts, and other tissue deficient areas of the body. In terms of scar release, not only has fat provided additional soft tissue coverage but also the relief of pain in scars in those patients suffering from disease processes, such as complex regional pain syndrome with steroid-induced atrophy, burn scars, morphea, and lupus. The purpose of this article is to demonstrate the senior author's technique and outcomes of using AFG in the face and body for treating volume deficiency, atrophic scarring, and deformities.A retrospective chart review of 127 AFG procedures of the face and body from September 2006 to September 2019 was performed. Of these, 14 patients had scar releases performed with fat grafting of areas of scar contracture. Fat was harvested from the abdomen, thighs, and flanks using Toomey syringes or an enclosed power-assisted system with 3.7- or 3.0-mm cannulas. Grafting in small areas, such as the face, was performed with the 0.9-mm blunt cannula.The majority of AFG was completed in the face (45%), followed by breasts (22%), and scar contracture (16%). The mean volume of fat grafted in procedures involving the breasts, buttocks, and face was 102, 182, and 21 mL, respectively. For scar contracture, the mean volume was 38 mL and for deformations, 27 mL. Sixteen percent of the cohort required at least 1 additional AFG procedure to achieve satisfactory results. There were no major complications, such as skin loss, vascular injury, embolization, or blindness. Minor complications, such as erythema, edema, and hematoma at the fat harvest or graft site, did occur and were managed with local measures.Autologous fat grafting has consistently resulted in volume correction. In addition, in patients with autoimmune disorders, burn scars, and retracted scars, not only has there been volume correction but also decreased pain in the area of treatment. In our series of patients, we described our technique of AFG for the face, body, and scar contracture. Our results demonstrate that AFG remains an inexpensive, safe, and effective treatment option to achieve volume.


Assuntos
Cicatriz , Contratura , Tecido Adiposo , Mama/patologia , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Contratura/etiologia , Contratura/cirurgia , Humanos , Estudos Retrospectivos , Transplante Autólogo
10.
BMC Musculoskelet Disord ; 22(1): 481, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034736

RESUMO

BACKGROUND: Indications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP). METHODS: Inclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively. RESULTS: Sixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months. Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively. Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001. There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D. CONCLUSIONS: Relative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.


Assuntos
Paralisia Cerebral , Contratura , Transtornos Neurológicos da Marcha , Procedimentos Ortopédicos , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/cirurgia , Criança , Contratura/diagnóstico , Contratura/etiologia , Contratura/cirurgia , Marcha , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
11.
ANZ J Surg ; 91(9): E578-E583, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33792136

RESUMO

BACKGROUND: Severe burn scar contracture of the extremities, especially the joint areas, causes aesthetic problems and functional limitation. Release of burn scar contractures requires complete removal of the scars and resurfacing of the resulting defects. Here, we describe thoracodorsal artery perforator (TDAP) free flaps for reconstructing burn scar contractures. METHODS: Between August 2013 and July 2018, 25 patients with severe burn scar contractures of the extremities underwent reconstruction using TDAP free flaps. Twelve were men and the mean age of the patients was 38.1 years (range, 12-66 years). Five patients had upper extremity contractures and 20 had lower extremity contractures. RESULTS: Twenty-one patients underwent reconstruction with a TDAP flap alone, while three received two perforator flaps, a TDAP and an anterolateral thigh flap or deep inferior epigastric artery perforator (DIEP) flap. The remaining patient received three perforator flaps, two TDAP and an anterolateral thigh flap. Fourteen patients had an improved range of motion after reconstruction. All the flaps survived except in the case of four patients who suffered partial loss of a TDAP flap. In one patient, there was partial skin graft loss at the donor site. The mean follow-up was 17.2 months (range 6-36 months). CONCLUSION: Ideal reconstruction of burn scar contracture yielding functional and aesthetic results involves complete removal of scar tissue and reconstruction. Depending on the extent of the defect, the TDAP flap, with its thin and pliable tissue and minimal donor site morbidity, may be the best option for reconstruction of burn scar contracture.


Assuntos
Queimaduras , Contratura , Retalhos de Tecido Biológico , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Idoso , Artérias , Queimaduras/complicações , Queimaduras/cirurgia , Criança , Cicatriz/etiologia , Cicatriz/cirurgia , Contratura/etiologia , Contratura/cirurgia , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
Zhonghua Shao Shang Za Zhi ; 37(4): 377-381, 2021 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-33887884

RESUMO

Objective: To explore the clinical effects of axillary propeller flaps in reconstructing the axillary fold scar contracture. Methods: A retrospective cohort study was conducted. From July 2016 to January 2020, 11 patients with anterior axillary fold or anterior and posterior axillary fold scar contractures after burns were admitted to Xiangya Hospital of Central South University, including 7 males and 4 females, aged 8 to 48 years. The lesions involved unilateral axilla in 9 cases and bilateral axilla in 2 cases, with the joint abduction angle of the affected shoulder ranging from 25 to 100°. The axillary fold contracture scars were excised and released, resulting in wound of 8 cm×5 cm-24 cm×20 cm. According to the condition of the residual normal skin in axilla, 2, 3, and 4-leaf propeller flaps with area of 5 cm×3 cm-24 cm×10 cm were designed to repair the wounds after scar excision and release. The donor site wound was closed by suturing directly, and the residual wound that could not be completely sutured was transplanted with free full-thickness skin grafts from the inner thigh or abdomen. The application of 2, 3, and 4-leaf propeller flaps, the joint abduction angle of the affected shoulder immediately after operation, and the survival of the flaps and skin grafts after operation were recorded. The recurrence of scar contracture, the appearance of the flaps, the joint abduction angle of the affected shoulder, and the functional recovery of the affected shoulder joint and upper arm were observed through a follow-up. Results: Among the 13 axillary propeller flaps transplanted in the 11 patients in this group, there were 9 double-leaf propeller flaps, two 3-leaf propeller flaps, and two 4-leaf propeller flaps. The joint abduction angle of the affected shoulder reached 110-165° immediately after operation. All the flaps survived after operation. Nine flap donor sites were repaired with free skin grafts, with skin grafts survived in 7 flap donor sites after operation. Scar erosion in incision and small area of skin graft necrosis developed in 2 flap donor sites. One of the wounds was debrided and repaired by transplantation of split-thickness skin grafts from inner thigh, and the other wound was healed after dressing changes. A follow-up of 6 to 24 months was conducted after surgery, and all the patients had no recurrence of axillary scar contracture; the color of the flap matched the receiving area; the elasticity of flap was good; the joint abduction angle of the affected shoulder reached 120-165°, and the joint pronation and supination, upper arm lifting and circular rotation of the affected shoulder were all good. Conclusions: Reconstruction of the axillary fold scar contracture with axillary propeller flaps has good result, with better flap appearance and recovery of the shoulder joint activity and upper arm function after operation.


Assuntos
Contratura , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Axila/cirurgia , Criança , Cicatriz/cirurgia , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento , Adulto Jovem
13.
J Biomech ; 120: 110367, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33887615

RESUMO

Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.


Assuntos
Artroplastia do Joelho , Contratura , Artroplastia do Joelho/efeitos adversos , Simulação por Computador , Contratura/cirurgia , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 483-487, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855834

RESUMO

Objective: To investigate the effectiveness of retrograde muscle release in treatment of mild to moderate type ischemic muscle contracture of forearm classified by Tsuge. Methods: Between March 2010 and September 2018, 11 patients with mild to moderate ischemic muscle contracture of forearm were treated with retrograde muscle release. There were 6 males and 5 females with an average age of 24 years (range, 16-29 years). According to Tsuge classification, 6 cases were mild type and 5 cases were moderate type. The interval between injury and operation was 9 months to 25 years, with a median of 17 years. The scar cords in the muscle of the middle one-third of the forearm was released firstly. If the standard of sufficient release was not reached, further releasing the scar cords in the muscle and the tense tendon structure in the proximal one-third of the forearm and the origins of the flexor muscles was necessary. If the standard was still not reached, the origins of the flexor muscles can be released and slid. The effectiveness was evaluated from six aspects of the range of motion of the hand and wrist, dexterity, grip strength, sensation, subjective function scores [quick-disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and the patient-related wrist/hand evaluation (PRWHE)] and satisfaction. Results: All the incisions healed by first intention. Eight patients were followed up 1-106 months (median, 13 months). The range of motion of the hand and wrist was significantly improved, the results were excellent in 3 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 75%. The patient's dexterity evaluation scored a perfect score of 12, which was close to the normal hand dexterity. At last follow-up, the grip strength on the affected side was 37.6%-95.5% of the contralateral side, with an average of 77.6%. Seven patients had normal sensation before and after operation, and the two-point discrimination of median nerve and ulnar nerve was 4-5 mm at last follow-up; 1 patient with forearm mechanical crush injury still felt numb after operation, and the two-point discrimination of median nerve and ulnar nerve was 8 mm and 7 mm, respectively. The Quick-DASH score was 0-15.9, with an average of 4.5, and the PRWHE score was 0-23.0, with an average of 6.6. All the patients were satisfied with the surgery and the effectiveness. Conclusion: A targeted retrograde muscle release method for mild to moderate type ischemic contracture of forearm can achieve satisfactory effectiveness.


Assuntos
Contratura , Contratura Isquêmica , Adulto , Contratura/etiologia , Contratura/cirurgia , Feminino , Antebraço/cirurgia , Humanos , Masculino , Músculos , Amplitude de Movimento Articular , Resultado do Tratamento , Articulação do Punho , Adulto Jovem
15.
Acta Orthop Traumatol Turc ; 55(2): 177-180, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847582

RESUMO

OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP). METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group. RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications. CONCLUSION: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.


Assuntos
Paralisia Cerebral , Músculos Isquiossurais , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho , Tenotomia , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/cirurgia , Criança , Contratura/etiologia , Contratura/cirurgia , Feminino , Músculos Isquiossurais/patologia , Músculos Isquiossurais/fisiopatologia , Humanos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Tenotomia/efeitos adversos , Tenotomia/métodos , Resultado do Tratamento
16.
Ulus Travma Acil Cerrahi Derg ; 27(3): 337-343, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33884605

RESUMO

BACKGROUND: Burn contractures that cause a restriction in extremity movements have to be reconstructed. Free microvascular flaps are generally needed in cases of severe contractures. The ideal free flap for severe contracture defects has to have a large skin island without bulk and a long pedicle for preventing recurrence and tension-free adaptation. Anterolateral thigh flap (ALT flap) that meets these features has widely been used for several indications in reconstructive surgery. Usage of ALT flap in burn contracture was described for burn and axillary contractures in literature. In this study, the usage of free ALT flaps in various anatomic contracture sites was reported. METHODS: Fifteen free ALT flaps were performed in 14 (12 male, two female) patients with a mean age of 36.6. Burn contracture defects in neck, axilla, popliteal, cubital region, plantar foot and hand were reconstructed with ALT flap. RESULTS: No total flap loss was encountered. Distal flap necrosis was seen in one case. All patients had significant improvement in a range of motions. Recurrence in contracture was seen in one patient with hand flexor contracture due to lack of physical treatment. CONCLUSION: ALT flap can safely be used in various anatomic contracture sites. Suprafascial elevation of the flap can be preferred for better adaptation in the neck, hand and foot and prevention of bulky appearance.


Assuntos
Queimaduras , Contratura , Retalhos de Tecido Biológico/transplante , Procedimentos Cirúrgicos Reconstrutivos , Coxa da Perna/cirurgia , Adulto , Queimaduras/complicações , Queimaduras/cirurgia , Contratura/etiologia , Contratura/cirurgia , Feminino , Humanos , Masculino
17.
Int Orthop ; 45(6): 1523-1530, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33822275

RESUMO

PURPOSE: Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery. METHODS: The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed. Knee FC was treated by hamstring lengthening, posterior knee capsulotomy, and femoral shortening/extension osteotomy until full extension was obtained. Kaplan-Meier analysis was used to estimate the probability of the correction being maintained. Cox proportional hazard modeling was used to compare parameters between patients with and without recurrent knee FC, with the time to recurrence as the endpoint. Potential confounding factors were included in the multivariate analysis. RESULTS: In total, the procedure was performed on 122 knees. The average weight-for-age z score was -1.3±1.2. The average follow-up period was 5.4±4.2 years. Knee FC recurrence was observed in 37 knees (30%). The average recurrence-free time was 4.9 years, with most cases of recurrence (33 knees) occurring within six years after surgery. The factors associated with recurrence were age (HR, 1.19) and a required posterior knee capsulotomy procedure (HR, 4.53). CONCLUSION: Recurrent knee FC after correction is associated with CCP who are older at the time of operation and when posterior knee capsulotomy is performed. The age at operation should be optimized. The sequence of procedures should be performed only as necessary to minimize the chance of post-operative muscle weakness and recurrence.


Assuntos
Paralisia Cerebral , Contratura , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/cirurgia , Criança , Contratura/etiologia , Contratura/cirurgia , Humanos , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
18.
J Pediatr Orthop ; 41(5): e356-e366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33734198

RESUMO

BACKGROUND: Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO. METHODS: After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical, radiographic, and instrumented gait analysis data were analyzed preoperatively and at 1 year following surgery. RESULTS: Twenty-eight patients (54 extremities) with a diagnosis of cerebral palsy and crouch gait were included. Significant improvements were appreciated in the degree of knee flexion contracture, quadriceps strength, knee extensor lag, and popliteal angle (P<0.01). Knee flexion at initial contact and during mid-stance improved significantly (P<0.0001), and knee moments in late stance were significantly reduced (P<0.01). The anterior pelvic tilt, however, significantly increased postoperatively (P<0.0001). Radiographic improvements were seen in the knee flexion angle and patellar station as assessed by the Koshino Sugimoto Index (P<0.0001). Four patients (14.2%) developed a recurrence of knee flexion contracture requiring further intervention. CONCLUSIONS: PTI is a simplified and safe technique to address quadriceps insufficiency when performing DFEO. The short-term results of patients who underwent DFEO with PTI demonstrated improvements in clinical, radiographic, and gait analysis variables of the knee. Investigating long-term outcomes, comparing techniques, and assessing quality of life measures are important next steps in research. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Fêmur/cirurgia , Transtornos Neurológicos da Marcha/cirurgia , Osteotomia , Ligamento Patelar/cirurgia , Músculo Quadríceps/fisiopatologia , Adolescente , Paralisia Cerebral/complicações , Criança , Contratura/etiologia , Contratura/fisiopatologia , Contratura/cirurgia , Feminino , Marcha , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Força Muscular , Patela/diagnóstico por imagem , Patela/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
19.
Plast Reconstr Surg ; 147(3): 401e-411e, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620926

RESUMO

BACKGROUND: Autologous adipose-derived stromal vascular fraction treatments have been shown to elicit antiinflammatory, antifibrotic, immunomodulatory, angiogenic, and regenerative effects. Injections of adipose-derived stromal vascular fraction have been used to treat severely scarred tissues. METHODS: Revision septorhinoplasty was performed in 40 patients with severely contracted noses. Clinical outcomes and adverse events were compared between one group of patients treated with adjuvant adipose-derived stromal vascular fraction injections and a control group of patients treated with adjuvant 0.9% preservative-free saline injections. RESULTS: In the adipose-derived stromal vascular fraction group, nasal lengths were estimated at 4.2 ± 0.2 cm at baseline to 5.1 ± 0.2 cm at 18 months after revision septorhinoplasty. The lengths of nasal tip projection improved from 2.2 ± 0.2 cm at baseline to 2.9 ± 0.1 cm 18 months after surgery. In addition, nasofrontal angles improved from 125.6 ± 5.1 degrees at baseline to 128.1 ± 4.8 degrees 18 months after surgery. Nasolabial angles in the adipose-derived stromal vascular fraction group were estimated at 105.8 ± 6.5 degrees at baseline and 94.9 ± 5.6 degrees 18 months after surgery. Of these, nasal length, nasal tip projection, and nasolabial angle, but not nasofrontal angle, values improved more in the adipose-derived stromal vascular fraction group than in the control group. CONCLUSION: Preoperative and postoperative adjuvant adipose-derived stromal vascular fraction treatment markedly improved the therapeutic outcomes of revision rhinoseptoplasty of severely contracted noses without major side effects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Cicatriz/cirurgia , Contratura/cirurgia , Transplante de Células-Tronco Mesenquimais/métodos , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Rinoplastia/efeitos adversos , Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/citologia , Adulto , Grupo com Ancestrais do Continente Asiático , Cicatriz/diagnóstico , Cicatriz/etiologia , Terapia Combinada/métodos , Contratura/diagnóstico , Contratura/etiologia , Feminino , Humanos , Injeções , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , República da Coreia , Estudos Retrospectivos , Rinoplastia/métodos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
20.
J Pediatr Orthop ; 41(3): e266-e271, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33492039

RESUMO

BACKGROUND: Open arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open arthrolysis in children and adolescents with posttraumatic elbow stiffness. METHODS: Data of 31 children and adolescents with posttraumatic elbow stiffness following open arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables. RESULTS: The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy. CONCLUSIONS: Most patients showed satisfactory functional outcomes after arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes. LEVEL OF EVIDENCE: Therapeutic level III.


Assuntos
Contratura/cirurgia , Articulação do Cotovelo/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Cotovelo/cirurgia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiologia , Feminino , Humanos , Instabilidade Articular , Masculino , Procedimentos Ortopédicos/métodos , Ossificação Heterotópica , Dor Pós-Operatória , Amplitude de Movimento Articular , Estudos Retrospectivos , Neuropatias Ulnares , Adulto Jovem
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