Cases reported "Contracture"

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1/86. Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report.

    Postburn neck contractures still represent a surgical challenge due to their exposed location; and early operative treatment is necessary for both functional as well as aesthetic reasons. An excellent functional result was obtained by using a supercharged super-thin occipito-cervico-dorsal flap described by Hyakusoku to repair a large defect of the anterior neck following a very wide neck burn contracture release. In this case report, the technique and its advantages among the other reconstructive modalities are discussed briefly.
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ranking = 1
keywords = operative
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2/86. Surgical management of hands in children with recessive dystrophic epidermolysis bullosa: use of allogeneic composite cultured skin grafts.

    Recessive dystrophic epidermolysis bullosa (RDEB) is characterised by progressive childhood hand syndactyly and flexion contractures, which can be managed surgically but require split thickness autografts to facilitate satisfactory postoperative healing. We report on the partial substitution, for autografts, of improved composite cultured skin (CCS) allografts. The structure and preparation of these CCSs is outlined and their application in the course of 16 operations performed on 7 RDEB children with syndactyly and flexor contractures of fingers is described. hand contractures were released and web spaces were covered with local flaps and split thickness autografts, while adjacent sides of the digits and other areas, as well as donor sites were generally grafted with CCS. Morphologic and functional results with CCS were judged to be good to excellent, the average time to recurrence was increased approximately 2-fold and smaller autografts needed to be used. In addition, healed CCS-treated donor sites could provide superior donor sites for further surgery.
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ranking = 1
keywords = operative
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3/86. Anaesthetic implications of rigid spine syndrome.

    The perioperative management of a 14-year-old girl, suffering from the muscular disorder rigid spine syndrome, is presented. The anaesthetic implications with regard to possible difficult intubation, cardiac involvement, malignant hyperthermia, neuromuscular blocking agents, and postoperative recovery are discussed.
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ranking = 2
keywords = operative
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4/86. Surgical management of hand contractures and pseudosyndactyly in dystrophic epidermolysis bullosa.

    The term epidermolysis bullosa refers to a group of disorders characterized by skin blistering following minor trauma. The hands, because of constant use during normal daily activity, are especially exposed to blistering, with secondary scarring leading to pseudosyndactyly, adduction contracture of the thumb, and flexion or extension contracture of the fingers. The standard surgical approach for the correction of these deformities is based on the incisional release of pseudosyndactyly and contractures, and split skin grafting of the secondary wounds. A simplified approach without skin grafting is presented in this paper. Four children (8 hands) underwent 25 operations over two decades. The results, in terms of postoperative healing and recurrence, were comparable with those of the standard approach involving skin grafting.
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ranking = 1
keywords = operative
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5/86. Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review.

    OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. methods: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.
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ranking = 1
keywords = operative
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6/86. Arthroscopic capsular release for contracture of the wrist: a new technique.

    SUMMARY: Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist. A cadaveric study was performed to assess the safety of arthroscopic capsular release. Arthroscopic capsular release was performed on 2 patients with limited wrist mobility. The average distance from the radiocarpal joint capsule to the neurovascular structures were 6.9 mm to the median nerve, 6.7 mm to the ulnar nerve and 5.2 mm to the radial artery. At 6 months follow-up, the average range of motion had improved from 17 degrees flexion and 10 degrees extension to 47 degrees flexion and 50 degrees extension. The average grip strength had improved from 13 to 31 kg. pain measured on a visual analogue score (0-10) had improved from 1.5 to 1.0. There were no complications. Arthroscopic capsular release of the wrist is a safe and minimally invasive technique that provides good improvement to range of motion.
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ranking = 1
keywords = operative
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7/86. Congenital trismus secondary to masseteric fibrous bands: endoscopically assisted exploration.

    The authors present an 18-month-old female infant with congenital trismus. Computed tomography and magnetic resonance imaging were not helpful in determining the cause. A surgical endoscope was used to explore her temporomandibular joints and temporal fossae, thus avoiding the morbidity of a bicoronal incision. The cause was bilateral fibrous bands on the anterior border of the masseter muscles. Incision of these fibrous bands led to relief of the trismus. This finding is consistent with a previously described variant of the Hect-Beals-Wilson trismus-pseudocamptodactyly syndrome. This patient, however, had no evidence of the autosomal dominant inheritance pattern nor did she exhibit pseudocamptodactyly, both of which are generally ascribed to this syndrome. Unfortunately the trismus recurred 3 months postoperatively.
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ranking = 1
keywords = operative
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8/86. Correction of axillary burn scar contracture with the thoracodorsal perforator-based cutaneous island flap.

    Axillary scar contracture is observed frequently after severe burn insult and is usually accompanied by injuries to the adjacent area. Although many therapeutic methods, including skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. We applied thoracodorsal perforator-based cutaneous flaps to 5 patients with axillary burn scar contractures and damaged adjacent tissues. In 1 patient both axillae were involved. Elevated flaps as large as 11 x 27 cm in size were used. All flaps survived completely even when raised in scar tissue. The donor sites were closed primarily except one, which needed a skin graft. Three patients obtained satisfactory release with more than 160 deg shoulder abduction. In 2 patients, release was incomplete with only 110 deg shoulder abduction, but neither one required a second release. The range of motion in terms of shoulder abduction was improved preoperatively (30-90 deg) to postoperatively (110-170 deg). The thoracodorsal perforator-based cutaneous flap presents a very useful reconstructive method for the treatment of axillary defects.
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ranking = 2
keywords = operative
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9/86. A case of congenital inverse Duane's retraction syndrome.

    Inverse Duane's retraction syndrome is very uncommon. Congenital cases are even more unusual. A 6-year-old girl with convergent squint along with severe restriction on abduction is described. On attempted abduction, a narrowing of the palpebral fissure, upshoot and retraction of the eyeball were observed. brain and orbit MRI demonstrated no intracranial or intraorbital mass, fracture, or entrapment of the medial rectus. Forced duction test was strongly positive. The primary lesion was found to be a tight medial rectus with shortening and soft tissue contracture. Surgical tenotomy of the medial rectus led to successful postoperative motility, but some limitation at full adduction and abduction persisted. This is a case reported with congenital medial rectus shortening, suggesting that this condition may be one of the etiologies of the rare inverse Duane's retraction syndrome.
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ranking = 1
keywords = operative
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10/86. Correction of scar contracture deformities of the big toe with a multiplanar distraction device.

    A multiplanar distraction device was used in a 65-year-old woman for correction of multiplanar deformities of her right big toe. These deformities were caused by long-standing scar contracture after a crushing injury to the right foot. Without the necessity of other complicated procedures, the dorsal contracture and lateral deviation were corrected from 43 deg to 0 deg and from 22 deg to 0 deg respectively 3 weeks postoperatively. Kirschner wires were inserted temporarily for prevention of recurrence after removal of the frame, and were removed 6 weeks later. In follow-up after 8 months, the position of the big toe was stable and without recurrence of contracture. Application of the multiplanar distraction device simplified the surgical procedure to achieve this correction.
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ranking = 1
keywords = operative
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