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Viktor M. Grishkevich – One of the best experts on this subject based on the ideXlab platform.

  • Burned Perineum: Anatomy of Medial Contracture and Reconstruction with Trapezoid Adipose-Scar Flaps
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Deep burns of the perineum result in Contractures that restrict smooth motion and make personal hygiene difficult. There are two basic Contracture types: (1) medial, in which scars form the fold of the perineum; and (2) total, characterized by perineum obliteration. The inelastic scar fold causing tightness and restriction of movement is more easily observed with abducted thighs. The transverse scar fold is formed below or above the genitals. Scar folds, protruding distally, obliterate the perineum. Scars of the perineum make walking and personal hygiene difficult and this indicates surgery. Total Contracture, or perineum obliteration, does not have a transverse fold. The fold is scar surface surplus, allowing the medial Contracture elimination with local trapezoid flaps. Anatomy and treatment of medial perineal Contracture is presented in this chapter.

  • Shoulder Medial Adduction Contracture: Anatomy and Treatment with Local Adipose Scar Trapezoid Flaps
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Medial shoulder adduction Contracture is a result of burns and scars of the axillary fossa, the joint flexion medial (FM) surface, and the inner surface of the shoulder and truncal lateral surface. Scars undergo repeat injury with shoulder abduction, and this stimulates connective scar tissue to grow. Therefore, scars of the axilla, growing distally and contracting, cause smoothing of the axillary fossa, pull axilla down, and form a crescent fold, where the crest passes along the medial line of axilla. The shoulder medial Contracture is an unknown form of scar Contracture, not included in existing classifications, and reconstructive techniques for its elimination have not yet been developed. Our broad experience has shown that medial scar Contractures represent 8–10% of all axillary Contractures. In this chapter we present all aspects of shoulder medial Contractures from formation to treatment.

  • Lateral Neck Contractures: Anatomy and Treatment
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Two types of lateral neck scar Contractures exist: edge and medial. Lateral neck edge Contracture is the result of a posterior neck burn. Medial neck Contracture is caused by burns and scars located on the lateral neck surface. In the literature, we did not find articles devoted to lateral neck postburn Contractures. Our observations showed that Contracture folds usually form along the lateral surface of the neck, causing restriction in head motion and presenting severe cosmetic defects. Use of local neck tissues with mobilization of surrounding areas in Contracture elimination became possible with the use of trapeze-flap plasty. Methods of treatment of edge and medial neck Contracture with trapezoid flaps are presented in this chapter.

Max Grishkevich – One of the best experts on this subject based on the ideXlab platform.

  • Burned Perineum: Anatomy of Medial Contracture and Reconstruction with Trapezoid Adipose-Scar Flaps
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Deep burns of the perineum result in Contractures that restrict smooth motion and make personal hygiene difficult. There are two basic Contracture types: (1) medial, in which scars form the fold of the perineum; and (2) total, characterized by perineum obliteration. The inelastic scar fold causing tightness and restriction of movement is more easily observed with abducted thighs. The transverse scar fold is formed below or above the genitals. Scar folds, protruding distally, obliterate the perineum. Scars of the perineum make walking and personal hygiene difficult and this indicates surgery. Total Contracture, or perineum obliteration, does not have a transverse fold. The fold is scar surface surplus, allowing the medial Contracture elimination with local trapezoid flaps. Anatomy and treatment of medial perineal Contracture is presented in this chapter.

  • Shoulder Medial Adduction Contracture: Anatomy and Treatment with Local Adipose Scar Trapezoid Flaps
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Medial shoulder adduction Contracture is a result of burns and scars of the axillary fossa, the joint flexion medial (FM) surface, and the inner surface of the shoulder and truncal lateral surface. Scars undergo repeat injury with shoulder abduction, and this stimulates connective scar tissue to grow. Therefore, scars of the axilla, growing distally and contracting, cause smoothing of the axillary fossa, pull axilla down, and form a crescent fold, where the crest passes along the medial line of axilla. The shoulder medial Contracture is an unknown form of scar Contracture, not included in existing classifications, and reconstructive techniques for its elimination have not yet been developed. Our broad experience has shown that medial scar Contractures represent 8–10% of all axillary Contractures. In this chapter we present all aspects of shoulder medial Contractures from formation to treatment.

  • Lateral Neck Contractures: Anatomy and Treatment
    Plastic and Reconstructive Surgery of Burns, 2018
    Co-Authors: Viktor M. Grishkevich, Max Grishkevich
    Abstract:

    Two types of lateral neck scar Contractures exist: edge and medial. Lateral neck edge Contracture is the result of a posterior neck burn. Medial neck Contracture is caused by burns and scars located on the lateral neck surface. In the literature, we did not find articles devoted to lateral neck postburn Contractures. Our observations showed that Contracture folds usually form along the lateral surface of the neck, causing restriction in head motion and presenting severe cosmetic defects. Use of local neck tissues with mobilization of surrounding areas in Contracture elimination became possible with the use of trapeze-flap plasty. Methods of treatment of edge and medial neck Contracture with trapezoid flaps are presented in this chapter.

Marianne K. Nieuwenhuis – One of the best experts on this subject based on the ideXlab platform.

  • Prevalence of scar Contractures after burn : A systematic review
    Burns, 2016
    Co-Authors: Anouk M. Oosterwijk, Leonora J Mouton, H. J. Schouten, Laurien M. Disseldorp, Cees P. Van Der Schans, Marianne K. Nieuwenhuis
    Abstract:

    Abstract Objective Burn scar Contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such Contractures, insight into the prevalence, course, and determinants is essential. Methods A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar Contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar Contracture assessment, point prevalence, and possible determinants. Results Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38–54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. Conclusions The prevalence of burn scar Contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar Contractures, their evolvement over time, and risk factors.

  • a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
    Burns, 2011
    Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van Zuijlen
    Abstract:

    Abstract Background Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar Contractures in the early phase of wound healing. However, scar Contractures are still a common complication. In this article we review the information concerning the incidence of scar Contracture, the effectiveness of static splinting therapy in preventing scar Contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound. Method A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO. Results Incidence of scar Contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar Contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity. Conclusion The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent Contractures is a well-considered intervention or just wishful thinking.

H. J. Schouten – One of the best experts on this subject based on the ideXlab platform.

  • Prevalence of scar Contractures after burn : A systematic review
    Burns, 2016
    Co-Authors: Anouk M. Oosterwijk, Leonora J Mouton, H. J. Schouten, Laurien M. Disseldorp, Cees P. Van Der Schans, Marianne K. Nieuwenhuis
    Abstract:

    Abstract Objective Burn scar Contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such Contractures, insight into the prevalence, course, and determinants is essential. Methods A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar Contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar Contracture assessment, point prevalence, and possible determinants. Results Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38–54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. Conclusions The prevalence of burn scar Contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar Contractures, their evolvement over time, and risk factors.

  • a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
    Burns, 2011
    Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van Zuijlen
    Abstract:

    Abstract Background Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar Contractures in the early phase of wound healing. However, scar Contractures are still a common complication. In this article we review the information concerning the incidence of scar Contracture, the effectiveness of static splinting therapy in preventing scar Contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound. Method A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO. Results Incidence of scar Contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar Contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity. Conclusion The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent Contractures is a well-considered intervention or just wishful thinking.

Paul P M Van Zuijlen – One of the best experts on this subject based on the ideXlab platform.

  • Perforator-based flaps for the treatment of burn scar Contractures: a review
    Burns & Trauma, 2017
    Co-Authors: C M Stekelenburg, R E Marck, P. D. H. M. Verhaegen, K.w. Marck, Paul P M Van Zuijlen
    Abstract:

    Patients with burn scars often experience functional problems because of scar Contractures. Surgical treatment may be indicated for those burn scar Contractures. If the Contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse Contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar Contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar Contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar Contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar Contracture release.

  • a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
    Burns, 2011
    Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van Zuijlen
    Abstract:

    Abstract Background Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar Contractures in the early phase of wound healing. However, scar Contractures are still a common complication. In this article we review the information concerning the incidence of scar Contracture, the effectiveness of static splinting therapy in preventing scar Contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound. Method A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO. Results Incidence of scar Contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar Contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity. Conclusion The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent Contractures is a well-considered intervention or just wishful thinking.