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Viktor M. Grishkevich - One of the best experts on this subject based on the ideXlab platform.
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Burned Perineum: Anatomy of Medial Contracture and Reconstruction with Trapezoid Adipose-Scar Flaps
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Shoulder Medial Adduction Contracture: Anatomy and Treatment with Local Adipose Scar Trapezoid Flaps
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Lateral Neck Contractures: Anatomy and Treatment
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Shoulder edge anterior adduction Contracture in pediatric patients after burns: Anatomy and treatment: A new approach
Elsevier, 2018Co-Authors: Viktor M. Grishkevich, Max Grishkevich, Vasiliy A. MenzulAbstract:Background: Burns of anterior shoulder joint surface and neighboring areas produce shoulder edge adduction Contracture and scar deformity, slowing down the development of upper limbs in pediatric patients. Therefore, surgical reconstruction is indicated as early as the Contracture is formed. Currently used surgical techniques, based on counter transposition of the local triangular flaps and skin transplants, do not solve the problem because of incomplete release of the Contractures; repeated operations are often performed. The scar deformity also remains. Methods: The anatomy of shoulder edge scar adduction Contractures was studied in 16 personally-operated pediatric patients before and during surgery. Being dissatisfied by outcomes from the skin graft and triangular flaps’ use, we started involving the undamaged axillary tissue in the form of adipose-cutaneous whole layer in plasty to fully release the Contracture and reduce the deformity of rough scars’ excision. Results: Edge shoulder adduction Contractures were caused by scars covering the joint’s anterior flexion lateral (FL) surface and scars of lateral sheet of the crescent fold located along the anterior edge of axillary fossa. We pointed out that contracted scars were not restricted only by the fold, but spread from the fold’s crest to the joint rotation axis and the Contracture was caused by the surface deficit on all extent. After contracted scar dissection with Y-incision, wound’s edges divergence and at the joint rotation axis wound (scar surface deficit) accepted a positive linear meaning that gives for deficit and wound a trapezoid form. Reconstruction consisted in Contracture release on all its extent with a Y-incision, mobilization of axillary and neighboring tissues in a form of non-incised/whole adipose-cutaneous layer. According to whole flap/layer surface, the scars adjusting to wound/scar surface deficit were excised and the wound was covered with axillary tissue layer that was transposed with tension. Excellent functional outcomes and improved appearance of cosmetically important zone were achieved without complication and donor site morbidity. Conclusion: The presented new technique is simple, safe, and effective; it allows one to avoid skin transplants, as well as triangular and regional flaps use. These factors enable the authors to recommend a wider use of the axillary layer in pediatric practice for edge shoulder adduction Contracture treatment. Keywords: Axilla Contracture, Pediatric burns, Axilla reconstruction, Edge axillary contractur
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Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.
Journal of burn care & research : official publication of the American Burn Association, 2015Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract:Lateral Contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion Contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical Contractures were divided into two types based on their anatomy: edge and medial. Edge Contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the Contracture. Medial Contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, Contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (Contracture cause). In all cases, there was surface surplus in the fold's sheets allowed Contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full Contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar Contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.
Max Grishkevich - One of the best experts on this subject based on the ideXlab platform.
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Burned Perineum: Anatomy of Medial Contracture and Reconstruction with Trapezoid Adipose-Scar Flaps
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Shoulder Medial Adduction Contracture: Anatomy and Treatment with Local Adipose Scar Trapezoid Flaps
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Lateral Neck Contractures: Anatomy and Treatment
Plastic and Reconstructive Surgery of Burns, 2018Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract: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.
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Shoulder edge anterior adduction Contracture in pediatric patients after burns: Anatomy and treatment: A new approach
Elsevier, 2018Co-Authors: Viktor M. Grishkevich, Max Grishkevich, Vasiliy A. MenzulAbstract:Background: Burns of anterior shoulder joint surface and neighboring areas produce shoulder edge adduction Contracture and scar deformity, slowing down the development of upper limbs in pediatric patients. Therefore, surgical reconstruction is indicated as early as the Contracture is formed. Currently used surgical techniques, based on counter transposition of the local triangular flaps and skin transplants, do not solve the problem because of incomplete release of the Contractures; repeated operations are often performed. The scar deformity also remains. Methods: The anatomy of shoulder edge scar adduction Contractures was studied in 16 personally-operated pediatric patients before and during surgery. Being dissatisfied by outcomes from the skin graft and triangular flaps’ use, we started involving the undamaged axillary tissue in the form of adipose-cutaneous whole layer in plasty to fully release the Contracture and reduce the deformity of rough scars’ excision. Results: Edge shoulder adduction Contractures were caused by scars covering the joint’s anterior flexion lateral (FL) surface and scars of lateral sheet of the crescent fold located along the anterior edge of axillary fossa. We pointed out that contracted scars were not restricted only by the fold, but spread from the fold’s crest to the joint rotation axis and the Contracture was caused by the surface deficit on all extent. After contracted scar dissection with Y-incision, wound’s edges divergence and at the joint rotation axis wound (scar surface deficit) accepted a positive linear meaning that gives for deficit and wound a trapezoid form. Reconstruction consisted in Contracture release on all its extent with a Y-incision, mobilization of axillary and neighboring tissues in a form of non-incised/whole adipose-cutaneous layer. According to whole flap/layer surface, the scars adjusting to wound/scar surface deficit were excised and the wound was covered with axillary tissue layer that was transposed with tension. Excellent functional outcomes and improved appearance of cosmetically important zone were achieved without complication and donor site morbidity. Conclusion: The presented new technique is simple, safe, and effective; it allows one to avoid skin transplants, as well as triangular and regional flaps use. These factors enable the authors to recommend a wider use of the axillary layer in pediatric practice for edge shoulder adduction Contracture treatment. Keywords: Axilla Contracture, Pediatric burns, Axilla reconstruction, Edge axillary contractur
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Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.
Journal of burn care & research : official publication of the American Burn Association, 2015Co-Authors: Viktor M. Grishkevich, Max GrishkevichAbstract:Lateral Contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion Contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical Contractures were divided into two types based on their anatomy: edge and medial. Edge Contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the Contracture. Medial Contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, Contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (Contracture cause). In all cases, there was surface surplus in the fold's sheets allowed Contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full Contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar Contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty.
Marianne K. Nieuwenhuis - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of scar Contractures after burn : A systematic review
Burns, 2016Co-Authors: Anouk M. Oosterwijk, Laurien M. Disseldorp, Leonora J Mouton, Cees P. Van Der Schans, H. J. Schouten, Marianne K. NieuwenhuisAbstract: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.
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a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
Burns, 2011Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van ZuijlenAbstract: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.
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Prevalence of scar Contractures after burn : A systematic review
Burns, 2016Co-Authors: Anouk M. Oosterwijk, Laurien M. Disseldorp, Leonora J Mouton, Cees P. Van Der Schans, H. J. Schouten, Marianne K. NieuwenhuisAbstract: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.
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a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
Burns, 2011Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van ZuijlenAbstract: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.
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Perforator-based flaps for the treatment of burn scar Contractures: a review
Burns & Trauma, 2017Co-Authors: C M Stekelenburg, R E Marck, P. D. H. M. Verhaegen, K.w. Marck, Paul P M Van ZuijlenAbstract: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.
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a review on static splinting therapy to prevent burn scar Contracture do clinical and experimental data warrant its clinical application
Burns, 2011Co-Authors: H. J. Schouten, Marianne K. Nieuwenhuis, Paul P M Van ZuijlenAbstract: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.