1/20. 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.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/20. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/20. Reconstruction of burn scar of the upper extremities with artificial skin.The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the food and Drug Administration, artificial skin (Integra) has been available in taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/20. Treatment of cicatricial lagophthalmos: very small orbicularis oculi muscle pedicled skin flap.There are many methods for the correction of cicatricial lagophthalmos. skin and soft tissue should be used to reconstruct the defect after release of tension. We used a very small orbicularis oculi muscle pedicled skin flap for the correction of mild to moderate degrees of cicatricial lagophthalmos in six cases. A small skin island flap from near the skin defect, pedicled on the orbicularis oculi muscle, was transposed to fill the defect. The length of the skin flap ranged from 5 mm to 11 mm. With a follow-up period ranging from 6 months to 18 months (mean: 11 months),we obtained satisfactory functional and aesthetic results. The eyelid closure was much improved and the discomfort was relieved. All the flaps survived without any healing problems. This small orbicularis oculi myocutaneous flap is very reliable and has a wide range of motion. This technique can be applied to eyelid-skin defects of various causes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/20. Treatment of severe equinus deformity associated with extensive scarring of the leg.Nine severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using a hinged Ilizarov apparatus and free-tissue transfer. The average duration of followup was 38 months (range, 28-54 months). Free tissue transfer was done in all patients; a parascapular flap was used in seven patients, and a groin flap was used in two patients. The results were evaluated using two objective criteria and one subjective assessment: the degree of active dorsiflexion, the range of active movement of the ankle, and daily activities. For active dorsiflexion of the ankle and activities, the results were good in seven patients and fair in two patients. For range of active motion of the ankle, the results were good in six patients and fair in two patients. One patient with ankle arthrodesis was excluded. This study showed that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively with heel cord lengthening, free-tissue transfer, and a hinged ilizarov technique.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/20. Double-muscle flap repair of the tethered tracheostomy scar.Whether for facial trauma, extensive cancer resection, or long-term pulmonary ventilation, the final result after prolonged placement of a tracheostomy is usually a widened, depressed scar that is adherent to the underlying trachea. This adherence creates an unsightly up-and-down movement to the scar with swallowing. This "tracheal tug" is distressful emotionally to many patients and may even be painful. Simple methods of repair do not separate the skin closure adequately from the trachea, leading to recurrence of the tracheal tug. Use of the surrounding strap muscles to cover the trachea in conjunction with allogeneic dura mater has been described as one method of repair. In an attempt to perform a repair without the need for an outside tissue source, the double-muscle flap technique was developed. During this procedure the retracted scar is released from the trachea, the strap muscles are used to cover the tracheal closure, and the medial edge of the platysma muscle on each side is dissected free and sutured together in the midline. This separates effectively the tracheal closure from the skin, allowing the trachea to move independently. The cutaneous scar is revised along skin tension lines to create a fine-line linear scar. This procedure has been used in 2 patients with tracheal tug after prolonged tracheostomy placement. In each patient, the tracheal tug was eliminated completely, and an imperceptible cutaneous scar was the only remaining evidence of what had been a long and arduous recovery for these patients. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome scars.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/20. Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/20. Treatment of facial scarring and ulceration resulting from acne excoriee with 585-nm pulsed dye laser irradiation and cognitive psychotherapy.BACKGROUND: Self-inflicted skin ulcers and scars are often observed in patients with compulsive skin picking. The term "neurotic excoriation" has been used to describe this condition and may or may not coexist with other true skin pathologies, such as acne. The condition poses a diagnostic and treatment challenge because patients often also have an undiagnosed underlying psychologic disorder. case reports: Two patients with numerous linear and stellate facial ulcers and hypertrophic and erythematous scars were diagnosed with acne excoriee in the setting of an obsessive-compulsive disorder linked to emotional stress and anxiety. The scars were treated with a 585-nm flashlamp-pumped pulsed dye laser using a 7-mm spot size, 1.5-msec pulse duration, and fluence range of 4.5 to 6.0 J/cm(2). The patients received concomitant cognitive psychodynamic therapy to halt the cycle of impulse-driven skin picking and ulcer/scar formation. Marked clinical improvement of the scars and successful treatment of the acne excoriee were achieved with this combination approach. Relapses occurred when psychodynamic intervention was interrupted. CONCLUSION: The 585-nm flashlamp-pumped pulsed dye laser improves the appearance of hypertrophic erythematous facial scars and ulcers in patients with severe acne excoriee. Proper diagnosis of underlying impulse-control disorders and ongoing psychodynamic therapy is necessary to maintain improvement.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/20. Management of close-range, high-energy shotgun and rifle wounds to the face.Close-range, high-energy shotgun wounds of the face are life-threatening and devastating traumas of the face. Suicidal attempts are the main reason in the great majority of the patients in civilian life. There is no consensus on the timing of reconstruction for bone and soft tissue defects resulting from high-energy shotgun wounds. The conventional method is primary repair as soon as possible and serial debridements and definitive reconstruction in the delayed stage. An alternative to this approach is the immediate definitive surgical reconstruction of the patient during the first operation for acute management of trauma. We had 15 patients with close-range, high-energy shotgun wounds in 10 years. Six of 15 patients referred to our center for definitive reconstruction after the acute management of the patients were performed in another center and the rest were all admitted in the acute period. Either conventional approach with delayed reconstruction for 10 patients or immediate definitive surgical reconstruction for 5 patients was used. Immediate reconstruction eliminated disadvantages of the conventional method such as high infection and scarring rate and deformities resulting from contraction of tissues. The emotional conditions of the patients were evaluated and major depression signs were determined. Functional evaluation showed that there was great correlation between facial appearance after reconstruction and social activity level.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/20. Burn scars treated by pinhole method using a carbon dioxide laser.Many patients with burn injuries have various complications and emotional problems due to scars. Although various modalities to improve burn scars have been attempted, such as excision of scars, skin grafts, laser abrasion and silicone product usage, the cosmetic outcomes have not been satisfactory for a large portion of patients. Herein, we describe two cases which showed satisfactory cosmetic results after treatment of burns scars with the pinhole method using a carbon dioxide (CO(2)) laser that allowed us to make deep, closely set holes reaching down to the upper dermis. A 20-year-old female patient with a scar on her neck and a 25-year-old female patient with a scar on her right forearm after burn injuries are presented. As early as only a few weeks after the treatment, the scars showed relaxation of contracture, reduction of wrinkles and improvement of texture and color compared to before the treatment. Treatment of burn scars with the pinhole method can be easily performed and results in dramatic improvement in scar quality with only a few side-effects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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