1/5. Rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps-an experimental study in the rat inguinal skin.PURPOSE: To investigate the rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps. MATERIALS AND methods: Lower extremities of 20 male Sprague-Dawley rats were strained and fixed on a table to provide a tension line over the inguinal area. Two rhomboid shaped adjacent flaps with subcutaneous pedicles were designed over the tension line. Each flap was 1cm long and the distance between two flaps was 0.5 cm. The total pre-operative length was 2.5 cm. Flaps were incised and freed from the stretched skin. Tension line over the inguinal area was relieved by relaxation incisions. The resulting defects were then closed by suturing the rhomboid flaps in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final elongation was measured and the results were analysed statistically. RESULTS: All relaxation incisions were effective in relief of tension over the inguinal area and in lengthening the tension line. Pre-operative 2.5 cm lengths ranged between 5.7 and 6.3 cm post-operatively (mean /- standard deviation = 5.99 /- 17 cm). The mean difference between pre- and post-operative measurements was 3.49 cm (139.6% gain in length). The subcutaneous pedicle rhomboid flaps easily closed all defects generated by relaxation and elongation. Statistical analysis revealed that two adjacent subcutaneous pedicle rhomboid flaps were efficient to close the defects generated by the relaxation incisions that produced a 139% gain in length (P < 0.001). CONCLUSION: The results of this experimental study show that multiple subcutaneous pedicle rhomboid flaps promise to be a good alternate technique in the treatment of long contracture bands in terms of rate of elongation and simplicity.- - - - - - - - - - ranking = 1keywords = relaxation (Clic here for more details about this article) |
2/5. Treatment of recontracture with the subcutaneous pedicle rhomboid flap.BACKGROUND: Treatment of recontractures that were previously skin grafted or treated with Z-plasty is a challenge. Application of a subsequent Z-plasty is risky because of the possibility of tip necrosis of the triangular flaps, whereas donor-site morbidity is undesirable if subsequent skin grafting is planned. The subcutaneous pedicle rhomboid flap is an effective technique for the treatment of every type of contracture. This article presents the clinical results of the rhomboid flap used in treatment of recontractures as an alternate technique to Z-plasty and skin grafting. methods: The authors operated on seven patients with recontractures (aged 4 to 45 years) using 19 rhomboid flaps. Flaps were applied in the upper extremity (seven flaps), lower extremity (five flaps), trunk (five flaps), neck (one flap), and axilla (one flap). Z-plasty scars were present in three locations, whereas skin grafting was previously applied in 16 locations. Preoperative rhomboid flap designs were made regardless of previous scars as single flaps in six locations and multiple flaps in 13 locations. Operations were performed under local and general anesthesia. RESULTS: patients were followed up for at least 6 months. All flaps achieved adequate relaxation postoperatively and healed uneventfully. The subcutaneous pedicle of the flap provided a distinct advantage in terms of vascularity. recurrence was not seen in any of the patients. CONCLUSIONS: The subcutaneous pedicle rhomboid flap is an effective and reliable technique for the treatment of recontractures. Preoperative planning is simple and independent of previous scars. Because the rhomboid flap resurfaces the emerged defects generated by relaxation incisions, one should consider that the flexibility of a single flap may not be adequate in some cases, and multiple flaps should be used.- - - - - - - - - - ranking = 0.4keywords = relaxation (Clic here for more details about this article) |
3/5. 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 = 0.2keywords = relaxation (Clic here for more details about this article) |
4/5. Continuous muscle activity and distal spinal muscular atrophy.A young man presented with myokymias, cramp-like difficulty in muscle relaxation and peroneal atrophy. EMG studies revealed continuous muscle activity (CMA) manifested as grouped potentials and high frequency discharges. Sensory nerve conduction studies and sural nerve biopsy gave normal results, and he was thought to suffer from distal spinal muscular atrophy with CMA. This association suggests that the lower motor neuron may have an important role in the generation of the continuous muscle activity.- - - - - - - - - - ranking = 0.2keywords = relaxation (Clic here for more details about this article) |
5/5. Treatment of a knee contracture using a knee orthosis incorporating stress-relaxation techniques.The subject of this case report was a 67-year-old Caucasian woman who had undergone total knee arthroplasty of the right knee. Postoperative physical therapy and a new orthosis that utilizes principles of stress relaxation (constant displacement) and static progressive stretching were used to reestablish range of motion. The total treatment time (cumulative orthosis wear time) was 32.5 hours over a period of 29 days, and the patient obtained a 17-degree increase in active range of motion. Six months later there was no measurable loss in range of motion. The results of the treatment may be beneficial for some patients. Researchers and clinicians need to conduct studies to further evaluate this approach to knee contracture management.- - - - - - - - - - ranking = 1keywords = relaxation (Clic here for more details about this article) |