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1.
Head Neck ; 46(6): 1390-1399, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38468132

ABSTRACT

BACKGROUND: This study aimed to investigate the incidence of toe flexion deformity after fibular free flap transplantation and to analyze the etiology of the deformity. METHODS: Fifty patients underwent vascularized fibular free flap transplantation were retrospectively included. Statistical analysis examined correlations between deformity occurrence and resected fibula length and residual distal fibula length using the χ2 test. Doppler ultrasound and anatomical evaluations were conducted. RESULTS: Flexion deformity of the first toe was observed in all patients (100%), exacerbated by ankle dorsiflexion. χ2 test revealed no significant correlation between fibula length, distal residual fibula length, and flexion deformity. Doppler ultrasound revealed elevated echoes and blurred textures in the flexor hallucis longus post-fibular transplantation, while anatomical evaluation confirmed the peroneal artery as its primary nutrient supplier. CONCLUSION: This study reports a 100% incidence of toe flexion deformity post-transplantation. The deformity correlated strongly with ischemic contracture of the flexor hallucis longus.


Subject(s)
Fibula , Free Tissue Flaps , Hallux , Humans , Male , Female , Retrospective Studies , Fibula/transplantation , Middle Aged , Free Tissue Flaps/blood supply , Adult , Aged , Ischemic Contracture/surgery , Ischemic Contracture/etiology , Muscle, Skeletal , Postoperative Complications , Young Adult , Contracture/surgery , Contracture/etiology , Ultrasonography, Doppler
2.
Hand Clin ; 40(2): 269-281, 2024 May.
Article in English | MEDLINE | ID: mdl-38553098

ABSTRACT

Volkmann ischemic contracture (VIC) is a devastating condition that results from neglected compartment syndrome, which leads to prolonged ischemia, irreversible tissue necrosis, and various degrees of muscle and nerve damage, causing serious motor and sensory functional implications for the limb and a spectrum of diseases associated with worsening deformities. A thorough understanding of the anatomy and VIC pathophysiology is needed to plan an appropriate strategy. Functioning free muscle transplantation (FFMT) can restore finger movement in a paralyzed limb but requires a three-staged approach to maximize the benefits of FFMT, leading to meaningful finger extrinsic function.


Subject(s)
Compartment Syndromes , Contracture , Ischemic Contracture , Humans , Ischemic Contracture/surgery , Compartment Syndromes/complications , Fingers/surgery , Muscles , Contracture/surgery , Contracture/etiology
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 37(4): 447-451, 2023 Apr 15.
Article in Chinese | MEDLINE | ID: mdl-37070312

ABSTRACT

Objective: To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases. Methods: Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard. Results: All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively. Conclusion: The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.


Subject(s)
Contracture , Ischemic Contracture , Male , Female , Humans , Forearm/surgery , Contracture/diagnosis , Contracture/etiology , Contracture/surgery , Ischemic Contracture/surgery , Fingers/surgery , Muscle, Skeletal/surgery
4.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-981613

ABSTRACT

OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.


Subject(s)
Male , Female , Humans , Forearm/surgery , Contracture/surgery , Ischemic Contracture/surgery , Fingers/surgery , Muscle, Skeletal/surgery
5.
Acta Biomed ; 92(S3): e2021562, 2022 03 10.
Article in English | MEDLINE | ID: mdl-35604260

ABSTRACT

OBJECTIVE: Volkmann's ischemic contracture (VIC) represents the outcome of a compartment syndrome, not adeguately managed during the acute phase. It is still to be found in the developing contries, while it is rarely present in the developed countries. In this report we refer on our african experiences on VIC, because we beleive might be useful for last generation of italian orthopaedics which rarely have a chance to see Volkmann's cases. MATHERIALS AND METHODS: AA report their 2-years experience of 16 patients aged 7 to 17, presenting various entities of Volkmann's in Tigrai. RESULTS: in all patients there has been an aceptable recovery of hand function, also although the difficulty to verify the outcomes because of the scarce overlapping of the clinical status and different operations. CONCLUSIONS: attention shall be drawn to the outcomes and a healthcare education is necessary in those villages where cures are entrusted to the so called "traditional doctors" who are nothing more than "bone-setters".


Subject(s)
Compartment Syndromes , Ischemic Contracture , Orthopedic Procedures , Compartment Syndromes/etiology , Demography , Ethiopia , Humans , Ischemic Contracture/complications , Ischemic Contracture/surgery
6.
Injury ; 52(12): 3640-3645, 2021 Dec.
Article in English | MEDLINE | ID: mdl-33896611

ABSTRACT

INTRODUCTION: Severe Volkmann's Ischemic Contracture (VIC) is a reconstructive challenge for the surgeon because of the loss of entire flexor muscle mass and lack of powerful wrist extensors for restoration of finger flexion. In such cases, free functioning muscle transfer (FFMT) using gracilis is our choice. We herein summarize the technical considerations to achieve a successful outcome and report functional outcome achieved in our series. PATIENTS AND METHOD: Between 2007-2018, 22 patients of VIC underwent gracilis FFMT for restoration of finger flexion. FFMT was done as a second stage following an initial stage of neurolysis/excision of fibrotic flexor muscles/contracture release/flap cover in these patients. Cases were retrospectively reviewed and their functional outcome at a minimum of one-year follow up was analyzed. Follow-up duration ranged from 2-13 years (average-4 years). At the final follow up, the motor and sensory recovery was evaluated using the Medical Research Council Grading and their function using Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: The average age at surgery ranged from 3-45 years (average-18.4 years). All the transferred muscles survived. Secondary procedures to further improve the hand function were done in nine patients. The motor recovery for finger flexion was graded as M2 in two, M3 in nine and M4 in 11 cases. These 20/22 patients who recovered M3/M4 finger flexion expressed high satisfaction with the operation while other two also felt that they were better after the surgery. DASH score was available for 13 patients and it averaged 13.21 (Range-1.8-34.5). Grip strength was available for 10/22 patients and it averaged 10.5 kg (range-0-21kg) amounting to 24% of the normal side. The sensory recovery was graded as S4 in two, S3 in 17 and S2 in three cases. CONCLUSION: Gracilis FFMT is a reliable option for restoration of finger flexion in patients with severe VIC. Outcome is better when done after an early preliminary stage of excision of fibrosed muscles and neurolysis which allows recovery of intrinsic function and sensation. FFMT is best carried out 3-6 months after the first stage with supple skin and good passive range of movement in the fingers.


Subject(s)
Gracilis Muscle , Ischemic Contracture , Adolescent , Adult , Child , Child, Preschool , Humans , Ischemic Contracture/surgery , Middle Aged , Range of Motion, Articular , Retrospective Studies , Treatment Outcome , Wrist Joint , Young Adult
7.
J Hand Surg Am ; 45(8): 746-757, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32600789

ABSTRACT

Volkmann ischemic contracture (VIC) is a late sequela of acute compartment syndrome and consists of extensive muscle necrosis, fibrosis, contracture, and variable degrees of neural dysfunction. The outcome depends on successful restoration of muscle and neural function. The timing of surgery is often determined by the development of contractures and is delayed in the interest of observing some spontaneous recovery and infarct maturation. This period of observation may be detrimental to nerve function with gradual formation of scar tissue and worsening constrictive neuropathy. Early intervention appears to be more effective in preventing further nerve damage and restoring protective sensation. In this article, common features of compartment syndrome, frequently seen nerve lesions, and the effect of timing of surgical intervention on the outcome of VIC were reviewed in the light of the current basic and clinical science literature.


Subject(s)
Compartment Syndromes , Contracture , Ischemic Contracture , Cicatrix , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Contracture/etiology , Contracture/surgery , Humans , Ischemic Contracture/surgery
8.
Orthop Traumatol Surg Res ; 105(3): 423-427, 2019 05.
Article in English | MEDLINE | ID: mdl-30470521

ABSTRACT

OBJECTIVES: Volkmann's ischemic contracture is rare and surgical treatment remains a challenge. The goal of treatment is to obtain permanent recovery of joint range of motion and strength. The goal of this study was to evaluate the functional and socioprofessional outcome of surgical treatment of Volkmann's ischemic contracture. METHODS: This retrospective study was performed in two centers with one surgeon. Seven patients were included; mean age 23.6 years old. The Quick-Dash score, Patient Rated Wrist Questionnaire (PRWE) scores were obtained. Grip strength was compared to the contralateral side. Satisfaction was evaluated by the question: would you have surgery again? The surgical technique included 7 muscle slide procedures. RESULTS: Wrist and finger range of motion was good at least 6.1years in all cases according to the system by Buck-Gramcko. Grip strength on the operated side was 72.3% of the contralateral side. The mean PRWE was 14.64/100, mean QUICK-DASH score was 7.9/100. Patients returned to their professional activities in all cases. Patients who were questioned were all satisfied with surgery. CONCLUSIONS: Once the contracture is established in Volkmann's contracture Page-Scaglieti-Gosset muscle slide procedure can be used with good results allowing a return to socioprofessional activities. LEVEL OF EVIDENCE: IV, retrospective study.


Subject(s)
Ischemic Contracture/surgery , Patient Satisfaction , Quality of Life , Range of Motion, Articular/physiology , Wrist Joint/physiopathology , Adolescent , Adult , Female , Fingers/physiopathology , Humans , Ischemic Contracture/physiopathology , Ischemic Contracture/psychology , Male , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , Wrist Joint/diagnostic imaging , Wrist Joint/surgery , Young Adult
9.
Plast Reconstr Surg ; 139(6): 1291e-1304e, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28538571

ABSTRACT

BACKGROUND: As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage "like for like" has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture. METHODS: Twenty fresh cadaver dissections and 30 archival lead oxide radiographic studies were examined to (1) identify potential upper limb vascularized composite allotransplantation donor sites (i.e., elbow, forearm, and flexor tendon complex) and (2) demonstrate a "mock transplant" of the vascularized volar forearm allograft for a severe Volkmann ischemia defect. They were designed without skin to reduce antigenicity. RESULTS: The elbow joint was supplied within the brachial angiosome and the flexor tendon complex of the flexor digitorum superficialis and flexor digitorum profundus by the superficial palmar arch of the ulnar angiosome. The forearm allograft of flexor muscles, median, ulnar, and anterior interosseous nerves, when harvested on the brachial vessels, was supplied within the radial, ulnar, and anterior interosseous angiosomes but could be based on the ulnar artery alone because of intramuscular connections with the other territories. A mock transplant was performed with a distal-to-proximal dissection of the allograft, facilitating the best and fastest technique. CONCLUSIONS: This application of the angiosome concept highlights the anatomical feasibility of the volar forearm vascularized composite allotransplantation donor site focusing on a complex subunit problem in the upper limb-severe Volkmann ischemic contracture. It demonstrates the potential use and immunologic advantage of subdivided and modified nonskin variations of vascularized composite allotransplantation in reconstructive transplantation surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Subject(s)
Ischemic Contracture/surgery , Plastic Surgery Procedures/methods , Vascularized Composite Allotransplantation/methods , Aged , Cadaver , Feasibility Studies , Female , Forearm/blood supply , Forearm/surgery , Humans , Male , Middle Aged , Sensitivity and Specificity
10.
Medicine (Baltimore) ; 96(1): e5807, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28072735

ABSTRACT

RATIONALE: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. PATIENT CONCERNS: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. DIAGNOSES:: localized type Volkmann's contracture. INTERVENTION: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. OUTCOMES: Within 9 weeks after surgery, full ROM had been regained. LESSONS: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner.


Subject(s)
Fingers , Ischemic Contracture , Tendon Transfer/methods , Tendons , Adult , Early Ambulation/methods , Female , Fingers/physiopathology , Fingers/surgery , Humans , Ischemic Contracture/diagnosis , Ischemic Contracture/etiology , Ischemic Contracture/physiopathology , Ischemic Contracture/surgery , Plastic Surgery Procedures/methods , Recovery of Function , Tendons/physiopathology , Tendons/surgery , Treatment Outcome
11.
Hand Clin ; 32(2): 243-56, 2016 May.
Article in English | MEDLINE | ID: mdl-27094895

ABSTRACT

Free functional muscle transfer provides an option for functional restoration when nerve reconstruction and tendon transfers are not feasible. To ensure a successful outcome, many factors need to be optimized, including proper patient selection, timing of intervention, donor muscle and motor nerve selection, optimal microneurovascular technique and tension setting, proper postoperative management, and appropriate rehabilitation. Functional outcomes of various applications to the upper extremity and the authors' algorithm for the use of free functional muscle transfer are also included in this article.


Subject(s)
Arm Injuries/surgery , Muscle, Skeletal/transplantation , Peripheral Nerve Injuries/surgery , Upper Extremity/surgery , Arm Injuries/diagnosis , Arm Injuries/rehabilitation , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/surgery , Humans , Ischemic Contracture/diagnosis , Ischemic Contracture/surgery , Muscle, Skeletal/surgery , Peripheral Nerve Injuries/diagnosis , Plastic Surgery Procedures , Recovery of Function , Tendon Transfer , Tissue Donors , Treatment Outcome , Upper Extremity/injuries , Upper Extremity/innervation , Upper Extremity/physiopathology
13.
J Hand Surg Eur Vol ; 40(6): 614-9, 2015 Jul.
Article in English | MEDLINE | ID: mdl-24664161

ABSTRACT

The purpose of this study is to report our experience with free functional muscle transfer procedures for the late sequelae of the rare condition of congenital Volkmann's ischaemic contracture of the forearm. Four children, with an average age of 9.5 years (range 1.5-17), were treated and were followed for a mean of 6 years (range 1-14). Two patients had dorsal forearm contractures, and two had both flexor and extensor forearm contractures. We carried out free functional muscle transfers to replace the flexor or extensor muscles. The functional result was assessed according to the classification system of Hovius and Ultee. All patients had wrist contractures and skeletal involvement with limb length discrepancy that influenced the outcome. All five transferred muscles survived and improved the function of the hand in three of the four patients. LEVEL OF EVIDENCE 4.


Subject(s)
Forearm , Ischemic Contracture/congenital , Ischemic Contracture/surgery , Myocutaneous Flap , Plastic Surgery Procedures , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Ischemic Contracture/physiopathology , Male , Range of Motion, Articular , Treatment Outcome
15.
Klin Khir ; (7): 39-41, 2014 Jul.
Article in Ukrainian | MEDLINE | ID: mdl-25252412

ABSTRACT

The results of operative treatment of 8 patients was analyzed, in whom the lower extremity amputation on the upper third of the shin was performed for severe stage of the ischemic foot contacture. Operative interventions is expedient to perform in a specialized stationary, were exists possibility of further prosthesis. It is necessary to perform the extremity amputation in a residual period of the foot ischemic contracture, when operations for restoration of the sole sensitivity are nonperspective as well as in presence of severe trophic disorders on the sole and the shin, but without purulent--necrotic signs. Confirmed data of clinic--instrumental investigations for chronic course of the ischemic process constitutes an absolute indication for operation.


Subject(s)
Amputation, Surgical , Foot Deformities, Acquired/surgery , Foot/surgery , Ischemic Contracture/surgery , Adult , Aged , Aged, 80 and over , Amputation, Surgical/methods , Blood Flow Velocity , Female , Foot/blood supply , Foot/innervation , Foot Deformities, Acquired/diagnostic imaging , Foot Deformities, Acquired/pathology , Humans , Ischemic Contracture/diagnostic imaging , Ischemic Contracture/pathology , Male , Middle Aged , Necrosis , Radiography , Ultrasonography
16.
Hand Surg ; 19(2): 275-9, 2014.
Article in English | MEDLINE | ID: mdl-24875519

ABSTRACT

Wrist arthrodesis is exceptionally performed in children. The main indication is severe wrist flexion contracture resulting from Volkmann's ischaemia or spasticity. In such cases, a proximal row carpectomy is usually necessary to allow the wrist to be positioned in neutral position. In young children, it is essential to preserve the distal radius growth plate, to prevent physeal closure. In these very particular indications, with high stresses along the stretched palmar soft-tissues, Kirschner wire fixation provides poor stability, and plate fixation is contra-indicated. Radio-metacarpal external fixation is an excellent alternative, preserving the distal radius growth plate and offering sufficient stability. This technique was used in a seven-year-old girl suffering from Volkmann's ischaemic contracture, treated by first carpal bone resection and subsequent arthrodesis with radio-metacarpal external fixation. Bone healing was achieved in three months, with a five years follow-up preservation of the distal radius growth plate.


Subject(s)
Arthrodesis/methods , Casts, Surgical/adverse effects , Ischemic Contracture/surgery , Wrist Joint/surgery , Carpal Bones/surgery , Child , Female , Fracture Fixation , Humans , Humeral Fractures/therapy , Reoperation
17.
Ann Chir Plast Esthet ; 59(3): 200-3, 2014 Jun.
Article in French | MEDLINE | ID: mdl-24793235

ABSTRACT

OBJECTIVES: Congenital Volkmann ischemic contracture is a rare entity. The neonate presents nerve palsy, cutaneous and muscular necrosis of the forearm. METHODS: We report a case of a newborn who presented with necrotic subcutaneous tissue of the right forearm and absence of active flexion and extension of the wrist and fingers. She was initially treated with debridement of necrotic tissues and orthosis of the wrist. Latissimus dorsi free flap was used for forearm reconstruction at age of 7months. The thoracodorsal nerve was anastomosed with a motor branch of the median nerve. The proximal part of the muscle was fixated to the lateral epicondyle of humerus, and the distal part of muscle was sutured with a flexor digitorum tendons and radial extensor carpi. The cutaneous component of the flap was used to cover a defect of soft tissue of the forearm. RESULTS: At age of 12 months, the patient has a good two-hand function with a pollici digital clamp of the right hand. She also has a recovery of active wrist extension and fingers flexion. DISCUSSION: Free re-innervated latissimus dorsi muscle transfer is an alternative to restore a useful hand function in case of congenital Volkmann ischemic contracture.


Subject(s)
Ischemic Contracture/congenital , Ischemic Contracture/surgery , Myocutaneous Flap/innervation , Plastic Surgery Procedures/methods , Superficial Back Muscles/transplantation , Female , Humans , Infant, Newborn
19.
Ann R Coll Surg Engl ; 95(2): e36-7, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23484979

ABSTRACT

Compartment syndrome affecting the upper limb is reported rarely in the literature and is usually limited to single case reports. Upper limb compartment syndrome secondary to envenomation is rare, especially in the UK. Worldwide, it has been reported resulting from snake and insect bites, mostly from snakes from the Viperidae family, and from insects such as bees and wasps. Reports from the UK are limited to one case of an adder bite. We present a case of a previously fit and well adult who developed an ischaemic contracture of the forearm after an insect bite. Surgical exploration revealed segmental necrosis and contracture of the superficial and deep flexors of the fingers, requiring fasciotomy and tendon-lengthening procedures. This is the first report of a compartment syndrome, or a late ischaemic contracture from an insect bite in the UK. Owing to the rarity of compartment syndrome of the upper limb secondary to envenomation, a delay in diagnosis and treatment can lead to irreversible changes in the muscular compartments of the forearm.


Subject(s)
Insect Bites and Stings/complications , Ischemic Contracture/etiology , Female , Forearm , Humans , Insect Bites and Stings/pathology , Ischemic Contracture/pathology , Ischemic Contracture/surgery , Necrosis/etiology , Necrosis/pathology , Young Adult
20.
J Orthop Traumatol ; 13(4): 189-96, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23053046

ABSTRACT

BACKGROUND: Volkmann's ischemic contracture is a less common but crippling condition affecting the extremities. Once the condition sets in, the prognosis always remains guarded, even after long and intensive physiotherapy and various restorative surgical techniques. This study was undertaken to evaluate the long-term functional results of the Max Page muscle slide operation in patients with Volkmann's ischemic contracture of the forearm of moderate degree (Tsuge classification). MATERIALS AND METHODS: Nineteen patients treated between 1997 and 2009 were evaluated. The functional outcome (measured as the dexterity score, hand grip strength, sensibility, and appearance) was analyzed postoperatively. The pre- and postoperative values were compared using a paired t test. The final results were graded as good, fair, and poor. RESULTS: The average age at the time of presentation was 18 years (range 3-25 years). Tight external splintage for injuries around elbow and forearm was the primary factor. The mean period of follow-up was 3.53 years. Fifteen patients were able to achieve good functional results. Three had fair and one had poor results. All three variables showed significant improvements postoperatively. Wound dehiscence was the most common complication. One patient needed a second surgery to restore good hand function. CONCLUSION: The Max Page muscle sliding operation to treat Volkmann's ischemic contracture of moderate degree gives good functional results. The procedure is simple and easy to perform. Adequate muscle release and proper postoperative physiotherapy are key to achieving good results.


Subject(s)
Forearm/blood supply , Ischemic Contracture/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Hand Strength , Humans , Male , Orthopedic Procedures , Prognosis , Range of Motion, Articular , Splints , Treatment Outcome , Wrist Joint/physiopathology , Young Adult
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