What Are the Different Types of Contracture Treatment?

Contracture scar is a kind of extensive soft tissue defect that has not been repaired. The contracture deformity left after the scar has healed is common in the sequelae of limb III burns that have not been repaired early. In addition, such as skin avulsion, extensive subcutaneous cellulite inflammation and other causes. Diseases of large-scale skin and subcutaneous tissue necrosis can also cause scar contracture deformities.

Contracture scar

Contracture scar is a kind of extensive soft tissue defect that has not been repaired. The contracture deformity left after the scar has healed is common in the sequelae of limb III burns that have not been repaired early. In addition, such as skin avulsion, extensive subcutaneous cellulite inflammation and other causes. Diseases of large-scale skin and subcutaneous tissue necrosis can also cause scar contracture deformities.

Chinese name

Contracture scar

Concept

Extensive soft tissue defect without repair,

Harm

Secondary contracture of deep tissue

The power of scar contracture is great. During the scar healing process of extensive tissue defects, the contracture power is increasing gradually. Before the early trauma does not heal, the movement and shape of the limbs can be almost normal; once healed, its contracture power increases. The lighter ones are just skin and subcutaneous soft tissue contractions. The severe ones can cause muscle, tendon, blood vessel, nerve shortening, and even bone. Joint deformities, contractures for many years, can cause limbs to deform into snake-like deformities, completely losing work functions. Scar contracture can be stronger than bones, joints,

Contracture deformities such as chronic scars often cause secondary contractures in deep tissues

The treatment of contracture scars includes steps such as choosing the timing of surgery, completely removing contractures, repairing the wound properly, and performing appropriate postoperative treatment.

The operation time is generally not too early, the scar should be stable, it has entered the mature stage, and the basement is loosened. Premature surgery, due to scar adhesion at the normal anatomical level, is often not clear, prone to accidental injury, and more bleeding. However, in the eyelid or around the mouth, surgery should be performed as soon as possible in order to protect vision or solve eating difficulties. At present, in the post-repair treatment of burns, it is advisable to perform surgery early for scar contractures that occur at functional sites to avoid secondary deformities, especially in childhood. While waiting for surgery, if the contracture scars of the joints of the extremities are involved, the injured should be instructed to perform active functional exercises.

The complete removal of contractures is a key step in surgical treatment. Extremities should be performed under an inflatable tourniquet, which can reduce bleeding, make the surgical field clear, and speed up the surgical progress. After the incision perpendicular to the longitudinal axis of the contracture begins to release, it is gradually stripped through the layers of scar and normal tissue. In this process, the assistant supports and maintains the tension of the contracture to facilitate the operation. As the wounds continue to expand, the contracture is completely relieved. He asked that in the extremities, sometimes supplementary surgery such as tendon elongation, joint capsule incision, and joint ligament resection are needed to achieve sufficient relaxation. Appropriate external force can be applied during release, but violent traction should not be used to force joint reduction to avoid laceration of soft tissues such as nerves and blood vessels. Those who really cannot be reset can perform postoperative traction or arthroplasty or fusion according to the situation. If it is unstable after reduction, facet joints can be inserted into Kirschner wires for short-term braking for 2 to 3 weeks. Large joints must be maintained with a plaster bandage after surgery. Scars should be completely resected as a principle, but if the area is too large or the donor site is limited, it can also be partially removed under the premise of adequately releasing the contracture. Wound edges on both sides of the joint, if not in the lateral midline, must be cut into a jagged shape.

In addition to the repair of wounds, except for those with contracture scars that are web-shaped, they can be repaired by Z-plasty alone. In most cases, the skin needs to be replenished. Generally, medium-thickness skin grafts are available. If the skin area used is very large and the weight of the skin source is insufficient, a superficial atrophic scar can be used as the donor site. If the wound is deep after the scar is removed, and at the same time or more complicated surgery such as tendons, nerves or joints is still needed, skin flap or skin tube repair is required. This situation must be fully estimated before surgery. If you plan to use delayed flap or skin tube surgery, you should measure and compare the two sides repeatedly according to some body surface marks before the wood, to accurately predict the size and shape of the wound that will appear after the contracture is released. So as to avoid errors and be caught off guard temporarily, it is difficult to remedy.

1. On the face, perpendicular to the eyelid margin and lips, or on the limb flexion, extension and perpendicular to the articular surface, it will cause scar contracture deformities of varying degrees and accompanying dysfunction.

2. In the extremities, if not treated in time, over time, it can also cause a series of secondary changes such as shortening or displacement of deep tissues such as tendons, nerves, blood vessels, etc., and deformation and dislocation of bones and joints.

3. In childhood, treatment delays can also cause developmental disorders. These all further increase the degree of morphological and functional damage.

4. In the broad torso area of the skin, the compensatory ability is strong, and after the formation of contracture marks, if it does not exceed the limit of compensatory capacity, it may be gradually adjusted and adapted, although it causes a certain degree of contracture deformities of purpura, but often does not There is severe dysfunction.

In the early postoperative period, braking should be performed to ensure the smooth healing and survival of sutured wounds or transplanted skin or repaired tissues, and to maintain the stability of soft tissues or joints after reduction. After the wound is healed, long-term contraction measures against the transplanted skin, especially the skin patch, should be taken, and measures should be taken to restore the imbalance of local and adjacent tissues caused by prolonged contracture, and further improve joint function. In addition to the various methods used while waiting for the timing of surgery, it can also use splint braces with elastic traction or some special instruments for auxiliary function recovery. These are all important steps necessary to consolidate and further develop the curative effect, which must be repeatedly explained to the patient to abandon the one-sided misunderstanding of excessive dependence on surgical treatment and neglecting active cooperation for functional activity training.