• Archives of Plastic Surgery
• /
• v.42 no.5
• /
• pp.532-543
• /
• 2015

Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.

• Archives of Reconstructive Microsurgery
• /
• v.13 no.2
• /
• pp.117-122
• /
• 2004

Purpose : The aim of this study was to evaluate the efficacy of arterialized venous flap in finger flexion contracture correction. Materials and methods : From 2002 to 2004, we have performed 10 arteriaized venous flap for treatment of severe flexion contracture in digit. The duration of flexion contracture was from 1 year to 50 years. The cause of contracture were bum scar(7 cases), postoperative contracture(2 cases) and other(l case). We evaluated the survival of flap, flap size, recovery of flexion contracture and subjective satisfaction. Results : All arterialized venous flap survived. The marginal minimal skin necrosis developed in 2 cases. The flap size was average $5.2{\times}3.5cm$. The recovery of flexion contracture was 87% compared with non affected side. 9 patients(90%) satisfied the results of operation. Conclusion : Arterialized venous flap is one of the useful procedure in treatment of finger flexion contracture because it has many advantages such as thin and good quality, variable length of pedicle, preservation of major vascular pedicle, less operation time and in addition possibility of various modifications.

• Archives of Plastic Surgery
• /
• v.35 no.1
• /
• pp.78-85
• /
• 2008

Purpose: The capsular contracture has been the most common complication of augmentation with breast implant, a side effect quite difficult to treat. The latest trends in the correction of capsular contracture include total capsulectomy or conversion of implant pocket. In this study, in an attempt to correct capsular contracture, the authors performed reoperation which involved capsulectomy through peri-areolar approach and dual-plane conversion. The authors hereby report the clinical results of such correction of capsular contracture and examine the efficacy. Methods: The authors selected 46 patients who were admitted to the clinic from January 2004 to January 2007 (37 months), and performed dual-plane conversion through solely peri-areolar approach. Two types of operation were done: dual-plane conversion from subglandular plane or from submuscular plane. Results: The average follow-up time after conversion to the dual-plane position was 10 months. During the follow-up period, 83.1% of patients recovered from capsular contracture and were Baker class I, and in 10.9% the condition had relapsed into Baker class II or III contracture. Conclusion: This study has proven the effectiveness of the dual-plane conversion operation for correcting established capsular contracture after previous augmentation mammaplasty. In this study, all cases of dual-plane conversion operation was performed through peri-areolar approach, which can prevent the occurrence of visible scar on inframammary fold.

• Archives of Plastic Surgery
• /
• v.39 no.4
• /
• pp.426-430
• /
• 2012

Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.2
• /
• pp.137-142
• /
• 2001

This study evaluated the results of reconstructions of thumb web space in the patients with adduction contracture of thumb. Between February 1990 and April 2000, 28 patients with thumb web space adduction contracture were treated with various reconstruction methods. We divided the patients according to the severity; mild$(41^{\circ}{\sim}80^{\circ})$, moderate$(21^{\circ}{\sim}40^{\circ})$, severe$(20^{\circ}less)$ contracture. The number of patients with mild contracture was 5, moderate; 12, severe; 11. We performed Z-plasty in 15, free flap in 8, local flap in 3, abdominal flap in 1 and scar release only in 1 case. The mean follow-up period was 5.7 years, ranged from 1.5 to 11.2 years. The results of web reconstruction were evaulated by thumb web space angle. There were excellent in 9, good in 16, fair in 3 cases. Z-plasty was performed in the 5 cases with mild contracture, and all the results were excellent. Especially, free flap was performed in the 6 cases with severe contracture, and all the results were good or excellent. in the reconstruction of thumb web space contracture, we recommend Z-plasty for a mild contracture, and free flap for large soft tissue defect created by release of a severe contracture.

• The Korean Journal of Physiology
• /
• v.21 no.2
• /
• pp.191-200
• /
• 1987

The activation mechanism of the sustained contractions induced by norepinephrine and K-depolarization was studied in renal vascular muscle. Helical strips of arterial muscle were prepared from rabbit renal arteries. All experiments were performed in Tris-buffered Tyrode solution which was aerated with 100% $O_2$ and kept at $35^{\circ}C$. Renal arterial muscles developed a contracture rapidly when exposed to a 40 mM K-Tyrode solution. In the absence of external $Ca^{2+}$, however, no K-contracture appeared. The contracture induced by K-depolarization was abolished by the treatment with $Ca^{2+}-antagonist\;(verapamil)$ or lanthanum $(La^{3+})$. From these results, it is obvious that K-contracture of renal arterial strip required $Ca^{2+}$ in the medium and this contracture was developed by the increased $Ca^{2+}-influx$ due to K-depolarization. Noradrenaline (5 mg/l) induced also a similar sustained contraction rapidly in all strips. Even on the K-contracture and in $Ca^{2+}-free$ Tyrode solution and also in the Tyrode solution pretreated with verapamil or $La^{3+}$, noradrenaline produced a contraction. However, the contraction in $Ca^{2+}-free$ Tyrode solution was not sustained and decreased gradually. The amplitude of noradrenaline-induced contracture was dependent on external $Ca^{2+}$; The contracture increased dose-dependently, but over 3 mM $Ca^{2+}$, decreased. The results of this experiment suggest that K-contracture was developed by an increased $Ca^{2+}-influx$ due to membrane depolarization, while noradrenaline-induced contracture was developed by both transmembrane $Ca^{2+}-influx$ and the mobilizaiton of cellular $Ca^{2+}$

• Journal of rehabilitation welfare engineering & assistive technology
• /
• v.8 no.4
• /
• pp.233-238
• /
• 2014

In this paper, we developed a finger robot simulating spasticity and contracture which can be used as a testing bed for evaluating performance of hand rehabilitation devices while it can be also used to train clinicians for improving reliability of clinical assessment. The robot is designed for adult finger size and for independent control of Metacarpophalangeal Joint and Proximal Interphalangeal Joint. Algorithm for mimicking spasticity and contracture is implemented. By adjusting the parameters related to contracture and spasticity, the robot can mimic various patterns of responses observed in fingers with spasticity and contracture.

• Journal of Acupuncture Research
• /
• v.33 no.2
• /
• pp.173-180
• /
• 2016

Objectives : To treat the progression of fibroproliferative disease that affects the flexion contracture of the fingers for patients with Dupuytren's contracture, the purpose of this study is to report a case of a patient with Dupuytren's contracture after complex Korean medical treatment. Methods : A patient was treated with acupuncture, moxibustion and bee venom pharmacopuncture on their left palmar aponeurosis. Six rounds of acupuncture and moxibustion were administered from November 30, 2015 through to January 2, 2016. Three rounds of bee venom pharmacopuncture was administered from December 14, 2015 through to January 2, 2016. The degree of flexion contracture and the Tubiana's stage were measured to evaluate the clinical improvement. Results : After 30 treatment sessions the flexion contracture degrees of the 4th finger's metacarpophalangeal joint and proximal interphalangeal joint improved as much as $25^{\circ}$, $15^{\circ}$, respectively. And the flexion contracture degrees of the 5th finger's metacarpophalangeal joint, proximal interphalangeal joint and distal interphalangeal joint improved as much as $15^{\circ}$, $10^{\circ}$, $5^{\circ}$, respectively. The Tubiana's stage of each finger decreased from 4 to 3. Conclusion : This study suggests that acupuncture, moxibustion and bee venom pharmacopuncture could be effective for patients with Dupuytren's contracture.

• Archives of Plastic Surgery
• /
• v.46 no.2
• /
• pp.160-166
• /
• 2019

Background Implant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty. Methods Thirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy. Results Thirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%). Conclusions As with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.

• Journal of Korean Physical Therapy Science
• /
• v.8 no.1
• /
• pp.727-734
• /
• 2001

Contracture is defined as the lack of full passive range of motion resulting from pint, muscle or soft tissue limitationprolonged Pint immobilization will result in stress and stretch deprivation and gradual development of contracture. the tissue changes caused by immobilization may be categorized as cellular modeling, ground substance and collagen response, and tissue response. contracture can be divided into three categories according to the anatomical location of pathological changes :arthrogenic, myogenic, soft tissue contractures Therapeutic approach of contracture is thermal or cold agents application, stretch or restoration of length, traction, manipulation, mobilization positioning and restoration of function. The purpose of this article is to review current concepts of mechanical properties and synthesis of collagen tissue and the underlying pathomechanics as it relates to evaluation and treatment of contracture.