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Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8512-8518页

作者： Rui Yan Zhe Zhang Long Wu Zhi-Peng Wu He-De Yan The Second Clinical Medical College Zhejiang Chinese Medical UniversityHangzhou 310053Zhejiang ProvinceChina Department of Orthopedics(Division of Hand Surgery) The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhou 325026Zhejiang ProvinceChina Department of Hand Surgery The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhou 325026Zhejiang ProvinceChina

BACKGROUND Sarcoidosis is a multisystem disease characterized by granuloma formation in various organs.Sarcoidosis-related flexor tendon contractures are uncommon in clinical settings.This contracture is similar to stenosing tenosynovitis and po-tentially leads to misdiagnosis and mistreatment.Herein,we report a rare case of sarcoidosis-related finger flexor tendon contracture that was misdiagnosed as tenosynovitis.A 44-year-old woman presented to our department with flexion contracture of the right ring and middle fingers.The patient was misdiagnosed with tenosynovitis and underwent acupotomy release of the A1 pulley of the middle finger in an-other hospital that resulted in iatrogenic rupture of both the superficial and profundus flexors.Radiological presentation showed multiple sarcoid involve-ments in the pulmonary locations and ipsilateral forearm.A diagnosis of sar-coidosis was made based on the presence of non-caseating granulomas with tubercles consisting of Langhans giant cells with lymphocyte infiltration on biopsy,and the patient underwent surgical repair for the contracture.After 2 mo,the patient experienced another spontaneous rupture of the repaired middle finger tendon and underwent surgical re-repair.Satisfactory results were achieved at the 10 mo follow-up after reoperation.CONCLUSION Sarcoidosis-related finger contractures are rare;thus,caution should be exercised when dealing with such patients to avoid incorrect treatment.

关键词： Sarcoidosis Finger contracture Iatrogenic Misdiagnosis Case report

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Formation process of extension knee joint contracture following external immobilization in rats

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世界骨科杂志:英文版 2023年第9期14卷 669-681页

作者： Chen-Xu Zhou Feng Wang Yun Zhou Qiao-Zhou Fang Quan-Bing Zhang Department of Rehabilitation Medicine The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601Anhui ProvinceChina The Second Clinical Medicine College Anhui Medical UniversityHefei 230000Anhui ProvinceChina

BACKGROUND Current research lacks a model of knee extension contracture in rats.AIM To elucidate the formation process of knee extension contracture.METHODS We developed a rat model using an aluminum external fixator.Sixty male Sprague-Dawley rats with mature bones were divided into the control group(n=6)and groups that had the left knee immobilized with an aluminum external fixator for 1,2,and 3 d,and 1,2,3,4,6,and 8 wk(n=6 in each group).The passive extension range of motion,histology,and expression of fibrosis-related proteins were compared between the control group and the immobilization groups.RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization.After 2 wk,the contracture gradually changed from myogenic to arthrogenic.The arthrogenic contracture progressed slowly during the 1^(st) week,rapidly progressed until the 3^(rd) week,and then showed a steady progression until the 4^(rd) week.Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time.Correspondingly,the level of transforming growth factor beta 1(TGF-β1)and phosphorylated mothers against decapentaplegic homolog 2(p-Smad2)in the anterior joint capsule also increased with the immobilization time.Over time,the cross-sectional area of muscle fibers gradually decreased,while the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was increased.Unexpectedly,the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was decreased during the late stage of immobilization(6-8 wk).The myogenic contracture was stabilized after 2 wk of immobilization,whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk.CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.

关键词： Knee joint Immobilization contracture External fixator Rats

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Current progress in understanding the molecular pathogenesis of burn scar contracture

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Burns & Trauma 2017年第2期5卷 79-84页

作者： Jianglin Tan Jun Wu Institute of Burn Research State Key Laboratory of Trauma Burns and Combined Injuries Chongqing Key Laboratory for Disease ProteomicsSouthwest Hospital Third Military Medical University Chongqing 400038China Department of Burns First Affiliated Hospital of Sun Yat-sen University Guangzhou 510080 China

Abnormal wound healing is likely to induce scar formation, leading to dysfunction, deformity, and psychological trauma in burn patients. Despite the advancement of medical care treatment, scar contracture in burn patients remains a challenge. Myofibroblasts play a key role in scar contracture. It has been demonstrated that myofibroblasts, as well as inflammatory cells, fibroblasts, endothelial cells, and epithelial cells, secrete transforming growth factor-β1 (TGF-β1) and other cytokines, which can promote persistent myofibroblast activation via a positive regulation loop. In addition to the cellular contribution, the microenvironments, including the mechanical tension and integrin family, are also involved in scar contracture. Most recently, eukaryotic initiation factor 6 (eIF6), an upstream regulator of TGF-β1, has been demonstrated to be involved in myofibroblast differentiation and contraction in both in vitro fibroblast-populated collagen lattice (FPCL) and in vivo external mechanical stretch models. Moreover, the data showed that P311 could induce the transdifferentiation of epidermal stem cells to myofibroblasts by upregulating TGF-β1 expression, which mediated myofibroblast contraction. In this review, we briefly described the most current progress on the biological function of myofibroblasts in scar contracture and subsequently summarized the molecular events that initiated contracture. This would help us better understand the molecular basis of scar contracture as well as to find a comprehensive strategy for preventing/managing scar contracture.

关键词： Scar contracture Burn Molecular pathogenesis

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The neck burn scar contracture:a concept of effective treatment

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Burns & Trauma 2017年第3期5卷 140-147页

作者： Sadanori Akita Kenji Hayashida Satoshi Takaki Yoshihisa Kawakami Takuto Oyama Hiroyuki Ohjimi Department of Plastic Surgery Wound Repair and Regeneration School of Medicine Fukuoka University 7-45-1 Nanakuma Jonan ku Fukuoka 8140180 Japan Section of Plastic Surgery School of Medicine Shimane University Shimane Japan Department of Plastic Surgery School of Medicine Fukuoka University Fukuoka Japan

A neck scar contracture can severely and negatively affect the function of mastication, phonic, or breathing and result in neck pain and issues with esthetics. The best way is of course to avoid such contracture by means of non-surgical treatment such as use of a growth factor. The basic fibroblastic growth factor is clinically well proven in decreasing scar formation and improving healing. There are numerous reconstructive methods for neck contracture, especially when the lesions are relatively limited in part of the neck. However, a very severe and full circumferential scar contracture requires extensive reconstruction. The thin groin flap is one of the answers and well matches with the tissue texture and maintains the flexibility. Even with extensive burns and delayed reconstructions due to resuscitation first, the groin area is well preserved and can be safely harvested by dual vasculature systems of the superficial circumflex iliac artery and superficial epigastric artery, which warrant more reliability compared to the perforator flaps in this area. More demanding and stringent forms of the neck burn scar contracture are the sequelae of radiation. A radiation burn or radiation injury can be progressing and hard to heal. Adipose-derived stem cells can reverse the scar contracture as the surrounding tissue is softened and can accelerate wound healing. In this review, different types of neck burn scar contracture and reconstructive methods are summarized, including innovative use of bFGF and ADSCs in the management of difficult wound healing and scar contracture.

关键词： Neck scar contracture Anatomical locations Prophylaxis Severe scar contracture Thin groin flap Radiation injury Adipose-derived stem cell

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The mechanisms and treatments of muscular pathological changes in immobilization-induced joint contracture: A literature review

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Chinese Journal of Traumatology 2019年第2期22卷 93-98页

作者： Feng Wang Quan-Bing Zhang Yun Zhou Shuang Chen Peng-Peng Huang Yi Liu Yuan-Hong Xu Department of Rehabilitation Medicine The Second Hospital of Anhui Medical University Hefei 230601 China Department of Clinical Laboratory The First Hospital of Anhui Medical University Hefei. 230601 China

The clinical treatment of joint contracture due to immobilization remains difficult.The pathological changes of muscle tissue caused by immobilization-induced joint contracture include disuse skeletal muscle atrophy and skeletal muscle tissue fibrosis.The proteolytic pathways involved in disuse muscle atrophy include the ubiquitin-proteasome-dependent pathway,caspase system pathway,matrix metalloproteinase pathway,Ca2+-dependent pathway and autophagy-lysosomal pathway.The important biological processes involved in skeletal muscle fibrosis include intermuscular connective tissue thickening caused by transforming growth factor-β1 and an anaerobic environment within the skeletal muscle leading to the induction of hypoxia-inducible factor-1α.This article reviews the progress made in understanding the pathological processes involved in immobilization-induced muscle contracture and the currently available treatments.Understanding the mechanisms involved in immobilization-induced contracture of muscle tissue should facilitate the development of more effective treatment measures for the different mechanisms in the future.

关键词： Immobilization-induced joint contracture Disuse skeletal muscle atrophy Skeletal muscle fibrosis Treatment

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Diabetic foot:Which one comes first,the ulcer or the contracture?

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World Journal of Orthopedics 2021年第2期12卷 61-68页

作者： Raden Andri Primadhi Herry Herman Department of Orthopaedics and Traumatology Universitas Padjadjaran Medical SchoolHasan Sadikin HospitalBandung 40161Indonesia

Diabetic foot is among the most common complications of patients with diabetes.One of the known causes of foot ulceration is ankle equinus,which increases the pressure on the plantar surface during ambulation.Conversely,equinus contracture can be caused by a complicated wound,and it may be due to prolonged immobilization.In this paper,we reviewed the pathogenesis of both conditions and their clinical considerations.Poor glycemic control in patients with diabetes may result in angiopathy and neuropathy as an underlying condition.An ulcer can be precipitated by an injury,improper foot care,or increased biomechanical loading as seen in elevated plantar pressure following equinus contracture.Equinus contracture may be a direct effect of hyperglycemia or can arise in combination with another pathway,for example,involving the activation of transforming growth factorβ.Static positioning resulting from any prior foot wound may develop fibrotic changes leading to contracture.Wound healing promoting factors can also result in overhealing outcomes such as hypertrophic scarring and fibrosis.The body’s repair mechanism during the healing cascade activates repair cells and myofibroblasts,which also serve as the main producers and organizers of the extracellular matrix.Considering this intricate pathogenesis,appropriate interventions are essential for breaking the vicious cycle that may disturb wound healing.

关键词： Diabetes Ulcer contracture Vicious cycle Pathogenesis Intervention

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Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren's contracture

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World Journal of Orthopedics 2018年第9期9卷 130-137页

作者： Nathalia Shchudlo Tatyana Varsegova Tatyana Stupina Tamara Dolganova Michael Shchudlo Nathalia Shihaleva Vadim Kostin Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics" Laboratory of Morphology of Federal State Budget Institution Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopaedics"

AIM To investigate the structural and functional characte-ristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different agegroups.METHODS Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old(Y-group, n = 22); the others were 55 and older(O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.RESULTS Frequency of cases with rapid development of contracture(less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels(more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.CONCLUSION Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.

关键词： Dupuytren’s contracture Laser Doppler flowmetry Hypodermis Histo-morphometry Palmar fascia

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contracture Development in Whales

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Open Journal of Marine Science 2020年第3期10卷 173-176页

作者： Jessica Pingel Adrian Harrison Department of Neuroscience Faculty of Health & Medical Sciences University of Copenhagen Frederiksberg C Denmark PAS Physiology Faculty of Health & Medical Sciences University of Copenhagen Frederiksberg C Denmark

It is well known that whales in captivity suffer from dorsal fin bending. However, the mechanisms behind this change are poorly understood. Humans can suffer from similar symptoms either after a period of immobilization or after suffering a brain lesion. Therefore, we here speculate whether the bent dorsal fins are reflecting contracture development in whales.

关键词： Dorsal Fin Cetaceans contracture Immobilization CNS Lesion

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Reconstruction of Post Burn Neck contracture Using Full Thickness Skin Graft

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Modern Plastic Surgery 2018年第2期8卷 21-28页

作者： Dalia M. El Sakka Belal A. Al Mobarak Mohamed Elsayed Mohamed Mohamed Menoufiya University Al Minufya Egypt Plastic Surgery Department Ahmed Maher Teaching Hospital Cairo Egypt

Background: Neck contracture after burns is a major complication that affects function and cosmesis. The aim of covering the raw area and defects is through using good quality pliable skin. Full thickness skin graft allows a large dimension sheet of good quality skin with low donor-site morbidity. Also it provides similar skin quality to the recipient areas with much less cosmetic difference. Methods: Four men and eight women underwent neck contracture release and reconstruction from December of 2015 to August of 2016. Mean patient age was 29 years (range from 12 to 46 years). Burn scar contracture releases were performed and cervicoplasty was added for optimal neck appearance. Uniformly full thickness skin grafts were applied. Both lateral ends of these grafts (release incisions) were designed with a fishtail shape for sufficient release and to minimize linear scar band formation in the most lateral region of the neck. Results: Full thickness skin grafts as large as 24 ± 12 cm (in length) and 10 - 15 cm (in width) were used. All grafts were taken without significant complications. Range of neck motion increased, and the cervico-mental angle was regained in all patients. A highly natural neck contour was universally obtained without a secondary debulking procedure. Conclusions: Full thickness skin grafts for treatment of post burn neck contraction give good functional and cosmetic results. They give similar color match and good skin quality, also help in regaining of cervico-mental angle.

关键词： Neck contracture Skin Grafts Donor Site Morbidity

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Desmoid Tumor Causing Hip Joint contracture: A Case Report

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Open Journal of Orthopedics 2018年第5期8卷 175-182页

作者： Kazuhiko Hashimoto Shunji Nishimura Kensuke Toriumi Shunki Iemura Naohiro Oka Masao Akagi Department of Orthopedic Surgery Kindai University Hospital Osaka-Sayama City Japan

Desmoid tumor (DT) is a relatively uncommon, cytologically bland fibrous neoplasm that is associated with possibility of local recurrence but without the potential to spread to other parts of the body. This disease affects mostly younger adults and is the most common cause of abdominal wall masses in women 20 - 35 years of age. However, it may involve nearly every body part, including the extremities, head and neck, trunk, and abdominal cavity;as such, patients with DT may present to a range of general and subspecialty radiologists. The consensus for treatment has changed over the past decade, with most centers moving away from primary radical surgery towards a front-line “wait-and-see” policy. Here, we present a case of a tumor mass that induced hip joint contracture. DT does not usually cause functional disorder. Oncologists should be aware that a desmoid tumor can cause hip joint contracture if the mass occurs in the gluteal region. Moreover, DT resulting in such a functional disorder should be treated by resection.

关键词： Desmoid Tumor Hip Joint contracture Gluteal Region

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