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.
Male ; Female ; Humans ; Forearm/surgery* ; Contracture/surgery* ; Ischemic Contracture/surgery* ; Fingers/surgery* ; Muscle, Skeletal/surgery*

OBJECTIVE: Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.METHODS: After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).RESULTS: Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.CONCLUSION: In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.
Animals ; Cardiopulmonary Resuscitation ; Diacetyl ; Heart Arrest ; Hemodynamics ; Humans ; Ischemic Contracture ; Organophosphate Poisoning ; Perfusion ; Swine ; Ventricular Fibrillation

The free functional muscle transfer (FFMT) is the surgical procedure aimed at reconstructing defective or deteriorated muscle function by grafting free muscles including blood vessels and nerves. Since the free gracilis transfer in the facial paralysis was introduced in 1976, there have been many studies and clinical applications of the FFMT in various donor and recipient sites in brachial plexus injury, muscle ischemic contracture, muscle defect after tumor resection, congenital muscular deficit, multiple trauma. When the reconstruction of the nerve is delayed for 9 months to 1 year after the brachial plexus injury, voluntary muscle contracture is impossible even after the nerve regeneration by the irreversible degeneration of the muscles. And it is difficult to obtain adequate function even if nerve transfer or nerve transplantation is performed because the distance to be regenerated is too long. In these cases, the FFMT has been improved the functions of the upper limb in flexion or extension of the elbow, fingers. Many good clinical results of the FFMT have been reported, so the FFMT gets much interests and attentions. The essential things for the successful outcome of the surgery are the anatomical knowledge, the skilled surgical technique and the choice of patients who can meet the indications and receive long-term rehabilitation. Recent advances in surgical techniques will result in improved results of the FFMT.
Attention ; Blood Vessels ; Brachial Plexus* ; Contracture ; Elbow ; Facial Paralysis ; Fingers ; Humans ; Ischemic Contracture ; Multiple Trauma ; Muscle, Skeletal ; Muscles ; Nerve Regeneration ; Nerve Transfer ; Rehabilitation ; Tissue Donors ; Transplants ; Upper Extremity

Percutaneous transluminal angioplasty is being used to treat peripheral artery disease increasingly in place of conventional peripheral vascular surgery. Critical limb ischemia is the most severe form of peripheral artery disease and presents with ischemic resting pain and non-healing foot wounds or gangrene. It can result in amputation and increased mortality if aggressive revascularization to obtain sufficient blood is not performed as soon as possible. Generally, both femoral arteries are used for vascular access. However, we could not use the femoral artery for vascular access in a patient with multiple contractures of the extremities due to an old cerebral infarction. Consequently, we used the left brachial artery to perform successful revascularization of the left foot in critical limb ischemia.
Amputation ; Angioplasty* ; Brachial Artery ; Cerebral Infarction* ; Contracture* ; Extremities* ; Femoral Artery ; Foot ; Gangrene ; Humans ; Ischemia* ; Ischemic Contracture ; Limb Salvage* ; Mortality ; Peripheral Arterial Disease ; Wounds and Injuries

OBJECTIVETo evaluate the curative effects of manipulative reduction for children's type III humeral supracondylar fracture and the preventions of ischemic contracture of forearm in the early period.

METHODSFrom September 2008 to September 2011, 38 patients with humeral supracondylar fractures were treated with manipulative reduction and plaster stabilization, including 20 males and 18 females with an average age of 7.5 years (ranged, 2 to 13 years); the average time from injury to visit was 1.8 days(ranged,0.5 h to 6 d). There were 21 cases in straighten-ulnar deviation type and 17 cases in straighten-radial deviation type, 1 case in flexion type,all of them without vascular nerve injury. It was important to process swelling correctly in early stage of fracture. To decide fixed position according to the original displacement, and make a regular X-ray review, if found another displacement to correct it in 1-2 weeks after injury in time. Dismantle the plaster on the basis of bone healing and guide the functional exercise of elbow joint. According to Dodgt standard to evaluate clinical effects.

RESULTSAll patients were followed up from 3 months to 1 year with an average of 7 months. All fractures healed. According to Dodgt standard, 14 patients got an excellent results, 19 good, 4 fair and 1 poor. The excellent and good rate was 86.84%.

CONCLUSIONIt can obtain satisfactory clinical effects to treat humeral supracondylar fracture in children with closed manipulative reduction and plaster stabilization, while without vascular nerve injury. Early correct processing swelling and paying attention to gypsous angle can effectively prevent the ischemic contracture of forearm.

Adolescent ; Casts, Surgical ; Child ; Child, Preschool ; Female ; Forearm ; blood supply ; Humans ; Humeral Fractures ; therapy ; Ischemic Contracture ; prevention & control ; Male ; Manipulation, Orthopedic

OBJECTIVETo discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis.

METHODSA total of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient.

RESULTSPostoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral sural-tibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients.

CONCLUSIONSIschemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.

Adolescent ; Adult ; Child ; Female ; Humans ; Ischemic Contracture ; physiopathology ; surgery ; Leg ; blood supply ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Walking

OBJECTIVETo investigate the features of ischemic myocardial contracture after asphyxial cardiac arrest in rats.

METHODAsphyxial cardiac arrest was induced in 8 Wistar rats, and the length and width of the heart were measured at the different time points after cardiac arrest.

RESULTSObvious ischemic myocardial contracture occurred after the cardiac arrest, reaching the maximal contracture at 4-6 min after the arrest.

CONCLUSIONSIschemic myocardial contracture induced by asphyxia may be an important factor affecting the outcome of cardiopulmonary resuscitation.

Animals ; Asphyxia ; complications ; Female ; Heart Arrest ; complications ; etiology ; Ischemic Contracture ; etiology ; pathology ; Myocardium ; pathology ; Organ Size ; Rats ; Rats, Wistar ; Time Factors

Short period of ischemia and reperfusion protect heart against subsequent prolonged ischemia-reperfusion injury. This phenomenon was first described by Murry et al in 1986, who demonstrated that four 5-minute coronary artery occlusions followed by equal period of reflow at each time before a subsequent prolonged occlusion resulted in a reduction of infarct size in dog. Although the precise mechanism of preconditioning remains unknown, this phenome-non is present among different species of mammals, including dogs, rats, pigs, rabbits, and human. The objects of present study was to investigate effect of ischemic preconditioning on cell viability, structural changes and apoptosis during 60 min hypoxia and 60 min reoxygenation of the cell. In present study we investigated through cell culture system using myocyte of three days old neonatal rat cultured for three days. During hypoxia and reoxygenation, differences between preconditioned and nonpreconditioned of beating counts, morphological and structural changes are investigated through inverted phase contrast microscope and transmis-sion electron microscope. To detection of apoptotic cell, TUNEL (TdT-mediated dUTP-biotin nick end labeling) stain was accomplished, and through which we invesigate the effects of preconditioning on apoptosis. Viabiliy of each cell and it's mitochondria were measured quantitatively by MTT assay. After 60 min of hypoxia and 60 min of reoxygenation, beating rate decreased remarkably. But at the time of 60 min of reoxygenation, there was marked increase in beating count in pre-conditioned cell. Swollen mitochondria with amorphous granules in inner membrane, destroyed mitochondrial cristae, indented nuclear envelope, chromatin condensation, contracture of myofibril, fragmentation of myofilaments, cytoplasmic shrinkage were observed in both preconditioned cell and nonpreconditioned cell. But it is much less in pre-conditioned cell than in nonpreconditioned cell. MTT activity decreased in both experimental groups in compared with normal group, but in preconditioned group, MTT activity increased markedly in compared with nonpreconditioned group. And apoptosis is decreased by precontitioning in TUNEL staining. These results suggest that cardioprotective effects of ischemic preconditioning is mediated by attenuating structural destroy, increasing cell viability, decreasing apoptosis.
Animals ; Anoxia ; Apoptosis ; Cell Culture Techniques ; Cell Survival ; Chromatin ; Contracture ; Coronary Vessels ; Cytoplasm ; Dogs ; Heart ; Humans ; In Situ Nick-End Labeling ; Ischemia ; Ischemic Preconditioning* ; Mammals ; Membranes ; Mitochondria ; Muscle Cells ; Myocytes, Cardiac* ; Myofibrils ; Nuclear Envelope ; Rabbits ; Rats ; Reperfusion ; Reperfusion Injury ; Swine

BACKGROUND: No-reflow is a specific type of vascular damage occuring when removal of coronary occlusion dose not lead to restoration of coronary flow. There are three major explanations for the no-reflow phenomenon such as endothelial cell edema, microvascular plugging by platelets or thrombi and coronary occlusion by ischemic contracture of the myocardium. But detailed mechanisms of no-reflow phenomenon are not known. The objects of this study are to elucidate the possibility whether elevation of cytosolic Ca2+ concentration during ischemic cardioplegic period is mechanism of no-reflow phenomenon or not. METHODS: Changes in cytosolic Ca2+ concentration were measured under varying experimental condition. Free [Ca2+] in the cytosole [Ca2+]i of single rabbit coronary artery cells was measured with fluorescent Ca2+ indicator, Fura-2. RESULTS: Resting [Ca2+]i was 134.2+/-34 nM (n=43). When single cells were perfused with cardioplegic or ischemic cardioplegic solution, [Ca2+]i was significantly increased and degree of [Ca2+]i elevation was further augmented by ischemic cardioplegic solution. Pretreatment of sarcoplasmic reticulum emptying agent (20mM caffeine) had no effect on cardioplegia-induced [Ca2+]i change, but application of Ca2+ channel blocker (5x10-7M nifedipine) or an antagonist of Na+/Ca2+ exchange (5mM Ni2+ ) partially (nifedipine) or completely (nickel) inhibited the [Ca2+]i elevation. Pretreament of caffeine had no effect on ischemic cardioplegia-induced [Ca2+]i change, but application of nifedipine or nickel partially inhibited the [Ca2+]i elevation. Magnitude of ischemic cardioplegia-induced [Ca2+]i elevation was dependent on the Ca2+ concentration of perfusate from 0 to 2.5mM. When Ni2+ was added to reperfusion solution, recovery of ischemic cardioplegia-induced [Ca2+]i elevation was very rapid compared with control. CONCLUSIONS: From the above results, it may be speculated that ischemic cardioplegia-induced [Ca2+]i elevation may act as one of the mechanism of no-reflow phenomenon in rabbit coronary artery.
Caffeine ; Cardioplegic Solutions ; Coronary Occlusion ; Coronary Vessels* ; Cytosol* ; Edema ; Endothelial Cells ; Fura-2 ; Ischemic Contracture ; Muscle, Smooth* ; Myocardium ; Myocytes, Smooth Muscle* ; Nickel ; Nifedipine ; No-Reflow Phenomenon ; Reperfusion ; Sarcoplasmic Reticulum

BACKGROUND: Ischemic preconditioning reduces the infarct size and the severity of arrhythmia in a post-ischemic reperfused heart although the detailed mechanism is unknown. In the ischemic heart, a large amount of catecholamine is released from the adrenergic nerve terminal and this aggravates cell destruction and arrhythmia. In this study, the possibility for ischemic preconditioning to inhibit the release of endogenous catecholamine from the ischemic heart was tested to investigate the probable cardioprotective mechanism of ischemic preconditioning. METHODS: In the isolated, Langendorff perfused rat hearts, we observed the protective effect of ischemic preconditioning against post-ischemic reperfusion injury, and measured the amount of catecholamine released into coronary effuent. In addition, we observed the effect of catecholamine depletion on reperfusion injury in non-preconditioned and preconditioned hearts. RESULTS: During the reperfusion(20min) after ischemia(30min), the cardiac function was markedly depressed with the development of severe contracture. In the heart preconditioned by three sequential episodes of 5min ischemia and 5min reperfusion, the reperfusion contracture decreased significantly and the cardiac function was almost recovered to normal after 20min reperfusion. The release of lactate dehydrogenase was also decreased in the preconditioned heart. The release of endogenous catecholamine was abruptly increased immediately after the reperfusion and the release was exponentially decreased throughout the reperfusion period. THe pattern of catecholamine release was much different from that of lactate dehydrogenase release. In the preconditioned heart, the release was significantly decreased to about half of that in non-preconditioned t\heart. Endogenous catecholamine depletion by reserpine treatment did not affect the post-ischemic functional recovery in both non-preconditioned and preconditioned hearts. CONCLUSION: It is suggested from these results that ischemic preconditioning inhibis the release of endogenous catecholamine during ischemic period, which may be partly related to cardioporotective effect of preconditioning in ischemic and reperfused heart.
Animals ; Arrhythmias, Cardiac ; Contracture ; Heart* ; Ischemia ; Ischemic Preconditioning* ; L-Lactate Dehydrogenase ; Rats* ; Reperfusion ; Reperfusion Injury ; Reserpine