SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : CONTRACTURE SCAR AND SCAR SHRINKAGE (CONTRACTURAE CICATRICOSAE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Extensive soft tissue defects as the effects of trauma, extensive burns, inflammatory lesions of the skin, subcutaneous tissue, acute and chronic inflammatory processes in muscle.
The pathogenesis. In the process of scarring involved first a specific tissue layer, later degenerative changes spread wider. More rapid changes occur in the muscles and fascia, then hand ligaments, slower in the skin and even slower in the blood vessels and nerves. Dermatologie contractures occur due to the extensive damage of the skin, with a primary defect or subsequent necrosis; due to the extensive deep burns. Desmosine contractures occur after the inflammatory lesions of subcutaneous tissue. Myogenic contraction occur after acute or chronic inflammatory processes in the muscles due to the installation of the organ in the wrong position, circulatory disorders and local food. Neurogenic contractions occur due to pathological processes in the Central or peripheral nervous system.
Symptoms. Distress limbs with limited mobility of joints, caused by the presence of scars, soldered with the underlying tissues.
For. A gradual decrease in range of motion to complete the impossibility of motion. Progressive atrophy of the surrounding tissues. Stunted limbs.
Recognition is not difficult. Difficult to put pathogenetic diagnosis. To avoid ankylosis.
Immobilization of the joint in a functional position. Proper treatment of the disease, which threatens the development of contractures. Physiotherapy, physiotherapy. In open injuries - wide use of primary treatment of wounds with subsequent plastic primary or secondary closure of the defect.
Conservative; physiotherapy; electrotherapy, paraffin, mud, combined with physical therapy. At the same time the constant stretching of skin or skeletal using various devices, manzhetok, twists. With persistent contractures - surgery on the skin, fascia, muscles, tendons, with the aim of excision, dissection of the scar and plastic closure of the defect.