1
|
Zhu B, Liang L, Hui L, Lu Y. Exploring the role of dermal sheath cells in wound healing and fibrosis. Wound Repair Regen 2024. [PMID: 39129718 DOI: 10.1111/wrr.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024]
Abstract
Wound healing is a complex, dynamic process involving the coordinated interaction of diverse cell types, growth factors, cytokines, and extracellular matrix components. Despite emerging evidence highlighting their importance, dermal sheath cells remain a largely overlooked aspect of wound healing research. This review explores the multifunctional roles of dermal sheath cells in various phases of wound healing, including modulating inflammation, aiding in proliferation, and contributing to extracellular matrix remodelling. Special attention is devoted to the paracrine effects of dermal sheath cells and their role in fibrosis, highlighting their potential in improving healing outcomes, especially in differentiating between hairy and non-hairy skin sites. By drawing connections between dermal sheath cells activity and wound healing outcomes, this work proposes new insights into the mechanisms of tissue regeneration and repair, marking a step forward in our understanding of wound healing processes.
Collapse
Affiliation(s)
- Bing Zhu
- Translational Medicine Engineering Research Center of Inner Mongolia Autonomous Region, affiliated with Baotou Central Hospital, Baotou, China
| | - Lu Liang
- Translational Medicine Engineering Research Center of Inner Mongolia Autonomous Region, affiliated with Baotou Central Hospital, Baotou, China
| | - Lihua Hui
- Burn Research Institute of Inner Mongolia Autonomous Region, affiliated with Inner Mongolia Baogang Hospital, Baotou, China
| | - Yaojun Lu
- Translational Medicine Engineering Research Center of Inner Mongolia Autonomous Region, affiliated with Baotou Central Hospital, Baotou, China
| |
Collapse
|
2
|
Hardy M, Feehan L, Savvides G, Wong J. How controlled motion alters the biophysical properties of musculoskeletal tissue architecture. J Hand Ther 2023; 36:269-279. [PMID: 37029054 DOI: 10.1016/j.jht.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/06/2022] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Movement is fundamental to the normal behaviour of the hand, not only for day-to-day activity, but also for fundamental processes like development, tissue homeostasis and repair. Controlled motion is a concept that hand therapists apply to their patients daily for functional gains, yet the scientific understanding of how this works is poorly understood. PURPOSE OF THE ARTICLE To review the biology of the tissues in the hand that respond to movement and provide a basic science understanding of how it can be manipulated to facilitate better functionThe review outlines the concept of controlled motion and actions across the scales of tissue architecture, highlighting the the role of movement forces in tissue development, homeostasis and repair. The biophysical behaviour of mechanosensitve tissues of the hand such as skin, tendon, bone and cartilage are discussed. CONCLUSION Controlled motion during early healing is a form of controlled stress and can be harnessed to generate appropriate reparative tissues. Understanding the temporal and spatial biology of tissue repair allows therapists to tailor therapies that allow optimal recovery based around progressive biophysical stimuli by movement.
Collapse
Affiliation(s)
- Maureen Hardy
- Past Director Rehab Services and Hand Management Center, St. Dominic Hospital, Jackson, MS, USA
| | - Lynne Feehan
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Georgia Savvides
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Manchester Academic Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jason Wong
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, Manchester Academic Health Science Centre, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| |
Collapse
|
3
|
Raghavan U, Daoud M, Heywood EG, Ullas G. Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose. Aesthet Surg J 2022; 42:16-27. [PMID: 33959760 DOI: 10.1093/asj/sjab212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many locations for the nasal valve have been suggested, and more recently the concept of the flow-limiting segment was introduced. Rather than being controlled by an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum, and inferior turbinate. OBJECTIVES The aim of this study was to assess the balanced cantilever graft (BCLG) as a technique to support the lateral nasal wall. METHODS Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow-up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with a visual analog scale (VAS) and aesthetic outcomes by FACE-Q score. Objective assessment of the airway was performed with a nasal peak inspiratory flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported. RESULTS Sixty patients received BCLGs. The VAS score for nasal obstruction increased from 2.6 preoperatively to 8.1 postoperatively. FACE-Q increased from 16.7 preoperatively to 36.6 postoperatively. NPIF was 74.9 L/minute preoperatively, improving to 95 L/minute postoperatively. Statistically significant improvements were seen in these functional and aesthetic scores. CONCLUSIONS BCLGs support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and the graft can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Ullas Raghavan
- Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Teaching Hospitals, Nottinghamshire and South Yorkshire, UK
| | - Mahmoud Daoud
- Doncaster and Bassetlaw NHS Teaching Hospitals, Nottinghamshire and South Yorkshire, UK
| | - Emily G Heywood
- Department of ENT and Facial Plastic Surgery, Doncaster and Bassetlaw NHS Teaching Hospitals, Nottinghamshire and South Yorkshire, UK
| | - Gautham Ullas
- Department of Otorhinolaryngology, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
4
|
Melly V, Baia P. Standing biceps brachii tenectomy to treat chronic bicipital tendinopathy associated with bursal fibrosis and humeral adhesions in a Quarter Horse gelding. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V. Melly
- B. W. Furlong and Associates Califon New Jersey USA
| | - P. Baia
- B. W. Furlong and Associates Califon New Jersey USA
| |
Collapse
|
5
|
Pitts G, Custer M, Foister RD, Uhl T. The hand therapist's role in the prevention and management of upper extemity injuries in the modern mass production industrial setting. J Hand Ther 2021; 34:237-249. [PMID: 34034914 DOI: 10.1016/j.jht.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This case study presents the role of an onsite hand therapist (Certified Hand Therapist, Occupational Therapist, Physical Therapist) in an industrial setting and the services that can be provided in this comprehensive care model. Onsite hand therapists can impact on Occupational Safety and Health Administration (OSHA) first aid programs and can provide state of the art treatment for the injured worker in both a direct and indirect capacity. PURPOSE The purpose of this case study article is to review the many potential services the hand therapist can offer to facilitate the return-to-work of injured employees and provide employers with a proactive case management and state-of-the-art ergonomic prevention, improving profit margins and facilitating safe work environments. STUDY DESIGN A Case Study design demonstrating the diverse and positive impact of hand therapy on the mass production industrial setting. METHODS Novel to this approach is a description of outcome instruments (QuickDASH) administered in a periodic manner to understand the trajectory of change in patient-level disability throughout the rehabilitation process. The Optimal Screening for Prediction of Referral and Outcome (OSPRO-YF) is utilized to help predict the functional outcome for the injured worker. Case studies on common upper extremity pathologies will be discussed, demonstrating the benefits of onsite hand therapy with enhanced treatment and case management. RESULTS The utilization of the QuickDASH and the OSPRO-YF creates a process to determine the progression of injured workers in therapy, the trajectory of change in patient-level disability and to observe when changes occurred. An example of the periodic assessment approach is described in a case study to identify when the most significant change occurred and creating a mechanism to determine if patients were progressing as expected. CONCLUSIONS Inherent in this case study process is a fluidity in which the therapist can monitor patient progress and adjust the rehabilitation process that benefits both the patient and the industrial setting. A hierarchical functional level system is presented to describe an appropriate intervention strategy to coincide with a patient's progression of wound healing which can be provided by a hand therapist with specialized knowledge.
Collapse
Affiliation(s)
- Greg Pitts
- Commonwealth Hand Therapy, Lexington Kentucky 40504, Auerbach School of Occupational Therapy, Spalding University, Louisville, KY, USA.
| | - Melba Custer
- Auerbach School of Occupational Therapy, Spalding University, Chair, Research Ethics Committee REC, Louisville, KY, USA
| | | | - Tim Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
6
|
Parry IS, Schneider JC, Yelvington M, Sharp P, Serghiou M, Ryan CM, Richardson E, Pontius K, Niszczak J, McMahon M, MacDonald LE, Lorello D, Kehrer CK, Godleski M, Forbes L, Duch S, Crump D, Chouinard A, Calva V, Bills S, Benavides L, Acharya HJ, De Oliveira A, Boruff J, Nedelec B. Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines. J Burn Care Res 2021; 41:503-534. [PMID: 31504622 DOI: 10.1093/jbcr/irz150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.
Collapse
Affiliation(s)
- Ingrid S Parry
- From the Shriners Hospital for Children, Northern California, University of California-Davis, Sacramento
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Patricia Sharp
- Cincinnati Children's Hospital, University of Cincinnati College of Allied Health Sciences Program in Occupational Therapy, Ohio
| | - Michael Serghiou
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Jonathan Niszczak
- Bio Med Sciences Inc., Allentown, Pennsylvania Shriners Hospitals for Children Boston, Massachusetts.,Thomas Jefferson University Burn Center, Philadelphia, Pennsylvania.,Bio Med Sciences, Inc. Allentown, Pennsylvania
| | - Margaret McMahon
- Our Lady's Hopsice and Care Services, Harold's Cross, Dublin, Ireland
| | | | - David Lorello
- The Arizona Burn Center at Maricopa Medical Center, Phoenix
| | | | - Matthew Godleski
- Department of Physical Medicine and Rehabilitation, Ross Tilley Burn Centre, St. John's Rehab, University of Toronto, Ontario, Canada
| | - Lisa Forbes
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sarah Duch
- Westchester Medical Center, Valhalla, New York
| | - Donna Crump
- Parkland Health and Hospital System, PMR Department, Dallas, Texas
| | - Annick Chouinard
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Valerie Calva
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada
| | - Sara Bills
- Madonna Rehabilitation Hospitals, Lincoln, Nebraska University of Nebraska Medical Center, Omaha
| | | | - Hernish J Acharya
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ana De Oliveira
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Jill Boruff
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Bernadette Nedelec
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Riquet D, Houel N, Bodnar JL. Effect of osteopathic treatment on a scar assessed by thermal infrared camera, pilot study. Complement Ther Med 2019; 45:130-135. [PMID: 31331549 DOI: 10.1016/j.ctim.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Scar formation is influenced by mechanical forces and may generate mechanical tension. Scars induce a temperature difference in the body objectified by thermal imaging camera. The osteopath's task is to ensure the tissue good mobility in the body. The aim of this study was to measure the influence of osteopathic treatment on a scar by thermal camera. METHOD 12 subjects were analyzed: 4 scars by wounds and 8 by operations. A thermal camera was used to measure the temperature variations of the scars and peri-scar area after cooled stimulation. Measurements were made before and after osteopathic treatment. RESULTS/FINDINGS A significant difference was found between the scar and the peri-scar area before osteopathic treatment (p = 0.044) and no significant difference after osteopathic treatment (p = 0.069). Results showed that osteopathic treatment on a scar induces a more homogeneous local warming temperature. CONCLUSION The osteopathic treatment allows different warming between scar and peri-scar area; this suggests a modification of the connective tissue function after osteopathic treatment. Further studies are required to better understand the function of connective tissue and the mechanism of healing.
Collapse
Affiliation(s)
- Damien Riquet
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, Champs sur Marne, France; Institut de thermique Mécanique Matériaux, Campus du Moulin de la Housse, Reims, France.
| | - Nicolas Houel
- ESO Paris Recherche, Ecole Supérieure d'Ostéopathie, Cité Descartes, Champs sur Marne, France; Laboratoire Performance, Santé, Métrologie, Société, EA - 7507, UFR STAPS Campus du Moulin de la Housse, Reims, France.
| | - Jean-Luc Bodnar
- Institut de thermique Mécanique Matériaux, Campus du Moulin de la Housse, Reims, France.
| |
Collapse
|
8
|
Abstract
A major burn is a severe injury with a global impact. Our system of medical evacuation has led to the survival of many severely injured service members. Burn rehabilitation is a complex and dynamic process and will not be linear. Recovery requires a comprehensive, interdisciplinary team-based approach, individually designed to maximize function, minimize disability, promote self-acceptance, and facilitate survivor and family reintegration into the community.
Collapse
Affiliation(s)
- Alan W Young
- Complementary and Integrative Medicine Service, Department of Pain Management, Brooke Army Medical Center, JBSA, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA; Rehabilitation Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - William Scott Dewey
- Rehabilitation Services, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
| | - Booker T King
- Medical Corps US Army, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
| |
Collapse
|
9
|
Santacreu ES, Cabezas NV, Graupera AB. Combined treatment with paraffin, manual therapy, pegboard and splinting in a patient with post-traumatic stiff hand. Arch Physiother 2016; 6:14. [PMID: 29340195 PMCID: PMC5759923 DOI: 10.1186/s40945-016-0028-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background The stiff hand is a still common, severe complication of hand injuries. Case presentation We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job. Conclusion The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.
Collapse
Affiliation(s)
- Eva Santacreu Santacreu
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
| | - Núria Villanueva Cabezas
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
| | - Asunción Bosch Graupera
- Rehabilitation Service, Area of Traumatology, Hospital Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona, 08035 Spain
| |
Collapse
|
10
|
Mechanical boundary conditions bias fibroblast invasion in a collagen-fibrin wound model. Biophys J 2014; 106:932-43. [PMID: 24559996 DOI: 10.1016/j.bpj.2013.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/17/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022] Open
Abstract
Because fibroblasts deposit the collagen matrix that determines the mechanical integrity of scar tissue, altering fibroblast invasion could alter wound healing outcomes. Anisotropic mechanical boundary conditions (restraint, stretch, or tension) could affect the rate of fibroblast invasion, but their importance relative to the prototypical drivers of fibroblast infiltration during wound healing--cell and chemokine concentration gradients--is unknown. We tested whether anisotropic mechanical boundary conditions affected the directionality and speed of fibroblasts migrating into a three-dimensional model wound, which could simultaneously expose fibroblasts to mechanical, structural, steric, and chemical guidance cues. We created fibrin-filled slits in fibroblast-populated collagen gels and applied uniaxial mechanical restraint along the short or long axis of the fibrin wounds. Anisotropic mechanical conditions increased the efficiency of fibroblast invasion by guiding fibroblasts without increasing their migration speed. The migration behavior could be modeled as a biased random walk, where the bias due to multiple guidance cues was accounted for in the shape of a displacement orientation probability distribution. Taken together, modeling and experiments suggested an effect of strain anisotropy, rather than strain-induced fiber alignment, on fibroblast invasion.
Collapse
|
11
|
Winslow J. Treatment of lateral knee pain using soft tissue mobilization in four female triathletes. Int J Ther Massage Bodywork 2014; 7:25-31. [PMID: 25184012 PMCID: PMC4145001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Prospective case series. BACKGROUND These case reports present results of the treatment of lateral knee pain in four female amateur triathletes. The athletes were referred to the author's clinic with either a diagnosis of iliotibial band friction syndrome or patellofemoral pain syndrome, all four having symptoms for longer than seven months. Changes in training routines were identified as the possible cause of the overuse injuries that eventually developed into chronic conditions. INTERVENTION Treatment involved soft tissue mobilization of the musculotendinous structures on the lateral aspect of the knee. RESULTS At four weeks, three of the athletes improved 9 to 19 points on the Lower Extremity Functional Scale, 3 to 5 points on the Global Rating of Change Scale, and demonstrated improvement in hamstring and iliotibial band flexibility. At eight weeks the Global Rating of Change for these three athletes was a 7 ("a very great deal better") and they had returned to triathlon training with no complaints of lateral knee pain. One athlete did not respond to treatment and eventually underwent arthroscopic surgery for debridement of a lateral meniscus tear. CONCLUSIONS After ruling out common causes for lateral knee pain such as lateral meniscus tear, lateral collateral ligament sprain, patellofemoral dysfunction, osteochondral injury, biceps femoris tendonitis, iliotibial band friction syndrome or osteoarthritis, soft tissue restriction should be considered a potential source of dysfunction. In some cases soft tissue restriction is overlooked; athletes go undiagnosed and are limited from sports participation.
Collapse
Affiliation(s)
- John Winslow
- Corresponding author: John Winslow, DPT, OCS, MTC, ATC, Department of Physical Therapy, Ithaca College, 953 Danby Rd., Ithaca, NY 14850, USA.
| |
Collapse
|
12
|
The role of wound healing and its everyday application in plastic surgery: a practical perspective and systematic review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1. [PMID: 25289204 PMCID: PMC4174176 DOI: 10.1097/gox.0b013e31828ff9f4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND After surgery it is often recommended that patients should refrain from strenuous physical activity for 4-6 weeks. This recommendation is based on the time course of wound healing. Here, we present an overview of incisional wound healing with a focus on 2 principles that guide our postoperative recommendations: the gain of tensile strength of a wound over time and the effect of mechanical stress on wound healing. METHODS A systematic search of the English literature was conducted using OVID, Cochrane databases, and PubMed. Inclusion criteria consisted of articles discussing the dynamics of incisional wound healing, and exclusion criteria consisted of articles discussing nonincisional wounds. RESULTS Experiments as early as 1929 laid the groundwork for our postoperative activity recommendations. Research using animal models has shown that the gain in tensile strength of a surgical wound is sigmoidal in trajectory, reaching maximal strength approximately 6 weeks postoperatively. Although human and clinical data are limited, the principles gained from laboratory investigation have provided important insights into the relationship among mechanical stress, collagen dynamics, and the time course of wound healing. CONCLUSION Our postoperative activity recommendations are based on a series of animal studies. Clinical research supporting these recommendations is minimal, with the most relevant clinical data stemming from early motion protocols in the orthopedic literature. We must seek to establish clinical data to support our postoperative activity recommendations so that we can maximize the physiologic relationships between wound healing and mechanical stress.
Collapse
|
13
|
Manske RC, Prohaska D, Lucas B. Recent advances following anterior cruciate ligament reconstruction: rehabilitation perspectives : Critical reviews in rehabilitation medicine. Curr Rev Musculoskelet Med 2012; 5:59-71. [PMID: 22249750 DOI: 10.1007/s12178-011-9109-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Injuries to the anterior cruciate ligament are common. Surgical reconstruction is more prevalent than ever. This review article discusses treatment of the patient following surgical reconstruction of the anterior cruciate ligament. Various phases of rehabilitation are discussed with emphasis on early return of passive motion, early weight bearing, bracing, kinetic chain exercises, neuromuscular electrical stimulation and accelerated rehabilitation. Although evidence exists for the treatment of the surgically reconstructed cruciate ligament, more is needed to better define specific timeframes for advancement. Evidence exists that many of these young individuals are not fully returning to unlimited high level activities. This review article presents some of the latest evidence regarding anterior cruciate ligament rehabilitation in an attempt to help the busy clinician understand and relate basic and clinical research to rehabilitation of a patient following reconstruction.
Collapse
Affiliation(s)
- Robert C Manske
- Department of Physical Therapy, Wichita State University, 1845 North Fairmount, Wichita, KS, USA,
| | | | | |
Collapse
|
14
|
|
15
|
Regional mechanics determine collagen fiber structure in healing myocardial infarcts. J Mol Cell Cardiol 2012; 52:1083-90. [PMID: 22418281 DOI: 10.1016/j.yjmcc.2012.02.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 02/10/2012] [Accepted: 02/28/2012] [Indexed: 11/20/2022]
Abstract
Following myocardial infarction, the mechanical properties of the healing infarct are an important determinant of heart function and the risk of progression to heart failure. In particular, mechanical anisotropy (having different mechanical properties in different directions) in the healing infarct can preserve pump function of the heart. Based on reports of different collagen structures and mechanical properties in various animal models, we hypothesized that differences in infarct size, shape, and/or location produce different patterns of mechanical stretch that guide evolving collagen fiber structure. We tested the effects of infarct shape and location using a combined experimental and computational approach. We studied mechanics and collagen fiber structure in cryoinfarcts in 53 Sprague-Dawley rats and found that regardless of shape or orientation, cryoinfarcts near the equator of the left ventricle stretched primarily in the circumferential direction and developed circumferentially aligned collagen, while infarcts at the apex stretched similarly in the circumferential and longitudinal directions and developed randomly oriented collagen. In a computational model of infarct healing, an effect of mechanical stretch on fibroblast and collagen alignment was required to reproduce the experimental results. We conclude that mechanical environment determines collagen fiber structure in healing myocardial infarcts. Our results suggest that emerging post-infarction therapies that alter regional mechanics will also alter infarct collagen structure, offering both potential risks and novel therapeutic opportunities.
Collapse
|
16
|
Abstract
Proper hand function relies on a combination of strength and mobility. The intricate architecture that allows for hand mobility includes the articular surfaces of joints, periarticular ligamentous structures, tendon mechanisms, and the soft-tissue envelope. These structures are subject to injury and scarring. The net effect of a variety of etiologic factors is stiffness of the hand with diminution of hand function. This article reviews the biology of healing, pertinent anatomy of the hand, and operative and nonoperative treatment of the stiff hand.
Collapse
Affiliation(s)
- Andrew J Watt
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University Hospitals & Clinics, 770 Welch Road, Suite 400, Palo Alto, CA 94304 USA.
| | | |
Collapse
|
17
|
Bush JA, McGrouther DA, Young VL, Herndon DN, Longaker MT, Mustoe TA, Ferguson MWJ. Recommendations on clinical proof of efficacy for potential scar prevention and reduction therapies. Wound Repair Regen 2011; 19 Suppl 1:s32-7. [DOI: 10.1111/j.1524-475x.2010.00607.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Dewey WS, Richard RL, Parry IS. Positioning, Splinting, and Contracture Management. Phys Med Rehabil Clin N Am 2011; 22:229-47, v. [DOI: 10.1016/j.pmr.2011.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
|
20
|
Glasgow C, Tooth LR, Fleming J. Mobilizing the stiff hand: combining theory and evidence to improve clinical outcomes. J Hand Ther 2011; 23:392-400; quiz 401. [PMID: 20828988 DOI: 10.1016/j.jht.2010.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 05/28/2010] [Accepted: 05/28/2010] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this narrative review is to provide a clinically reasonable guide to intervention choices, by combining a sound understanding of theory with available research evidence. The pathology of contracture formation is presented within the context of tissue repair. The soft tissue response to stress is explained and the optimal "dose" of treatment is discussed. The evidence behind the use of exercise, joint mobilization, continuous passive motion, casting motion to mobilize stiffness, and mobilizing splinting is examined. Recommendations regarding treatment implementation and future research needs are highlighted. The importance of mobilizing splinting and exercise as treatment modalities in the management of joint contracture is demonstrated. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
- Celeste Glasgow
- EKCO Occupational Services, Brisbane, Queensland, Australia.
| | | | | |
Collapse
|
21
|
The Use of Mobilization, Muscle Energy Technique, and Soft Tissue Mobilization Following a Modified Radical Neck Dissection of a Patient with Head and Neck Cancer. REHABILITATION ONCOLOGY 2011. [DOI: 10.1097/01893697-201129010-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Hand Trauma, Dislocations and Fractures, Infections. Plast Reconstr Surg 2010. [DOI: 10.1007/978-1-84882-513-0_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Abstract
Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.
Collapse
|
24
|
Balestrini JL, Billiar KL. Magnitude and duration of stretch modulate fibroblast remodeling. J Biomech Eng 2009; 131:051005. [PMID: 19388775 DOI: 10.1115/1.3049527] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mechanical cues modulate fibroblast tractional forces and remodeling of extracellular matrix in healthy tissue, healing wounds, and engineered matrices. The goal of the present study is to establish dose-response relationships between stretch parameters (magnitude and duration per day) and matrix remodeling metrics (compaction, strength, extensibility, collagen content, contraction, and cellularity). Cyclic equibiaxial stretch of 2-16% was applied to fibroblast-populated fibrin gels for either 6 h or 24 h/day for 8 days. Trends in matrix remodeling metrics as a function of stretch magnitude and duration were analyzed using regression analysis. The compaction and ultimate tensile strength of the tissues increased in a dose-dependent manner with increasing stretch magnitude, yet remained unaffected by the duration in which they were cycled (6 h/day versus 24 h/day). Collagen density increased exponentially as a function of both the magnitude and duration of stretch, with samples stretched for the reduced duration per day having the highest levels of collagen accumulation. Cell number and failure tension were also dependent on both the magnitude and duration of stretch, although stretch-induced increases in these metrics were only present in the samples loaded for 6 h/day. Our results indicate that both the magnitude and the duration per day of stretch are critical parameters in modulating fibroblast remodeling of the extracellular matrix, and that these two factors regulate different aspects of this remodeling. These findings move us one step closer to fully characterizing culture conditions for tissue equivalents, developing improved wound healing treatments and understanding tissue responses to changes in mechanical environments during growth, repair, and disease states.
Collapse
Affiliation(s)
- Jenna L Balestrini
- Departments of Biomedical Engineering and Mechanical Engineering, Worcester Polytechnic University, Worcester, MA 01609-2280, USA
| | | |
Collapse
|
25
|
Abstract
UNLABELLED Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Glenohumeral intra-articular corticosteroid injections, exercise, and joint mobilization all result in improved short- and long-term outcomes. However, there is strong evidence that glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment. A rehabilitation model based on evidence and intervention strategies matched with irritability levels is proposed. Exercise and manual techniques are progressed as the patient's irritability reduces. Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion. Patients who do not respond or worsen should be referred for an intra-articular corticosteroid injection. Patients who have recalcitrant symptoms and disabling pain may respond to either standard or translational manipulation under anesthesia or arthroscopic release. LEVEL OF EVIDENCE Level 5.
Collapse
|
26
|
Abstract
Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.
Collapse
|
27
|
Harrison CA, MacNeil S. The mechanism of skin graft contraction: An update on current research and potential future therapies. Burns 2008; 34:153-63. [DOI: 10.1016/j.burns.2007.08.011] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 08/14/2007] [Indexed: 12/20/2022]
|
28
|
Franz MG, Steed DL, Robson MC. Optimizing healing of the acute wound by minimizing complications. Curr Probl Surg 2007; 44:691-763. [PMID: 18036992 DOI: 10.1067/j.cpsurg.2007.07.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michael G Franz
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | | |
Collapse
|
29
|
Bush JA, Ferguson MWJ, Mason T, McGrouther DA. Skin tension or skin compression? Small circular wounds are likely to shrink, not gape. J Plast Reconstr Aesthet Surg 2007; 61:529-34. [PMID: 17652049 DOI: 10.1016/j.bjps.2007.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 06/06/2007] [Indexed: 11/23/2022]
Abstract
The final appearance of a scar may be influenced by tension or mechanical factors [Borges AF. Scar prognosis of wounds. Br J Plast Surg 1960;13:47-54; Arem AJ, Madden JW. Effects of stress on healing wounds. J Surg Res 1976;20:93-102; Burgess LP, Morin GV, Rand M, et al. Wound healing. Relationship of wound closing tension to scar width in rats. Arch Otolaryngol Head Neck Surg 1990;116:798-802; Meyer M, McGrouther DA. A study relating wound tension to scar morphology in the pre-sternal scar using Langer's technique. Br J Plast Surg 1991;44:291-4] Karl Langer suggested that information could be gained about the tension inherent in skin, in all directions, by observing the wound edge retraction that occurred after making circular skin incisions [Langer K. On the anatomy and physiology of the skin II. Skin tension. Br J Plast Surg 1978;31:93-106]. Circular wounds may be used to demonstrate the orientation of the dominant axis of 'tension' in the skin but is this always a tensile stress as opposed to a compressive stress? This is the second article in a series documenting the mechanical properties of circular punch biopsy wounds. The aim of this study was to make detailed observations of the dimensional distortions of circular wounds on the face and neck, from which deductions could be made with regard to mechanical stress. One hundred and seventy-five benign head and neck lesions were excised from 72 volunteers using circular dermal punch biopsies. The distortions of the resulting wounds were observed to be elliptical in most cases. Measurements were taken of the maximum and minimum diameters of the wound and expressed as ratios of the size of the punch biopsy used for excision. The change in area from the area of the punch biopsy to that of the wound was also calculated. The maximum diameter of the wound was smaller than the diameter of the punch biopsy in 40.6% of cases, the minimum diameter of the wound was smaller in 97.7% of cases and the area of the wound was smaller than that of the punch biopsy in 90.3%. These dimensional changes varied between sites (P=0.0005, P=0.0001 and P<0.0001, respectively). We conclude that the reported rhomboidal or lattice structure [Ridge MD, Wright V. The directional effects of skin. A bioengineering study of skin with particular reference to Langer's Lines. J Invest Dermatol 1966;46:341-6] of skin has individual components which are under tensional force due to elastic retraction. Wounds smaller than the rhomboidal unit will reduce in area, due to the intact tensional forces in the individual dermal components, giving an appearance of the skin overall being under compression. Larger wounds, disrupting more of the lattice structure, will gape.
Collapse
Affiliation(s)
- James A Bush
- Renovo Group plc, The Manchester Incubator Building, 48 Grafton Street, Manchester M13 9XX, UK.
| | | | | | | |
Collapse
|
30
|
Branski RC, Verdolini K, Sandulache V, Rosen CA, Hebda PA. Vocal Fold Wound Healing: A Review for Clinicians. J Voice 2006; 20:432-42. [PMID: 16324825 DOI: 10.1016/j.jvoice.2005.08.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 08/10/2005] [Indexed: 11/30/2022]
Abstract
SUMMARY The basic science of wound healing is largely omitted from the curriculum of many voice clinicians. This fact is relatively disheartening as most therapeutic manipulation in the realm of laryngology and voice disorders deals with injured tissue. Therefore, the selection of therapeutic tasks for persons with vocal injury should ideally be informed by basic science in wound healing. Recently, several investigators have initiated lines of research to determine the course of vocal fold wound healing and the potential role of therapeutic agents, including behavioral agents. The current review seeks to provide a foundation of basic wound healing science and present the most current data regarding the wound healing process in the vocal folds.
Collapse
Affiliation(s)
- Ryan C Branski
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
| | | | | | | | | |
Collapse
|
31
|
Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther 2006; 36:385-402. [PMID: 16776488 DOI: 10.2519/jospt.2006.2222] [Citation(s) in RCA: 277] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rehabilitation following anterior cruciate ligament (ACL) reconstruction has undergone a relatively rapid and global evolution over the past 25 years. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through the end stages of rehabilitation and safe return to sport. Return-to-sport rehabilitation, progressed by quantitatively measured functional goals, may improve the athlete's integration back into sport participation. The purpose of the following clinical commentary is to introduce an example of a criteria-driven algorithm for progression through return-to-sport rehabilitation following ACL reconstruction. Our criteria-based protocol incorporates a dynamic assessment of baseline limb strength, patient-reported outcomes, functional knee stability, bilateral limb symmetry with functional tasks, postural control, power, endurance, agility, and technique with sport-specific tasks. Although this algorithm has limitations, it serves as a foundation to expand future evidence-based evaluation and to foster critical investigation into the development of objective measures to accurately determine readiness to safely return to sport following injury.
Collapse
Affiliation(s)
- Gregory D Myer
- Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA.
| | | | | | | | | |
Collapse
|
32
|
Balestrini JL, Billiar KL. Equibiaxial cyclic stretch stimulates fibroblasts to rapidly remodel fibrin. J Biomech 2006; 39:2983-90. [PMID: 16386746 DOI: 10.1016/j.jbiomech.2005.10.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 10/20/2005] [Indexed: 11/30/2022]
Abstract
Understanding the effects of the mechanical environment on wound healing is critical for developing more effective treatments to reduce scar formation and contracture. The aim of this study was to investigate the effects of dynamic mechanical stretch on cell-mediated early wound remodeling independent of matrix alignment which obscures more subtle remodeling mechanisms. Cyclic equibiaxial stretch (16% stretch at 0.2 Hz) was applied to fibroblast-populated fibrin gel in vitro wound models for eight days. Compaction, density, tensile strength, and collagen content were quantified as functional measures of remodeling. Stretched samples were approximately ten times stronger, eight-fold more dense, and eight times thinner than statically cultured samples. These changes were accompanied by a 15% increase in net collagen but no significant differences in cell number or viability. When collagen crosslinking was inhibited in stretched samples, the extensibility increased and the strength decreased. The apparent weakening was due to a reduction in compaction rather than a decrease in ability of the tissue to withstand tensile forces. Interestingly, inhibiting collagen crosslinking had no measurable effects on the statically cultured samples. These results indicate that amplified cell-mediated compaction and even a slight addition in collagen content play substantial roles in mechanically induced wound strengthening. These findings increase our understanding of how mechanical forces guide the healing response in skin, and the methods employed in this study may also prove valuable tools for investigating stretch-induced remodeling of other planar connective tissues and for creating mechanically robust engineered tissues.
Collapse
Affiliation(s)
- Jenna Leigh Balestrini
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | | |
Collapse
|
33
|
Abstract
Acute wound healing failure is an important source of morbidity and mortality for surgical patients. Many incisional hernias, gastrointestinal anastomotic leaks, and vascular pseudoaneurysms occur despite patient optimization and standardized surgical technique. Modern surgical experience suggests that biologic and mechanical pathways overlap during "normal" acute wound healing. The cellular and molecular processes activated to repair tissue from the moment of injury are under the control of biologic and mechanical signals. Successful acute wound healing occurs when a dynamic balance is met between the loads placed across a provisional matrix and the feedback and feed-forward responses of repair cells.
Collapse
Affiliation(s)
- Derek A Dubay
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
34
|
|
35
|
Fung BKK. Physiological and biomechanical principles in splinting the traumatised hands. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2002; 7:219-22. [PMID: 12596284 DOI: 10.1142/s0218810402001254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this article is to review the biological sequence of wound repair and the rationale of using splintage to modify the healing process. Appropriate use of splintage and controlled stress can prevent adhesion and periarticular fibrosis. Splinting prescribed at appropriate timing and methods will enhance wound healing and tissue remodelling. In reverse, it will cause permanent damage to the tissues.
Collapse
Affiliation(s)
- Boris K K Fung
- Department of Orthopaedic Surgery, Queen Mary Hospital, Hong Kong.
| |
Collapse
|
36
|
Wong JMW. Management of stiff hand: an occupational therapy perspective. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2002; 7:261-9. [PMID: 12596289 DOI: 10.1142/s0218810402001217] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Joint stiffness, resulting from a variety of complications after hand injuries, remains a common problem. Prolonged swelling, scar formation and shortening of soft tissue after prolonged period of immobilisation are the major causes leading to the loss of joint range of motion. Treatment used to improve the joint stiffness should be integrative and problem-focused. Pressure therapy, active and passive mobilisation through remedial activities and corrective splinting should be started as soon as problems arise. Applying low-load stress through prolonged periods of time onto the shortened tissue at its maximum tolerable range is the main principle in restoration of passive joint range of motion. The greater the joint limitation becomes, the longer the time the splint should be applied. Therapists should understand the process of tissue healing and different functions of splints before a correct and effective splint can be prescribed properly.
Collapse
Affiliation(s)
- Josephine M W Wong
- Department of Occupational Therapy, Prince of Wales Hospital, Shatin, New Territories, Hong Kong China.
| |
Collapse
|
37
|
Abstract
This review of the literature assessed what is known about the biomechanics of the normal anterior cruciate ligament during rehabilitation exercises, the biomechanical behavior of the anterior cruciate ligament graft during healing, and clinical studies of rehabilitation after anterior cruciate ligament replacement. After anterior cruciate replacement, immobilization of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the ligamentous, articular, and muscular structures that surround the joint. It is clear that rehabilitation that incorporates early joint motion is beneficial for reducing pain, minimizing capsular contractions, decreasing scar formation that can limit joint motion, and is beneficial for articular cartilage. There is evidence derived from randomized controlled trials that immediately after anterior cruciate ligament reconstruction, weightbearing is possible without producing an increase of anterior knee laxity and is beneficial because it lowers the incidence of patellofemoral pain. Rehabilitation with a closed kinetic chain program results in anteroposterior knee laxity values that are closer to normal, and earlier return to normal daily activities, compared with rehabilitation with an open kinetic chain program. This review revealed that more randomized, controlled trials of rehabilitation are needed. These should include the clinicians' and patients' perspective of the outcome, and biomarkers of articular cartilage metabolism.
Collapse
Affiliation(s)
- Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics & Rehabilitation, University of Vermont, Burlington 05405, USA
| | | | | |
Collapse
|
38
|
Abstract
Static progressive splinting is the use of inelastic components to apply torque to a joint in order to statically position it as close to end range as possible. It maximizes total end-range time, thus increasing passive range of motion. As tissue lengthens in response to this carefully applied stress, the clinician or wearer adjusts the joint position to progress tissue at the new maximum tolerable length. Static progressive splinting combines precision in joint position and torque application with patient-controlled stress to create an approach powerful enough to succeed when no other treatment approach does. This article discusses static progressive splinting indications, contraindications, and advantages as well as guidelines for a splinting regimen. It offers many examples of static progressive splinting and makes clear that this approach can be used with any mobilizing splint design. The unique mechanics of this splinting approach are described, and the various methods of achieving static progressive splinting are compared. Offering high levels of patient satisfaction and compliance, static progressive splinting has come to the forefront of clinical practice.
Collapse
|
39
|
Flowers KR. A proposed decision hierarchy for splinting the stiff joint, with an emphasis on force application parameters. J Hand Ther 2002; 15:158-62. [PMID: 12086026 DOI: 10.1053/hanthe.2002.v15.015015] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
40
|
Oguma H, Murakami G, Takahashi-Iwanaga H, Aoki M, Ishii S. Early anchoring collagen fibers at the bone-tendon interface are conducted by woven bone formation: light microscope and scanning electron microscope observation using a canine model. J Orthop Res 2001; 19:873-80. [PMID: 11562136 DOI: 10.1016/s0736-0266(01)00021-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To clarify the early process of recovery at the bone-tendon interface, we used light microscopy and SEM to examine the process of anchoring of collagen fibers to bone in a canine model. At two weeks, tendon, scar tissue, woven bone and lamellar bone were present at the insertion site. SEM revealed anchoring of collagen fibril bundles of the scar to the woven bone. By 4 weeks, the number of anchoring fibers had increased and a parallel arrangement of fibers was observed. SEM demonstrated deep penetration of fibers into the woven bone layer. In addition, the fibers were observed to project into and intermingle with the scar tissue. By 6 weeks, the anchoring fibers had developed fully and were distributed densely over the interface. SEM also revealed that the collagen fibril bundles in the scar tissue had connected with the collagen fibrils of the woven bone by way of the anchoring bundles. The woven bone was identifiable throughout the early stages of recovery as the interface between soft tissue and hard tissue. Throughout all experimental periods, no staining was observed at the interface of the tendon and bone by Saffranin-O. The formation of woven bone was important during early recovery of the tendon-bone interface prior to the completion of fibrocartilage-mediated insertion.
Collapse
Affiliation(s)
- H Oguma
- Department of Anatomy, Sapporo Medical University, Japan.
| | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- G Hritzo
- NovaCare, Pinal County, Tempe, Arizona 85282, USA
| |
Collapse
|
42
|
Reed BV, Ashikaga T, Fleming BC, Zimny NJ. Effects of ultrasound and stretch on knee ligament extensibility. J Orthop Sports Phys Ther 2000; 30:341-7. [PMID: 10871146 DOI: 10.2519/jospt.2000.30.6.341] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized, double-blind pre-test and post-test with repeated measures. OBJECTIVE To determine whether heating with continuous wattage ultrasound (CWUS) augmented the effects of stretching on ligament extensibility in nonimpaired human subjects. BACKGROUND Heating with CWUS, combined with static stretching, is often used to treat ligament "tightness," but "heat and stretch" has not been studied well in vivo. METHODS AND MEASURES Twenty-one nonimpaired women subjects (aged 31.5 +/- 11.0 years) underwent serial measurements of knee joint displacement (valgus and varus) on a Genucom arthrometer before and after valgus stretch (10 ft-lb x 2.5 minutes). Subjects received either simultaneous CWUS (3 MHz, 1.25 W/cm2) or sham CWUS applied over the medial collateral ligament. Five trials (2 before, 3 after treatment) were conducted with the right knee positioned in 20 degrees of flexion. Subjects received the alternate treatment 28 days later. For each subject, all testing was performed by the same investigator. RESULTS Repeated measures ANOVA revealed that stretching, combined with sham CWUS, increased mean valgus displacement from 8.95 degrees (+/-1.72 degrees) to 10.00 degrees (+/-2.10 degrees). Stretching, combined with CWUS, increased mean valgus displacement from 9.24 degrees (+/-2.36 degrees) to 10.48 degrees (+/-2.54 degrees). This was a 13.4% change from the control condition. CONCLUSION Heating with CWUS did not augment the effects of stretching. "Heat and stretch" with CWUS may not be more effective than stretching alone for increasing the extensibility of dense connective tissue.
Collapse
Affiliation(s)
- B V Reed
- Department of Physical Therapy, University of Vermont, Burlington 05405, USA.
| | | | | | | |
Collapse
|
43
|
Prajapati RT, Chavally-Mis B, Herbage D, Eastwood M, Brown RA. Mechanical loading regulates protease production by fibroblasts in three-dimensional collagen substrates. Wound Repair Regen 2000; 8:226-37. [PMID: 10886813 DOI: 10.1046/j.1524-475x.2000.00226.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mechanical loading is important in tissue formation and remodelling, notably in wound repair. The aim of this study was to measure the effects of controlled loading on the release of extracellular matrix protease activities by fibroblasts. Fibroblast populated collagen lattices were subjected to external cyclical loads through a computer controlled unit incorporated into a culture system, a tensioning-Culture Force Monitor. Cyclical loading was compared to untensioned and statically loaded gels (tethered endogenous contraction). Overall changes in a range of protease activities were monitored (chiefly by zymography) as measures of the cyto-mechanical response to these loads. Under static load, 2.5- and 13-fold more matrix metalloproteinase-2 was produced than matrix metalloproteinase-9, at 24 and 48 hours. Total matrix metalloproteinase-9 increased 37 fold on cyclical loading. Total matrix metalloproteinase-3 and urokinase plasminogen activator activities were dramatically reduced on cyclical loading while tissue type plasminogen activator activity was increased. Comparison with cell responses on stiffer substrates (collagen sponges) identified similar matrix metalloproteinase responses to load, but at much reduced levels (4-6 fold matrix metalloproteinase-9 stimulation on loading), showing the importance of matrix compliance to this mechano-response. In conclusion, physiological mechanical loading of fibroblasts in three dimensional collagen lattices elicited complex and substantial changes in matrix modifying proteases. These changes suggest that cells switch between expression of comparable protease activities mainly influencing cell-matrix interactions associated with migration or more generalized extracellular matrix remodelling.
Collapse
Affiliation(s)
- R T Prajapati
- University College London,Division of Plastic and Reconstructive Surgery, Tissue Repair Unit, London, United Kingdom
| | | | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
The anatomic architecture of connective tissue is dependent on the stresses associated with motion. Immobilization results in stress deprivation, causing structural changes in the tissue matrix. The structural changes that occur are due to the remodeling of tissue to its new resting length while being held immobile. The goal of remodeling stiffened, shortened tissues is to regain tissue length and promote unrestricted tissue gliding. The article reviews studies that examine the viscoelastic response of connective tissue to heat, cold, and stretch. An understanding of connective tissue response to these therapeutic interventions will enable clinicians to choose the appropriate modality and apply stretching techniques in a safe, efficient manner to enable patients to regain mobility.
Collapse
Affiliation(s)
- M Hardy
- University of Mississippi, School of Health Related Professions, USA
| | | |
Collapse
|
46
|
Abstract
Restoration of a patient's full range of motion, strength, and function are the primary goals of occupational and physical therapy. Immobilization of normal connective tissue leads to biochemical, biomechanical, and physiologic changes within a week. These changes are magnified in the presence of trauma or edema, and they may create permanent damage if not addressed swiftly and properly. This is best accomplished by applying specific types of stress to the involved and associated structures at optimal intervals during the rehabilitation process. Load must be applied at adequate intensity and duration to successfully affect the viscous property of connective tissue. This is necessary to effect permanent elongation of the restricted tissues. Early controlled motion is vital to prevent the negative changes associated with immobilization and to maintain normal viscoelasticity and homeostasis of connective tissue. Hand therapists must have a thorough understanding of the changes associated with injured structures. Only then can they provide optimal stress delivery to facilitate restoration of function.
Collapse
Affiliation(s)
- L M Cyr
- Physical Therapy Center Torrington, CT 06790, USA
| | | |
Collapse
|
47
|
Longterm comparison of soft palate scars after UPPP made by CO(2), contact Nd-YAG or combined CO (2) and Nd-YAG laser beams. Lasers Med Sci 1997; 12:347-51. [PMID: 20803275 DOI: 10.1007/bf02767158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/1997] [Revised: 05/08/1997] [Accepted: 06/30/1997] [Indexed: 10/22/2022]
Abstract
C0(2) laser, contact Nd-YAG laser and Combolaser (combined CO(2) and Nd-YAG laser beam) vary distinctively in the way they interact with target tissue. To study the quality of mature scars produced by these lasers, the ultrastructure and amount of collagen in soft palate scars after 60 uvulopalatopharyngoplasty (UPPP) operations were analysed. The CO(2) laser was used in 19, contact Nd-YAG in 21 and Combolaser in 20 operations. At a clinical follow-up examination carried out, on average, 51 (range 34-74) months postoperatively, a specimen was obtained from the soft palate scar for collagen analysis. Postoperative complaints of the patients were acknowledged. No differences between the laser groups were observed concerning the gross appearance of the scars or the amount and ultrastructure of collagen. Neither the frequency nor the quality of post-operative symptoms showed any differences between the lasers. Although the initial tissue effects are different, long-term remodelling produces nearly identical soft palate scars after the use of CO(2), contact Nd-YAG and Combolaser beams.
Collapse
|
48
|
Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. J Urol 1997; 158:4-11. [PMID: 9186313 DOI: 10.1097/00005392-199707000-00003] [Citation(s) in RCA: 174] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The use of shock waves in orthopedic diseases was reviewed with special regard to the clinical applications. MATERIALS AND METHODS Findings in the literature and results from our own studies were analyzed and summarized. RESULTS Extracorporeal shock waves induced osteoneogenesis in animal models with intact and fractured bones. Based on these findings shock waves were used for the treatment of pseudarthrosis in humans. Most patients had at least 1 unsuccessful operation before shock wave therapy. Complete reunion was noted in 62 to 91% of cases and shock waves are recommended by some as the first choice of treatment for hypertrophic pseudarthrosis. After failed nonoperative therapy shock waves were used for the treatment of patients with various diseases as secondary treatment. The success rate for treatment of tendinopathies, such as tennis elbow, periarthritis humeroscapularis or calcaneal spur, was approximately 80%. For calcific tendinitis shock wave therapy seems to be superior to all other minimal or noninvasive techniques without compromising a potential later operation. CONCLUSIONS Shock waves have changed medical therapy substantially. Accounting for the epidemiology of the treated diseases, this new change may equal or even surpass the impact of extracorporeal shock wave lithotripsy.
Collapse
Affiliation(s)
- G Haupt
- Department of Urology, Ruhr-University Bochum, Germany
| |
Collapse
|
49
|
|
50
|
Surveys of the Experience and Perceptions of Post-natal Superficial Dyspareunia of Post-natal Women, General Practitioners and Physiotherapists. Physiotherapy 1996. [DOI: 10.1016/s0031-9406(05)66958-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|