Nursing Care and Causative Analysis of Grade IV Capsular Contracture Following Breast Cancer Expander Implantation

Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.

Characterization of BellaGel SmoothFine^®Implant Surfaces and Correlation with Capsular Contracture

BellaGel SmoothFine®implant is a novel nanotextured silicone breast implant. The objective of this study was to characterize differences of BellaGel SmoothFine®surfaces with commercial available implant surfaces in terms of texture, topography, and wettability as well as the behavior of capsular contracture. The surface textures of breast implants from two different manufacturers (Hans Biomed and Motiva) were evaluated. The implants utilized in this study were BellaGel Smooth®, BellaGel Textured®, BellaGel SmoothFine®?or Motiva SilkSurface®. The shell textures of these implants were characterized using a scanning electron microscopy, three dimensional confocal laser scanning microscope, and contact angle goniometer. Silicone breast implants were emplaced beneath the panniculus carnosus muscle on the dorsum of Sprague Dawley rats and observed for up to 8 weeks postoperative days. The fibrous capsules around silicone implants were explanted for histological examination. BellaGel SmoothFine®exhibits a relatively flat, with little or no depth in the texturing, 5.96 ± 0.41 μm surface roughness, and a contact angle of 103.14 ± 2.06 BellGel SmoothFine®implant resulted in significant decreases in capsule thickness (P P ®and BellaGel Textured®implant groups. Significant (P ®. Fibrous tissue formation markers (Vimentin and alpha-smooth muscle actin) were significantly reduced in BellaGel SmoothFine®surfaces versus BellaGel Smooth®surfaces (P ®groups (P ®implant is associated with less breast implant derived capsular contracture than other surfaces.

Errors in visual estimation of flexion contractures during total knee arthroplasty

AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was placed.RESULTS: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error associated with visual estimation of knee flexion contractures, and developed a simple, reliable device and method to improve feedback related to sagittal alignment during TKA.

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

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

Evaluation of Clinical Efficacy of Combination of Surgery and Rehabilitation for Treatment of Scar Contracture after Hand Burn

Objective:To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn.Methods:Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019.The subjects were divided into regular group and combined group according to random number table method.The regular group(n=33)received surgical treatment alone.The combined group(n=33)patients were given surgery combined with rehabilitation.Recovery of hand function,efficacy of clinical treatment,hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn.Results:Efficacy,recovery of hand function(finger,finger flexion and extension,palm and finger adduction or abduction,daily activity,wrist rotation,wrist flexion and extension,appearance and sensory function)and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn.P<0.05,the indicator data showed statistical significance.Conclusion:Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.

Surgical Treatment of Complex Axillary Scare Contractures: One Case Report

Background: Axillary scar contracture is frequently observed after severe burn insult and is usually accompanied by scarred adjacent area. These scars result in adduction deformity, which may be severe and diffuse. The lack of adequate treatment in the acute phase leads to complex scars that require different surgical techniques depending on the clinical examination of surgeon. Aim: Expose the possible surgical techniques, their advantages and disadvantages in the case of burning of the entire axillary hollow. The surgical management of linear scares contractures will not be discussed in this article. Case presentation: This is a rare clinical case of a 12-year-old girl who was burned at the age of 5 with disabling functional sequelae of the axillary area (limitation of the abduction to 30 degrees). The patient is treated at ALGHASSANI Hospital in Fes city/Morocco. Parental consent was taken for scientific publication. Results: We did two surgical interventions: the first starting with excision of the scar tissue leaving a loss of skin covered by a laterothoracic IC fasciocutaneous flap. The second one was a semi-thick skin graft to cover the supero and infero external quadrants of the left breast. We obtain the abduction at 110 degrees. Conclusion: Early surgical management of deep lesions within 21 days of the burn associated with prolonged rehabilitation and the wearing of compression garments and splints are essential elements in the prevention of these axillary contractures.

Application of Frontotemporal Expanded Flap with Bilateral Superficial temporal vessels in Repair of Large Area Scar Contracture in Face and Neck

Objective To summarize the clinical experience of frontotemporal expanded flap with bilateral superficial temporal vessels in repairing large area scar contracture in face and neck.Methods 14 patients with facial and Cervical scar contracture in our hospital were taken as the research object.With bilateral superficial temporal vessels as pedicles,a 400-600 ml skin dilator was inserted into the forehead and 50-100 ml skin dilator was inserted into the two temporal parts respectively.Within 3-4 months,the water injection volume reaches 2 times of the dilator volume.After maintaining for one month,skin flap transplantation was performed.The frontal flap was reserved for hairline reconstruction,and the flap was cut to cover the area after facial and Cervical scar release to reconstruct the jaw-neck angle.The pedicle division and pedicle trimming were performed 3-4 weeks after operation.Results All the 14 patients completed the operation successfully.The flap expansion time is 5-6 months.The expanded skin flap covers an area of 26 cm×9 cm-42 cm×16 cm,and all the skin flaps survived after operation.Among them,2 patients suffered from flap congestion after flap transplantation.Follow-up for 6-12 months showed that the color and texture of the skin flap were similar to those of facial skin,with natural transition and no obvious bloating.The angle between the lower jaw and the neck is about 90.The anterior flexion,posterior extension,lateral flexion and rotation of the neck are obviously improved compared with the anterior,and the posterior extension is close to normal.Conclusion Frontotemporal expanded flap with bilateral superficial temporal vessels is suitable for patients with large-area scar contracture in face and neck that cannot be repaired after expansion of adjacent local normal tissues.

Application of fascial flaps of supraclavicular artery in repair of neck scar contracture

Objective To observe eflect uf fascial flaps of supraclavicular artery on treatment of neck scar contracture. Methods The supraclavicular flaps were designed according to direction of supraclavicular arteries and transferred into detective areas caused by scar releasing.

改进YOLOv5su模型检测桃树缩叶病

为实现自然环境下桃树缩叶病的检测,该研究提出了一种基于YOLOv5su的桃树缩叶病识别改进模型DLLYOLOv5su。首先,针对桃树缩叶病目标特征变化较大的问题,在骨干网络最后一层C3模块中加入可变形自注意力模块(deformable attention,DA),使模型更加关注目标区域,降低背景对模型的影响,提高模型在复杂背景下的拟合能力。其次在SPPF(fast spatial pyramid pooling)模块中引入LSKA(large separable kernel attention)结构,大核卷积增大了模型的感受野,使模型能够关注更多信息。最后,提出了LAWD(lightweight adaptive weighted downsampling)模块,使用轻量化的下采样结构替换卷积模块,减少计算开销。在桃树缩叶病数据集上进行试验,结果显示,DLL-YOLOv5su模型权重大小为17.6 MB,检测速度为83帧/s。识别准确率P、召回率R和平均精度均值mAP_(50)分别达到了80.7%、73.1%和80.4%,相较于原始YOLOv5su分别提高了4.2、2.4和4.3个百分点。与YOLOv3-tiny、Faster R-CNN、YOLOv7和YOLOv8相比mAP_(50)分别高出了28.5、11.8、2.1和4.1个百分点。改进模型识别精度高,误检、漏检率低,检测速度满足实时检测的要求,可以为桃树缩叶病的实时监测和预警提供参考。

A Retrospective Analysis of the Gluteal Muscles Contracture and Discussion of the Relative Problems

Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscles contracture, being subjected to a 'Z-shaped' release lengthening operation and efficiency exercise, was clearly standardized. All the cases were followed up from 3 months to 2 years with the effective rate being 100 %, the cure rate being 98. 5 %, the recent complications being 5%, and the far complications being 0. 2 %. It was concluded that the clear diagnosis combined with standarized operation and efficiency functional exercise could greatly improve the therapeutic effects of gluteal muscles contracture.

Treatment of Severe Gluteal Muscle Contracture in Children

To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondence or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.

小麦SUS基因家族鉴定与生物信息学分析

【目的】对小麦蔗糖合成酶(sucrose synthase,SUS)基因家族进行鉴定和生物信息学分析,为探究小麦SUS(TaSUS)基因家族的作用机制提供理论参考。【方法】采用生物信息学方法在小麦全基因组上鉴定TaSUS基因家族成员,并对其系统进化关系、染色体位置、基因结构、保守结构域、启动子顺式作用元件和基因表达模式进行分析。【结果】在小麦基因组中共鉴定到分布于14条染色体上的24个TaSUS基因,可分为3个亚组。TaSUS基因含有多个外显子,但部分基因缺失非翻译区结构。TaSUS基因家族成员启动子区域包含45种顺式作用元件,涉及植物生长发育和逆境胁迫响应。大多数TaSUS基因在小麦穗中显著表达,在叶、茎和根中的相对表达量较低。【结论】研究结果有助于了解小麦SUS基因家族的进化,为后期小麦SUS基因家族的生物功能研究奠定理论基础。

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

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

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

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

A Rare Case of Multiple Scar Contractures after Burn Injury

A nine-year-old girl sustained extreme postburn contractures of the face, neck, both axillae, elbows, wrists, and ankles, due to flame injury 5 years ago. No primary and plastic surgical burn treatment was available in a remote area of China. From October, 2005 to April, 2007, all adhesions were released in five operations and the huge defects covered with local musculo-cutaneous flaps, z-plasties, and with thick split skin gafts. This led to an optimal functional result and an aesthetic restoration of the face, giving her, back her self-esteem in daily life.

Contracture Development in Whales

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

Desmoid Tumor Causing Hip Joint Contracture: A Case Report

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

温度对SUS410/BNi-2/Hastelloy X钎焊接头界面组织及力学性能的影响

目的针对汽封部件的高质量制造需求,系统研究了温度对SUS410/BNi-2/Hastelloy X钎焊接头微观组织及力学性能的影响。方法将以SUS410/BNi-2/Hastelloy X搭接结构装配的试样放入真空炉中在不同温度(1060~1140℃)下进行钎焊连接,利用SEM和EDS等手段分析钎料与母材之间的相互作用,测试接头的力学性能并分析接头断裂行为,研究温度对接头界面组织演化和力学性能的影响。结果钎缝主要由Ni(s,s)与Cr-B相组成,B元素扩散进入两侧母材,在晶界处聚集形成硼化物相。随着钎焊温度的升高,钎缝中富Cr的硼化物和浅灰色Ni(s,s)相消失,形成均匀的Ni(s,s)组织,两侧母材中B元素扩散深度增加。随着钎焊温度不断升高,钎焊接头的抗剪强度逐渐上升,上升到某一强度后,温度继续升高,但强度反而下降,断裂位置由钎缝中心先转移至Hastelloy X基体,随着温度继续升高,断裂位置又转移至SUS410扩散区。断裂形式由脆性断裂转变为韧性断裂。结论采用BNi-2黏带钎料实现了SUS410与Hastelloy X合金的可靠连接,接头典型界面组织为SUS410/扩散区((Fe,Cr)+(Fe,Cr)-B)/钎缝区(Ni(s,s)+Cr-B+β_(1)-phases)/扩散区(γ-phase+(Cr,Ni)-B+(Cr,Ni,Mo)-B)/Hastelloy X;钎焊接头的最大抗剪强度为235.6 MPa(1100℃)。

Modified Z-Plasty for Reconstruction of Webbed Scar Contractures

Rationale: Webbed scar contractures deformity caused by burns and other factors will lead to joint disorders and affect the mental health of patients, resulting in a severe decline in quality of life. Rapid, effective and less complicated surgical methods can help patients with post-burn rehabilitation. Objective: This article argues that a modified Z-plasty can quickly improve the range of motion caused by webbed scar contractures in joint areas, including surgical methods, postoperative care and prognosis. Methods and Results: The study took place from 2018 to 2022. Thirty-two patients with joint scar contracture deformity, with a mean age of 32.5 years, were included in the study. All patients underwent contracture scar revision and modified Z-plasty repair under anesthesia. All the flaps survived and the joint function was improved. Compared with the traditional Z-plasty, the duration of the operative procedure of the modified Z-plasty was significantly shorter, more surrounding scar tissue was mobilized, and the effectiveness of postoperative scar contracture release was better. Discussions: The modified Z-plasty for scar contracture deformity in joint area is simple, rapid, effective and easy to manage.

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

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