Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P. 221005, India.
Burns. 2011 Jun;37(4):692-7. doi: 10.1016/j.burns.2011.01.020. Epub 2011 Feb 22.
Burn scar hand contractures of variable degree are frequently encountered. Although the forearm is apparently spared, it was clinically observed that there was disuse atrophy in the unburnt extrinsic forearm muscles. Usually the clinicians do not give much importance to this fact. The girth at the midforearm was significantly reduced as compared to normal side. The flexion of the hand joints are governed by two components (a) intrinsic and (b) extrinsic muscles. The intrinsic muscles are directly involved in the contracted tissue. Therefore it was thought essential to evaluate the extrinsic group of muscles for their contribution in the final functional recovery following corrective surgery. Thirty patients having unilateral post thermal burn contracture sparing forearm were studied. A detailed clinical evaluation was made including grade of contracture and reduction in the forearm girth. The forearm unburnt muscles were evaluated by preoperative electrophysiological studies. Intraoperative biopsies were taken from these muscles for histopathological examination. On histopathological examination, there were significant abnormal changes in the form of muscle fiber atrophy, fibrolipomatous tissue replacement of atrophic muscle fibers and sarcolemmal changes. These changes were directly proportional to the severity of contractures. The electrophysiological studies showed proportionate changes in the form of reduction in amplitude, duration and interference. This study suggests that if these changes are mild and in reversible stage, they will favourably affect the functional recovery following surgery. However if these changes are of severe grade and irreversible, in spite of adequate surgery, splinting and physiotherapy, the functional recovery may not be complete.
烧伤后手的瘢痕挛缩程度不一，较为常见。虽然前臂明显未受累，但临床上观察到未烧伤的前臂外在肌肉存在废用性萎缩。通常，临床医生不会过多关注这一事实。与正常侧相比，前臂中段的周长明显减小。手部关节的弯曲由两部分组成：（a）内在肌肉和（b）外在肌肉。内在肌肉直接参与挛缩组织。因此，人们认为评估外在肌肉群对于矫正手术后的最终功能恢复至关重要。研究了 30 例单侧热烧伤后挛缩但前臂未受累的患者。进行了详细的临床评估，包括挛缩程度和前臂周长减少。通过术前电生理研究评估未烧伤的前臂肌肉。从这些肌肉中取活检进行组织病理学检查。组织病理学检查显示，肌肉纤维萎缩、纤维脂肪组织替代萎缩肌肉纤维以及肌膜变化等异常改变。这些变化与挛缩的严重程度直接相关。电生理研究显示，振幅、持续时间和干扰的减少呈比例变化。本研究表明，如果这些变化是轻度的、可逆转的，它们将有利于手术后的功能恢复。然而，如果这些变化是严重的、不可逆转的，即使进行了充分的手术、固定和物理治疗，功能恢复也可能不完全。
