Referat Bedah Plastik

NECK CONTRACTURES

Presented by:
Laode Mukhlis Adiguna G99161117
Akbar Deyaharsya G99171004

Pembimbing:
Amru Sungkar, dr., SpB, Sp.BP-RE

KEPANITERAAN KLINIK SMF ILMU BEDAH

FAKULTAS KEDOKTERAN UNS/RSUD DR MOEWARDI
SURAKARTA
2017
Contracture
Contracture is the shortening of two anatomical point that
cause restricted range of motion. It can be caused by fibrosis
of the tissues supporting the muscle or the joint, or by
disorders of the muscle fibers themselves.
AETIOLOGY

1. Heat injuries
2. Chemical injuries
3. Electrical injuries
4. Post-trauma (Volkmann’s)
5. Buruli ulcer
6. Idiopathic (dupuytren’s)
7. Congenital (camptodactyly)
CLASSIFICATIONS

Based on the severity

Grade I: Symptomatic tightness but no limitation in range
of motion or function

Grade II: Mild decrease in range of motion or mild

impairment of function, but wihtot significant impact on
activities of daily living, no distortion of normal
architecture

Grade III: Functional deficit noted, with early changes in

normal architecture of the site or part

Grade IV: Loss of function of the site of the part

CLASSIFICATIONS

Based on the outcome

A: Excellent (normal function)

B: Good (Abnormal function, but able to perform

activities of daily living)

C: Poor (cannot perform activities of daily living)

ETIOPATHOLOGY OF NECK FRACTURE
• The obvious pathophysiology of hypertrophy scarring is
not yet known but many factors contribute to the
fibroproliferative process of the skin. The most commonly
used paradigm is "seed and soil". Cellular components
such as fibroblasts, keratinocytes, stem cells, and
inflammatory cells are seeds whereas non-cellular
components such as extracellular matrix, mechanical
strength, oxygen pressure, and cytokine milieu are soil.
(Wong & Gurtner, 2010).
ETIOPATHOLOGY OF NECK FRACTURE
 The basic mechanisms of contracture formation are
derived from a wide variety of etiologies: congenital,
acquired, or idiopathic. This process is caused by the active
miofibroblasts (a cell with fibroblasts and with
characteristics such as smooth muscle that the granulation
is distributed throughout the tissues present in the
wound). The contraction of the miofibroblasts causes the
wound to shrink. It is also followed by collagen deposition
and interconnected to maintain contraction. In
embryogenesis, failure of the differentiation of the fingers
results in the formation of scarring that causes proximal
flexion of the interphalangeal joint which results in
camptodactyly (Adu, 2011).
DIAGNOSIS
Disinguish between contracture and joint ankylosis

Disinguish between miogenic and neurogenic contractures

Differential diagnosis of contracture from the anatomical structure

a.Cutant, subcutant, or facial
b.Tendon contracture
c.Ligament contracture

d.Muscle contracture

Asses the contracture scar to decide management

Evaluate functionally and aesthetically from joints or tissues on before and

after therapy
PREVENTION
Contractures can be prevented from the original
cause. Many contractures are caused by burns. Burn
prevention is divided into primary, secondary and
tertiary prevention. Primary prevention aims to
reduce the incidence of burns through safe cooking,
firefighting, and education about substances that
cause heat trauma in schools or communities.
Secondary prevention aims to reduce the severity of
burns through education of first aid. Tertiary
prevention aims to reduce mortality and morbidity to
burns
PREVENTION
1. Position for preventing contracture
o Front neck
Positions that can cause contracture are neck flexion, chin pulled
toward the chest, neck contour disappears while position that
prevents the occurrence of contracture is neck extension, no cushion
on the back of the head, turn the neck. Head tilted when sitting
position.
PREVENTION
o Posterior neck
Positions that can cause contractures are neck extensions and other
neck movements whereas the position that prevents the contracture
is sitting with the position of the neck flexion, lying with a pillow
behind the head.
PREVENTION
2. Splint
3. Early stretching and mobilization
4. Daily activities
5. Massage and moisturizer
6. Pressure therapy
7. Silicon
MANAGEMENT
1. Release of contracture
Complete release of contractures should be done
by preventing damage to important structures such as
arteries, nerves, tendons, and so on. The incision starts
in the maximum tension trajectory that is the fastest
area. This point is usually opposite to the joint line.
The incision is deepened until the tissue is not scarred.

2. Skin closure
Closure by using skin grafts or skin flap.
Generally the area is discarded after disposal of
contractile tissue will be closed by using skin grafts.
Closure using flaps is used in special situations.
MANAGEMENT
3. Post-operative care
Maintenance and a loose position are required
for up to 3 weeks or until the flap border is healed.
Postoperative care using static or dynamic splint and
also physical exercise therapy is necessary to maintain
the scope of joint motion.