Retrograde muscle release method in treatment of mild to moderate ischemic muscle contracture of forearm_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Rongcan ¹ , LI Chengli ¹ , GUO Xinfeng ¹ , YUAN Ye ² , DENG Jiuzheng ² ,  PAN Yongwei ²

1. School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China;
2. Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, P.R.China;

Corresponding author：

PAN Yongwei, Email: ywpan2013@163.com

Keywords：

Forearm; ischemic muscle contracture; muscle release; functional reconstruction

DOI：

10.7507/1002-1892.202011004

Video：

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Objective To investigate the effectiveness of retrograde muscle release in treatment of mild to moderate type ischemic muscle contracture of forearm classified by Tsuge.Methods Between March 2010 and September 2018, 11 patients with mild to moderate ischemic muscle contracture of forearm were treated with retrograde muscle release. There were 6 males and 5 females with an average age of 24 years (range, 16-29 years). According to Tsuge classification, 6 cases were mild type and 5 cases were moderate type. The interval between injury and operation was 9 months to 25 years, with a median of 17 years. The scar cords in the muscle of the middle one-third of the forearm was released firstly. If the standard of sufficient release was not reached, further releasing the scar cords in the muscle and the tense tendon structure in the proximal one-third of the forearm and the origins of the flexor muscles was necessary. If the standard was still not reached, the origins of the flexor muscles can be released and slid. The effectiveness was evaluated from six aspects of the range of motion of the hand and wrist, dexterity, grip strength, sensation, subjective function scores [quick-disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and the patient-related wrist/hand evaluation (PRWHE)] and satisfaction.Results All the incisions healed by first intention. Eight patients were followed up 1-106 months (median, 13 months). The range of motion of the hand and wrist was significantly improved, the results were excellent in 3 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 75%. The patient’s dexterity evaluation scored a perfect score of 12, which was close to the normal hand dexterity. At last follow-up, the grip strength on the affected side was 37.6%-95.5% of the contralateral side, with an average of 77.6%. Seven patients had normal sensation before and after operation, and the two-point discrimination of median nerve and ulnar nerve was 4-5 mm at last follow-up; 1 patient with forearm mechanical crush injury still felt numb after operation, and the two-point discrimination of median nerve and ulnar nerve was 8 mm and 7 mm, respectively. The Quick-DASH score was 0-15.9, with an average of 4.5, and the PRWHE score was 0-23.0, with an average of 6.6. All the patients were satisfied with the surgery and the effectiveness.Conclusion A targeted retrograde muscle release method for mild to moderate type ischemic contracture of forearm can achieve satisfactory effectiveness.

Citation： HAN Rongcan, LI Chengli, GUO Xinfeng, YUAN Ye, DENG Jiuzheng, PAN Yongwei. Retrograde muscle release method in treatment of mild to moderate ischemic muscle contracture of forearm. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 483-487. doi: 10.7507/1002-1892.202011004 Copy

1.	Mirza TM, Shrestha AB. Volkmann contracture. Treasure Island (FL): StatPearls Publishing, 2020. PMID: 32491686.
2.	Tsuge K. Treatment of established Volkmann’s contracture. J Bone Joint Surg (Am), 1975, 57(7): 925-929.
3.	程贺云, 巨积辉, 赵强, 等. 肌腱 “Z” 形延长术治疗小儿晚期轻中型前臂缺血性肌挛缩致手指畸形. 实用手外科杂志, 2019, 33(4): 371-373.
4.	曹广超, 郑大伟, 张广宇, 等. 肌腱延长术联合动力型支具治疗轻中型前臂缺血性肌挛缩的疗效. 实用手外科杂志, 2016, 30(4): 442-443, 446.
5.	Sharma P, Swamy MK. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm. J Orthop Traumatol, 2012, 13(4): 189-196.
6.	Kaji Y, Nakamura O, Yamaguchi K, et al. Localized type Volkmann’s contracture treated with tendon transfer and tension-reduced early mobilization: A case report. Medicine (Baltimore), 2017, 96(1): e5807.
7.	Ultee J, Hovius SE. Functional results after treatment of Volkmann's ischemic contracture: a long-term followup study. Clin Orthop Relat Res, 2005, (431): 42-49.
8.	李中檀, 李炳万, 李大村, 等. 前臂缺血性肌挛缩症畸形固定期的手术方法及其疗效. 解剖与临床, 2005, 10(3): 178-180.
9.	蒋电明, 安洪, 毛莉颖, 等. 屈肌起点滑移术治疗前臂缺血性肌挛缩. 中华手外科杂志, 1998, 14(1): 32-34.
10.	Griffart A, Gauthier E, Vaiss L, et al. Functional and socioprofessional outcome of surgery for Volkmann’s contracture. Orthop Traumatol Surg Res, 2019, 105(3): 423-427.
11.	MacDermid JC, Tottenham V. Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther, 2004, 17(1): 18-23.
12.	Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. Volume 2.7th eds. Philadelphia, PA: Elsevier, 2017: 1763-1787.
13.	Kistler JM, Ilyas AM, Thoder JJ. Forearm Compartment syndrome: Evaluation and management. Hand Clin, 2018, 34(1): 53-60.
14.	Seddon HJ. Volkmann’s contracture: treatment by excision of the infarct. J Bone Joint Surg (Br), 1956, 38-B(1): 152-174.
15.	Stevanovic M, Sharpe F. Management of established Volkmann’s contracture of the forearm in children. Hand Clin, 2006, 22(1): 99-111.

1. Mirza TM, Shrestha AB. Volkmann contracture. Treasure Island (FL): StatPearls Publishing, 2020. PMID: 32491686.
2. Tsuge K. Treatment of established Volkmann’s contracture. J Bone Joint Surg (Am), 1975, 57(7): 925-929.
3. 程贺云, 巨积辉, 赵强, 等. 肌腱 “Z” 形延长术治疗小儿晚期轻中型前臂缺血性肌挛缩致手指畸形. 实用手外科杂志, 2019, 33(4): 371-373.
4. 曹广超, 郑大伟, 张广宇, 等. 肌腱延长术联合动力型支具治疗轻中型前臂缺血性肌挛缩的疗效. 实用手外科杂志, 2016, 30(4): 442-443, 446.
5. Sharma P, Swamy MK. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm. J Orthop Traumatol, 2012, 13(4): 189-196.
6. Kaji Y, Nakamura O, Yamaguchi K, et al. Localized type Volkmann’s contracture treated with tendon transfer and tension-reduced early mobilization: A case report. Medicine (Baltimore), 2017, 96(1): e5807.
7. Ultee J, Hovius SE. Functional results after treatment of Volkmann's ischemic contracture: a long-term followup study. Clin Orthop Relat Res, 2005, (431): 42-49.
8. 李中檀, 李炳万, 李大村, 等. 前臂缺血性肌挛缩症畸形固定期的手术方法及其疗效. 解剖与临床, 2005, 10(3): 178-180.
9. 蒋电明, 安洪, 毛莉颖, 等. 屈肌起点滑移术治疗前臂缺血性肌挛缩. 中华手外科杂志, 1998, 14(1): 32-34.
10. Griffart A, Gauthier E, Vaiss L, et al. Functional and socioprofessional outcome of surgery for Volkmann’s contracture. Orthop Traumatol Surg Res, 2019, 105(3): 423-427.
11. MacDermid JC, Tottenham V. Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther, 2004, 17(1): 18-23.
12. Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. Volume 2.7th eds. Philadelphia, PA: Elsevier, 2017: 1763-1787.
13. Kistler JM, Ilyas AM, Thoder JJ. Forearm Compartment syndrome: Evaluation and management. Hand Clin, 2018, 34(1): 53-60.
14. Seddon HJ. Volkmann’s contracture: treatment by excision of the infarct. J Bone Joint Surg (Br), 1956, 38-B(1): 152-174.
15. Stevanovic M, Sharpe F. Management of established Volkmann’s contracture of the forearm in children. Hand Clin, 2006, 22(1): 99-111.

Chinese Journal of Reparative and Reconstructive Surgery

Retrograde muscle release method in treatment of mild to moderate ischemic muscle contracture of forearm

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