What type of surgery is recommended for contracture release?

Surgical Approaches for Contracture Release

For contracture release surgery, extensive transverse incisions across the affected area extending into subcutaneous tissue is recommended to improve function, reduce pain, and enhance quality of life.

Types of Surgical Procedures for Contracture Release

Foot Contracture Release

• Surgical release of pseudosyndactyly and mitten deformities of the feet, as well as contractures of the lower extremities, should be considered particularly in patients with dystrophic epidermolysis bullosa (DEB) 1
• For clawed toes, extensive transverse incisions across the dorsal and/or plantar surface of the toes and distal forefoot, extending into the subcutaneous tissue, improves foot contour, reduces pain on walking, and allows shoes to be worn 1
• Early extension procedures to address contractures of the toes and equinus and cavus deformities using soft-tissue surgery are recommended despite potential long-term complications 1

Minimally Invasive Approaches

• For stroke-related equinovarus foot contracture, a minimally invasive approach including Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy allows immediate weightbearing and improves outcomes 2, 3
• This approach improves foot and ankle alignment for ease of bracing, which improves gait, reduces fall risk, decreases pain, and prevents pressure sores 2

Patient Selection and Timing

• Surgery is primarily indicated when contractures limit function, cause pain, or prevent proper footwear use 1
• For lower extremity contractures, surgery should be considered when they affect mobility and quality of life 1
• Surgical intervention may be more beneficial before contractures become severe and fixed 1

Expected Outcomes and Limitations

• Improvements in foot contour, reduced pain on walking, and improved ability to wear shoes can be expected following successful contracture release 1
• The release of pseudosyndactyly makes it easier to wear normal footwear and provides psychological benefit to patients 1
• Improvements may last for several years, but recurrence is likely due to the progressive nature of underlying conditions 1
• Contractures almost always recur, and because of the lack of long-term benefit, patients often refuse further surgical interventions 1

Post-Surgical Management

• For stroke patients, early active-flexion range-of-motion exercises are essential to restore function 1
• Positioning of the affected area in maximum extension for 30 minutes each day either in bed or in a chair can help prevent contracture recurrence 1
• Standing on a tilt table for 30 minutes daily is useful in preventing contracture 1
• Nighttime extension splints may be used for several months postoperatively to maintain the correction achieved in surgery 1

Specific Considerations for Different Conditions

Epidermolysis Bullosa

• In patients with DEB, surgery for pseudosyndactyly and mitten deformities of the feet can reduce pain and improve mobility 1
• Due to the relative short-term nature of cosmetic improvement and limited functional improvement, selective digital amputation may be more appropriate in some cases 1
• Patients should carefully consider benefits versus risks, as contractures often recur 1

Stroke-Related Contractures

• For stroke patients with equinovarus deformity, minimally invasive soft tissue release allows immediate weightbearing and improves outcomes 2, 3
• Surgical release of the brachialis, brachioradialis, and biceps muscles is a reasonable option to treat pain and range-of-motion limitations in patients with substantial established elbow flexor contractures 1

Common Pitfalls and Caveats

• Recurrence of contractures is common, especially in progressive conditions, and patients should be counseled about this likelihood 1
• The benefits of surgery must be weighed against the risks, including wound healing complications, particularly in patients with underlying skin conditions 1
• Failure to implement appropriate post-surgical management, including positioning, splinting, and physical therapy, may lead to early recurrence 1
• Patients should be monitored for changes in pain levels, mobility, and development of new deformities or complications 4