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Electron Microscopic Study of Contracted Scarred Skin Under Distraction Produced by Ilizarov External Fixators

A new application of Ilizarov external fixators was used to correct post-burn contracture deformity of the wrist joint, by soft tissue distraction histogenesis. While distraction osteogenesis for bone lengthening and soft tissue expansion for soft tissue lengthening have been widely practiced, no previous experience was found in the literature about lengthening of scarred skin. Ilizarov apparatus was applied to eight post-burn flexion-contracture-deformed wrist joints in five patients: four females and one male, with the ages of 14, 15, 18, 20 and 25 years. Distraction was carried out at the rate of 1 mm/day and stopped at full correction of the deformity. The apparatus was removed four weeks after full correction. The period of distraction ranged between four and seven weeks. Full correction was obtained in seven wrists and a satisfactory correction in the eighth. Minor complications were encountered as infection at a K wire site or slight separation of radial epiphysis, which were managed by simple measures. A biopsy was taken from the scarred skin at the beginning and at the end of the distraction and examined under the Electron Microscope. Collagen fibers were found to be fragmented by the distraction. Signs of immaturity and increased mitosis were found. Due thanks are to the staff of the Electron Microscopic unit in the National Cancer Institute in Cairo for their great help.