Interpositional elbow arthroplasty using fascia lata autograft in stiff elbow: Case series of 8 patients

Abstract: Total elbow arthroplasty (TEA) has proven to be a reliable joint replacement procedure that has a high degree of patient satisfaction. Despite these favorable outcomes, few patientswith disabling elbow degenerative conditions have TEA recommendedto them as an alternative procedure by rheumatologists, physiatrists,or orthopedists. The semi-constrained, hinged (linked) prosthesis is the most commonly used prosthesis.This prosthesis is stable postoperatively. Patients are encouraged to do range of motionexercises and use their elbow for activities of daily living as dictated by their pain leveland status of wound healing. Wound management is critical following TEA. A posterior triceps–sparing approach, which preserves the continuity of the triceps, whenpossible, is typically used. Postoperatively the therapist and patient need to respect the integrity of the triceps and posterior incision when performing both active and passiveelbow flexion exercises and functional activities. The surgeon may choose to limitflexion range of motion based on the intraoperative inspection of the triceps tendon. We have study on 5 cases patients with elbow arthrosis and went TEA for management of elbow pain and joint limitation of movement

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Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1606288v ◽

2016 ◽

Vol 144 (5-6) ◽

pp. 288-292

Author(s):

Asen Velickov ◽

Predrag Kovacevic ◽

Aleksandra Velickov

Keyword(s):

Lymph Node ◽

Complication Rate ◽

Inguinal Lymph Node ◽

Donor Site ◽

Case Series ◽

Fascia Lata ◽

Tumor Type ◽

Tensor Fascia Lata ◽

Immediate Reconstruction ◽

Tfl Flap

Introduction. Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities. Among different reconstruction options we selected the tensor fascia lata (TFL) musculocutaneous flap. Objective. The paper aims at presenting a series of inguinal block dissections, followed by immediate reconstruction, using the TFL flap, and evaluation of tumor type, flap dimension, complication rate and the duration of hospital stay. Methods. We present a consecutive case series of 25 conducted block dissections. The defects were reconstructed using TFL flap, because of the extent and site of the tissue defects, reliability of the flap, and potentially primarily infected exulcerated tumors. Results. The reconstruction was successful in all cases, the incidence of surgical complications was 16%, no further complications, such as lymphedema or gait disturbances, were noted. Primary skin tumors were predominant (13 cases), followed by genitalia tumors (four cases). The male sex was more frequently affected (14 vs. 11 cases). Conclusion. Having in mind that TFL presents as a flap of adjustable size, length, shape, and volume, with negligible donor site morbidity, and after comparing of our results to those of other authors, we advise broader use of TFL flap. As a reliable flap, not too difficult to harvest, with a low complication rate, it must be taken into consideration regarding the benefits for the patient, and, on the other hand, the surgery cost and duration.

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Achilles Tendon Region Defects: Delayed Composite Anterolateral Thigh Flap With Stripping of Fascia Lata: A Case Series

Wound Management & Prevention ◽

10.25270/wmp.2020.12.1322 ◽

2020 ◽

Vol 66 (12) ◽

pp. 13-22

Author(s):

Cesare Tiengo ◽

Regina Sonda ◽

Andrea Monticelli ◽

Francesco Messana ◽

Alberto Crema ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Short Form ◽

Case Series ◽

Fascia Lata ◽

Anterolateral Thigh Flap ◽

Soft Tissue Reconstruction ◽

Medical Outcomes ◽

Anterolateral Thigh ◽

Tissue Reconstruction

Defects of the Achilles tendon that include the surrounding soft tissue represent a challenge due to complex functionality and biomechanics. PURPOSE: The purpose of this study was to evaluate the functional and physical functioning score outcomes of patients following microsurgical reconstruction of the yarrow region, using a combination of objective, subjective, and semi-subjective measurements. METHODS: Between 2007 and 2018, 15 patients underwent delayed Achilles tendon region reconstruction with different anterolateral thigh flap types. Seven (7) patients underwent tendon and soft tissue reconstruction with a chimeric anterolateral thigh flap (ALT) and rolled-up fascia lata, and 8 patients underwent soft tissue reconstruction and only tendon coverage with fascia lata. Follow-up assessments included maximal range of motion (MROM) (plantarflexion and dorsiflexion), the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale score, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning subscore. RESULTS: A total of 15 patients (11 males and 4 females with a mean age of 39.86 years) were evaluated during a mean follow-up time of 23 months (SD = 7.12). The MROM for plantarflexion and dorsiflexion was 42.71 degrees (SD = 2.9) and 24.8 degrees (SD = 4.29), respectively, in patients who underwent composite ALT with a rolled-up fascia lata. The MROM for plantarflexion and dorsiflexion was 43 degrees (SD = 5.37) and 27.37 degrees (SD = 3.2), respectively, in patients who underwent fasciocutaneous ALT. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 82 for the first group and 86.87 for the second, whereas the mean Medical Outcomes Study 36-item Short-Form Health Survey scores were 82.57 and 81.5, respectively, for the 2 groups. Statistical analysis showed no significant difference between the 2 groups. CONCLUSIONS: The results of this case series suggest that the single-stage composite reconstruction with a fasciocutaneous flap with or without a strip of fascia lata is a safe and reliable strategy for composite reconstruction of the Achilles tendon region. Additional studies to evaluate these outcomes and instruments to evaluate functioning are necessary.

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Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118808242 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711880824 ◽

Cited By ~ 18

Author(s):

Clara Isabel de Campos Azevedo ◽

Ana Catarina Leiria Pires Gago Ângelo ◽

Susana Vinga

Keyword(s):

Minimally Invasive ◽

Donor Site ◽

Case Series ◽

Donor Site Morbidity ◽

Fascia Lata ◽

Rotator Cuff Tears ◽

Shoulder Abduction ◽

Open Approach ◽

Superior Capsular Reconstruction ◽

The Mean

Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly ( P < .001): elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ± 31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months) and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0° ± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from 1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2 years). The mean functional shoulder scores improved significantly ( P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6 months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6 months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6 months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength improved significantly ( P < .001) from 0.0 to 1.1 ± 1.4 kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ± 3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years). This 0.7 ± 1.5–mm overall decrease was statistically significant ( P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery’s end result compensated for the thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.

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Outcomes of Gluteus Maximus and Tensor Fascia Lata Transfer for Primary Deficiency of the Abductors of the Hip

Hip International ◽

10.5301/hipint.5000504 ◽

2017 ◽

Vol 27 (6) ◽

pp. 567-572 ◽

Cited By ~ 14

Author(s):

Sivashankar Chandrasekaran ◽

Nader Darwish ◽

S. Pavan Vemula ◽

Parth Lodhia ◽

Carlos Suarez-Ahedo ◽

...

Keyword(s):

Case Series ◽

Gluteus Maximus ◽

Fascia Lata ◽

The Other ◽

Harris Hip Score ◽

Tensor Fascia Lata ◽

Outcome Score ◽

Small Series ◽

Patient Reported ◽

Abductor Strength

Purpose This study aims to present 3 patients’ results after undergoing gluteus maximus and tensor fascia lata (TFL) transfer for chronic abductor tears unable to be repaired primarily. Methods 3 patients were identified intraoperatively as having an abductor tear unable to be repaired primarily. The anterior 1/3 of the gluteus maximus and the posterior 1/3 of the TFL were mobilised and transferred to the greater trochanter in order to reproduce the normal force vector of the gluteus medius and minimus. Data was prospectively collected for changes in gait, abductor strength, and the following patient reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), visual analogue scale (VAS), and satisfaction. Results The patients were female, 63-75 years old, with BMIs of 23-28. All patients had follow-up at mean 2.1 years (1.25-2.5) with positive Trendelenburg signs preoperatively; 2 patients normalised postoperatively. For 2 patients, abductor strength improved by 2 grades postoperatively; the other patient maintained grade four. 2 patients’ PROs all improved; the other patient's PROs all improved except mHHS. Postoperative VAS scores were 0, 0, 1. 2 patients reported maximum satisfaction. Conclusions This case series suggests that gluteus maximus and TFL transfer for irreparable abductor deficiency may be effective for pain relief, improving abductor strength, and reconstructing abductor function. Although this is a small series, it is to our knowledge the first report of clinical outcomes of this procedure.

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Biocompatibility of allogenic canine fascia lata: In vitro evaluation and small case series

Veterinary Surgery ◽

10.1111/vsu.13358 ◽

2019 ◽

Vol 49 (2) ◽

pp. 310-320

Author(s):

Omar G. El‐Taliawi ◽

Takashi Taguchi ◽

Fanglong Dong ◽

Jean Battig ◽

Dominique J. Griffon

Keyword(s):

Case Series ◽

Fascia Lata ◽

In Vitro Evaluation ◽

Small Case Series

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Total elbow arthroplasty surgery in neglected elbow stiffness post open reduction and internal fixation with plate and screw: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205338 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4525

Author(s):

I. Gede Mahardika Putra ◽

Made Bramantya Karna

Keyword(s):

Internal Fixation ◽

Total Elbow Arthroplasty ◽

Dash Score ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Elbow Stiffness ◽

Postoperative Rehabilitation ◽

Elbow Arthroplasty ◽

Total Elbow Replacement ◽

Stiff Elbow

Post-traumatic and post-operative stiffness of the elbow joint constitutes a significant problem since the elbow is prone to develop soft-tissue contractures and heterotopic bone formation especially if happened in dominant arm. Total elbow replacement is considered as an ultimate treatment in salvaging a stiff elbow which has failed conservative and operative therapeutic procedures to overcome the stiffness and return the elbow to an effective functional arc. A 35-year-old female came to orthopaedic outpatient clinic in Sanglah Hospital, complaining on stiffness in her right elbow since one year prior to admission. This complain was felt after she underwent internal fixation on July 19th 2016, for closed fracture right monteggia bado type-3 post internal fixation. After the surgery, she couldn’t move her elbow because of inappropriate physiotheraphy. Neglected elbow stiffness in this patient was treated surgically with total elbow arthroplasty after physiotherapy has failed to improve her range of motion over 1-year period postoperatively. This decision stated when nonsurgical treatment fails, the patient who has realistic expectations of eventual outcome and who can comply with the arduous postoperative rehabilitation program may be a surgical candidate. Total elbow arthroplasty conducted for these patients resulted in satisfying functional outcome with using quick disabilities of the arm, shoulder and hand (DASH) score improved from 81.8 to 43.2 postoperatively and no complication was reported.

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