scholarly journals Saphenous Artery Perforator/Propeller Flap in the Reconstruction of Perigenual Soft Tissue Defects

2019 ◽  
Vol 52 (03) ◽  
pp. 330-336
Author(s):  
T. M. Balakrishnan ◽  
Aishwarya Vadakencherry Lakshmi Narayanan ◽  
J. Jaganmohan
Keyword(s):  
Cadaver Study ◽  
Level Of Evidence ◽  
Propeller Flap ◽  
Evidence Type ◽  
Therapeutic Study ◽  
Type V ◽  
Artery Perforator ◽  
Saphenous Artery

Abstract Introduction In this article, we investigate the saphenous artery perforator propeller flap for the reconstruction of perigenual defects. We describe the anatomy of the saphenous artery and the method of raising a perforator propeller flap based on our study and early clinical experience. Aim To assess the effectiveness of the saphenous artery perforator propeller flap in the reconstruction of perigenual defects. Materials and Methods A preliminary cadaver dissection and injection study was conducted to discern the anatomical details of the perforator system of the saphenous vessel in 35 cadaveric specimens in 18 fresh cadavers. From March 2016 to March 2018, 16 clinical cases (5 females and 11 males, in the average age group of 33.5 years) with perigenual defects were reconstructed with saphenous artery perforator propeller flap. They were followed up for an average period of 12.5 months. Results Cadaver study established anterior sartorial perforators as the dominant system of the saphenous vessel and brought to the forefront the type 2 blood supply of the saphenous nerve. All patients had well-settled flaps at the end of the follow-up period, with good return of knee function. Conclusion Saphenous artery perforator propeller flap is a viable option for the reconstruction of defects around the knee joint. Level of Evidence Type V, therapeutic study.

scholarly journals Complications and Pitfalls after Finger Replantation in Young Children

2018 ◽  
Vol 10 (02) ◽  
pp. 74-78 ◽  
Author(s):  
Thibault Lafosse ◽  
Pascal Jehanno ◽  
Frank Fitoussi
Keyword(s):  
Young Children ◽  
Young Patients ◽  
Case Series ◽  
Level Of Evidence ◽  
Active Range Of Motion ◽  
Evidence Type ◽  
Therapeutic Study ◽  
Everyday Life Activities ◽  
Finger Replantation

Abstract Study Design This is a retrospective cohort study. Objective The authors report surgical outcome in a series of very young children who underwent finger replantation after traumatic amputation. Methods During a 10-year period, 65 children were treated with replantation for finger amputation in two institutions. This study focused on replantation of 15 fingers in 13 young patients under 6 years of age (mean age: 2.9 years; range: 1.1–5.7 years). Early postoperative complications were categorized into major or minor. At the time of assessment, the authors evaluated everyday life activities, pain and cold tolerance, total active range of motion (TAM) in patients with successful replantation, and growth disturbance. Results The overall success rate for children younger than 6 years was 47% (7 out of 15), and the authors had 67% of major complications, mainly in patients with crush injuries. There was venous ischemia in 13 (86%) fingers treated with controlled bleeding. The hemoglobin level decreased more than 2 g/dL in six patients, and blood transfusion was necessary in two patients. At the last follow-up, patients with successful replantation had a mean TAM of 72%. Conclusion Despite numerous complications mainly in relation with venous congestion, the functional outcome is satisfactory after successful replantation in young children, which should always be attempted. Level of Evidence/Type of Study Level III, case series, therapeutic study.

scholarly journals Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

2017 ◽  
Vol 06 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Avanthi Mandaleson ◽  
Michael Wagels ◽  
Stephen Tham
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Pinch Grip ◽  
The Mean ◽  
Therapeutic Study

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

2021 ◽  
Author(s):  
Jaak Warlop ◽  
Maarten Van Nuffel ◽  
Luc De Smet ◽  
Ilse Degreef
Keyword(s):  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Visual Analog Scale Score ◽  
Distal Radioulnar Joint ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Therapeutic Study ◽  
And Function

Abstract Background A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ function. To date, most outcome reports are coauthored by the designer. Questions Does independent reporting confirm the promising results of the semiconstrained DRUJ prosthesis? Are complication and failure rates acceptable? Patients and Methods We evaluated patients with the semiconstrained DRUJ implant and a minimum follow-up of 2 years. We monitored patient satisfaction and function with functionality questionnaires and measured wrist range of motion, grip, and key pinch strength. Statistical analysis was done using descriptive statistics, Pearson correlation coefficients, linear and logistic regression. Results We included 41 patients with 42 implants. Mean follow-up was 46 months (range: 24–102 months). Eighty percent of wrist had undergone previous surgery. We found a mean pronation of 83 degrees (0–90 degrees), supination of 70 degrees (0–90 degrees), flexion of 42 degrees (0–90 degrees), extension of 49 degrees (0–90 degrees), ulnar deviation of 24 degrees (0–60 degrees), and radial deviation of 14 degrees (0–40 degrees). Grip and key pinch strength were 20.1 (1–50 kg) and 6 kg (1–12 kg), respectively. Average patient-rated wrist and hand evaluation score was 42.7 (0–95), disabilities of the arm, shoulder and hand score was 38 (0–88), and visual analog scale score was 3.6 (0–8). We found a 43% complication rate (mostly minor: ulnar or radial tendinopathy, temporary hypoesthesia) with 24% reoperation and 92% prosthesis survival rate. Conclusion The linked semiconstrained DRUJ prosthesis has its value in the surgical treatment of DRUJ failure. Currently, most implants are used in secondary surgery and multioperated wrists. More research is required to assess the value of the DRUJ prosthesis as a primary procedure. Level of evidence This is a level IV, therapeutic study.

Osseocartilaginous Rib Graft L-Strut for Nasal Framework Reconstruction

2019 ◽  
Author(s):  
Peter J Ciolek ◽  
Andrea L Hanick ◽  
Michael Roskies ◽  
Michael A Fritz
Keyword(s):  
Primary Outcome ◽  
Tertiary Care ◽  
Traumatic Injury ◽  
Care Hospital ◽  
Level Of Evidence ◽  
Type Iv ◽  
Type V ◽  
Contractile Forces ◽  
Nasal Defects

Abstract Background In the setting of major nasal framework reconstruction, it is critical to create a stable, warp-resistant L-strut to resist the contractile forces of healing to achieve a durable outcome. Objectives The authors sought to demonstrate the effectiveness of the osseocartilaginous rib graft for nasal framework reconstruction. Methods Retrospective analysis was performed of all patients who underwent osseocartilaginous rib graft for L-strut reconstruction from 2007 to 2017 at a tertiary care hospital. Only patients with severe framework-only defects (Type IV, Daniel Classification) or total/subtotal nasal defects (Type V, Daniel Classification) were included. Primary outcome measures were: (1) maintenance of projection; (2) graft warping; and (3) graft resorption. Results Twenty-six patients aged an average of 54.6 years underwent nasal framework reconstruction with an osseocartilaginous rib graft L-strut. Eighteen patients had framework-only deformities (Daniel Type IV) and 8 had total or subtotal nasal deformities (Daniel Type V). Twelve patients underwent reconstruction for autoimmune mediated deformity, 10 for malignancy, 3 for traumatic injury, and 1 for an iatrogenic deformity. Average follow-up was 21 months. There was no observed warping of the L-strut construct, and all but 2 patients demonstrated total maintenance of projection. Resorption of the caudal cartilage graft was identified as the etiology of partial loss of projection in 2 patients. Conclusions The osseocartilaginous rib graft L-strut provides a stable, warp-resistant construct for patients lacking major dorsal and caudal support, which may be applied to reconstruction of defects due to malignancy, autoimmune, traumatic, or iatrogenic etiologies. Level of Evidence: 4

scholarly journals A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

2021 ◽  
Vol 22 (6) ◽  
pp. 341-344
Author(s):  
Jong Yun Choi ◽  
Jeong Hwa Seo ◽  
Won Jin Cha ◽  
Bommie Florence Seo ◽  
Sung-No Jung
Keyword(s):  
Perforator Flap ◽  
Defect Coverage ◽  
Anatomical Structures ◽  
Propeller Flap ◽  
Superficial Branch ◽  
Cervical Artery ◽  
Rotational Flap ◽  
Artery Perforator ◽  
Transverse Cervical Artery

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

scholarly journals Temporary spanning plate across the elbow for complex fractures of the distal humerus

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ashraf N. Moharram ◽  
Mostafa Mahmoud ◽  
Ahmed Lymona ◽  
Ahmed Afifi ◽  
Mostafa Ezzat ◽  
...  
Keyword(s):  
Bone Loss ◽  
Internal Fixation ◽  
Early Mobilization ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
Level Of Evidence ◽  
The Mean ◽  
Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

scholarly journals Outcomes following endoscopic-assisted Woodward procedure for Sprengel deformity

2021 ◽  
pp. 1-6
Author(s):  
Francisco Soldado ◽  
Sergi Barrera-Ochoa ◽  
Paula Diaz-Gallardo ◽  
Trong-Quynh Nguyen ◽  
Dinh-Hung Nguyen ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Comparative Studies ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Recorded Data ◽  
Woodward Procedure ◽  
Therapeutic Study ◽  
Shoulder Elevation ◽  
Grade Iii

Purpose An endoscopic-assisted approach for Sprengel deformity has been previously reported. Our objective was to assess outcomes of the endoscopic Woodward procedure in a series of patients. Methods Retrospective analysis was performed of children with a Sprengel deformity treated between November 2014 and February 2018. Recorded data were demographic, pre- and postoperative active shoulder elevation and deformity severity according to Cavendish. Results A total of 12 children (four girls and eight boys, ten right-sided/two left-sided) with a mean age of nine years two months (3 years 5 months to 16 years 1 month) and mean follow-up 19.8 months (10 to 48) were assessed. Nine children were classified as Cavendish Grade III and three as grade IV, respectively. Mean preoperative active shoulder forward elevation was 100.8° (70° to 120°), while postoperatively it increased to 149.2° (100° to 170°). Mean preoperative scapular high difference was 4.5 cm (2.8 to 5.2), while postoperatively it was 1.33 cm (0 to 2.8). Conclusion The endoscopic assisted Woodward procedure is an effective technique. Further comparative studies will ascertain advantages in functional and cosmetic results compared to the standard Woodward procedure. Level of Evidence Therapeutic study, Level IV

scholarly journals Surgical Treatment of Cubital Tunnel in Pediatric Athletes

2018 ◽  
Vol 10 (02) ◽  
pp. 82-85 ◽  
Author(s):  
Daniel Quinn ◽  
Alex Gu ◽  
Jeffrey Greenberg ◽  
Thomas Fischer ◽  
Gregory Merrell
Keyword(s):  
Age Of Onset ◽  
Cubital Tunnel Syndrome ◽  
Surgical Decompression ◽  
Cubital Tunnel ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome ◽  
Therapeutic Study ◽  
Nerve Entrapment Syndrome

Abstract Background Cubital tunnel syndrome is the second most common upper extremity peripheral nerve entrapment syndrome. In particular, cubital tunnel has been documented occasionally in young, throwing athletes. Materials and Methods Billing databases were searched for patients undergoing surgical decompression of the ulnar nerve at the elbow, who were age 18 or younger at the time of surgery. Charts were reviewed and patients were included if they had an isolated mononeuropathy consistent with cubital tunnel syndrome and were symptomatic. Data on age of onset, duration of symptoms, Dellon classification, nerve subluxation, provocative testing results, nerve conductions, and exacerbating activities were abstracted. Patients were contacted for a postsurgical follow-up questionnaire. Results Seven patients were identified. The average age was 16, and duration of symptoms was 7 months. All seven patients had normal electrodiagnostic studies and had failed a course of conservative treatment. All were satisfied with surgery and felt improvement. One stopped playing their sport, and three had mild symptoms with varied activities. Conclusion Although uncommon, pediatric cubital tunnel syndrome does occur. Surgical release improves symptoms and return to activities. Nevertheless, some degree of symptoms often persists. Electrodiagnostic studies may be negative in many patients with an otherwise consistent history and examination. Level of Evidence This is a level IV therapeutic study.

scholarly journals Prophylactic antibiotics in soft-tissue procedures in children with cerebral palsy

2018 ◽  
Vol 12 (3) ◽  
pp. 279-281
Author(s):  
L. R. Perotti ◽  
O. Abousamra ◽  
K. J. Rogers ◽  
F. Miller ◽  
J. P. Sees
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Surgical Site Infections ◽  
Paediatric Population ◽  
Prophylactic Antibiotics ◽  
Level Of Evidence ◽  
Children With Cerebral Palsy ◽  
Antibiotic Group ◽  
Therapeutic Study

Purpose Data on the benefits of perioperative prophylactic antibiotics in the paediatric population are lacking. In this study, we aimed to assess the rate of infection after isolated soft-tissue procedures in patients with cerebral palsy with and without preoperative prophylactic antibiotics between 2009 and 2015. Methods We reviewed the records of all children with cerebral palsy who underwent isolated soft-tissue procedures (on the upper and lower limb) at our hospital between 2009 and 2015. Children with at least 30-day postoperative follow-up were included. Children who had groin incisions were excluded. Results Two groups were identified: the antibiotic group (77 children with 203 incisions and 343 procedures) had one surgical site infection; the no-antibiotic group (48 children with 102 incisions and 177 procedures) had no surgical site infections. Conclusion These results suggest that the use of preoperative antibiotics does not change the rate of postoperative surgical site infections. Level of Evidence Level III therapeutic study

scholarly journals Functional outcome of the elbow in toddlers with transphyseal fracture of the distal humerus treated surgically

2019 ◽  
Vol 13 (1) ◽  
pp. 47-56 ◽  
Author(s):  
W. Zhou ◽  
F. Canavese ◽  
L. Zhang ◽  
L. Li
Keyword(s):  
Functional Outcome ◽  
Distal Humerus ◽  
Level Of Evidence ◽  
Injured Side ◽  
Group A ◽  
Elbow Function ◽  
And Gender ◽  
Therapeutic Study ◽  
Type Of Fracture

Purpose To quantitatively evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) in children with transphyseal fracture of the distal humerus (TFDH) treated surgically. Methods During the period between 2005 and 2015, a total of 16 patients (ten male, six female) met the inclusion criteria. Mean age at the time of injury was 18 months (11 to 37) and mean follow-up was 42.3 months (6 to 98). Based on a modified version of Delee’s classification (Group A to C), the clinical and radiographic outcome of TFDH in toddlers treated surgically were retrospectively evaluated. Results Mean humeral-ulnar (HU) angle of the injured and non-injured side was 1.2° (-18° to 14°) and 8.8° (2° to 19°), respectively (p = 0.001). Closed and open reduction showed similar HU angle values (p = 0.682). Mean MEPS score of the injured and non-injured side was 85.5 points (70 to 95) and 95 points (90 to 100), respectively (p = 0.002). No significant association was identified between MEPS score and gender, side, age at trauma, direction of displacement, time from trauma to surgery, presence of ossified capitellum, type of surgery and type of fracture. Conclusion Functional outcome was generally good regardless of surgical procedure performed, closed or open and type of fracture according to modified Delee’s classification. However, a residual cubitus varus was commonly observed among toddlers with transphyseal fractures of the distal humerus. Level of evidence: Level IV – Therapeutic study

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