Sensory Reconstruction of a Posterior Heel Defect Using a Proximally Based Sensate Medial Plantar Flap with Retrograde Nerve Cleavage Technique

2021 ◽  
pp. 153473462110552
Author(s):  
Sung Yoon Jung ◽  
Min Bom Kim ◽  
Young Ho Lee
Keyword(s):  
Donor Site ◽  
Contralateral Side ◽  
Plantar Surface ◽  
Flap Coverage ◽  
Significant Difference ◽  
Sensate Flap ◽  
Sensory Reconstruction ◽  
Tissue Defects ◽  
Plantar Area

Reconstruction of posterior heel defects is important because it requires thick and durable skin that can withstand pressure and shear from shoe and bed contact. Therefore, the sensate flap could be a better option for the defect. This paper reports on the safety of a medial plantar sensory flap for these defects as well as an objective measurement of the sensation of the medial plantar flap and the plantar surface distal to the donor site. Twelve patients had soft-tissue defects in the posterior heel and underwent reconstructive surgery using a proximally based sensate medial plantar sensory flap. Cases of plantar defects involving not posterior heel were excluded. For wider flap coverage, special neurovascular dissection was required. We evaluated levels of sensation quantitatively using Semmes–Weinstein (SW) monofilaments and a two-point discriminator at the final follow-up. All flaps survived without major complications. Postoperative follow-up was 12 to 64 months (mean 26 months). All 12 flaps healed without postoperative complications. There was no significant difference in minimal two-point discrimination and SW evaluator size between the transferred medial plantar flap area and the contralateral heel area or between the plantar area distal to the donor site and the contralateral side. Patients could walk normally and sleep without protective shoes or brace. A proximally based sensate medial plantar flap is a good option for the reconstruction of posterior heel defects. It can restore the characteristics of the posterior heel for shoe wearing and sleeping.

scholarly journals Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gang Chen ◽  
Lu Cui ◽  
Jiaqi Shi ◽  
Peng Zhang ◽  
Jun Li ◽  
...  
Keyword(s):  
Articular Surface ◽  
Operation Time ◽  
Contralateral Side ◽  
Gender And Age ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Reliable Parameter ◽  
Cosmetic Outcomes ◽  
Humerus Fractures

Abstract Background The supracondylar humerus fractures are the most common fracture in children’s elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. Methods We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn’s grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn’s grading scores were compared between groups. Results A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn’s grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). Conclusions There was no significant difference in reduction quality and Flynn’s scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

2020 ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Wenrui Qu ◽  
Xiaolan Ou ◽  
Rui Li ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Nerve Injury ◽  
Donor Site ◽  
Graft Loss ◽  
Operation Time ◽  
Plantar Artery ◽  
Significant Difference ◽  
Medial Plantar Artery ◽  
Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

scholarly journals Utility of Groin Flap in Penile Reconstruction

2020 ◽  
Vol 16 (3) ◽  
pp. 150-157
Author(s):  
Ji-An Choi ◽  
Jung-Ha Kwak ◽  
Kwang-Ryeol Lim ◽  
Chung-Min Yoon
Keyword(s):  
Chart Review ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Postoperative Patient ◽  
Groin Flap ◽  
Volumetric Reconstruction ◽  
Tissue Defects

Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

Pyrocardan Scaphotrapeziotrapezoid Joint Arthroplasty for Isolated Osteoarthritis: Results after a Mean Follow-Up of 5 Years

2021 ◽  
Author(s):  
Martin Cholley-Roulleau ◽  
Yves Bouju ◽  
Flore-Anne Lecoq ◽  
Alexandre Fournier ◽  
Philippe Bellemère
Keyword(s):  
Case Series ◽  
Preoperative Assessment ◽  
Contralateral Side ◽  
High Rate ◽  
Significant Difference ◽  
Flexion Extension ◽  
Functional Scores ◽  
Before And After ◽  
The Mean

Abstract Background Isolated scaphotrapeziotrapezoid (STT) osteoarthritis (OA) mainly develops in women over 50 years of age in a bilateral manner. Many surgical treatments are available, including distal scaphoid resection with or without interposition, trapeziectomy, and STT arthrodesis. However, there is a controversy about which procedure is the most effective. Purposes The purpose of this study was to report the outcomes of the Pyrocardan implant for treating STT isolated OA at a mean follow-up of 5 years. Patients and Methods Consecutive patients who underwent STT arthroplasty using the Pyrocardan were reviewed retrospectively by an independent examiner who performed a clinical and radiological evaluation. Results The mean follow-up time was 5 years (range 3–8 years). Thirteen patients (76%) were followed for more than 5 years. Between the preoperative assessment and the last follow-up, pain levels decreased significantly. There was no significant difference in the mean Kapandji opposition score. Grip and pinch strengths were 88 and 91% of the contralateral side. The active range of motion in flexion–extension and radioulnar deviation was not significantly different to the contralateral side (119° vs. 121° and 58° vs. 52°, p > 0.1). Functional scores were improved significantly. No identifiable differences were found in the radioscaphoid, capitolunate, and scapholunate angles before and after surgery. In three cases, the preoperative dorsal intercalated scapholunate instability (DISI) failed to be corrected. In one case, DISI appeared after the procedure. There was one asymptomatic dislocation of the implant. Calcification around the trapezium and/or distal scaphoid was found in four cases. The survival rate of the implant without reoperation was 95%. Conclusions In the medium term, Pyrocardan implant is an effective treatment for STT OA as it reduces pain, increases grip strength, and maintains wrist mobility. This is consistent with the results of other published case series using pyrocarbon implants. It provides a high rate of patient satisfaction. Nevertheless, the surgical procedure must be done carefully to avoid STT ligament damage, periarticular calcifications, or dislocation.

scholarly journals Clinical Outcome, PROM’s, Power and Structural Integrity after Arthroscopic Subscapularis Tendon Repair

2021 ◽  
Author(s):  
Milad Farkhondeh Farkhondeh Fal ◽  
Knut Schwalba ◽  
Achim Hedtmann ◽  
Jörn Kircher
Keyword(s):  
Structural Integrity ◽  
Constant Score ◽  
Tendon Repair ◽  
Scoring Systems ◽  
Lesion Size ◽  
Contralateral Side ◽  
Shoulder Function ◽  
Subscapularis Tendon ◽  
Significant Difference

Abstract PurposeThe objective of this study is to assess tendon integrity, shoulder function and subscapularis (SCP) power in comparison to the contralateral normal shoulder after arthroscopic SCP repair using the SICK stitch technique.MethodsThis study assessed 32 patients with arthroscopically repaired SCP lesions. The mean age was 63.3years. All patients were assessed with a clinical examination and ultrasound pre and postoperatively. Shoulder function was evaluated using specific clinical tests and established scoring systems. The muscular strength was measured using an Isoforce Control EVO2 device in two positions for SCP (standing and sitting).ResultsAt a mean follow up of 18 months n=30 patients showed significantly improved range of motion and clinical scores (pre, post), Constant score (39.2, 66.7), subjective shoulder test (3.5, 92.32), subjective shoulder value (46.6, 88.2) and disabilities of arm, shoulder and hand score (69.3, 34). All tendons showed full integration in ultrasound and there was no significant difference for lesion size or additional SSP lesion. In comparison to the contralateral side a good restoration of power was observed.ConclusionsAfter arthroscopic repair of the subscapularis tendon using the SICK-stich technique, patients show a good restoration of shoulder function and power accompanied by good patient satisfaction. Additionally treated lesions did not significantly affect the surgical outcome.

scholarly journals Nipple Reconstruction Techniques: Which is the Best Choice?

2018 ◽  
Vol 5 (1) ◽  
pp. 62-75 ◽  
Author(s):  
Nicolò Bertozzi ◽  
Francesco Simonacci ◽  
Marianna Pesce ◽  
PierLuigi Santi ◽  
Edoardo Raposio
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Contralateral Side ◽  
Skin Thickness ◽  
Nipple Reconstruction ◽  
Areolar Complex ◽  
Long Term Follow Up ◽  
Case Basis

Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn’t been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients’ expectations to ensure the best cosmetic outcome.

scholarly journals Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

2020 ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Wenrui Qu ◽  
Xiaolan Ou ◽  
Rui Li ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Nerve Injury ◽  
Donor Site ◽  
Graft Loss ◽  
Operation Time ◽  
Plantar Artery ◽  
Significant Difference ◽  
Medial Plantar Artery ◽  
Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

scholarly journals Treatment of Defects on the Volar Surface of the Finger using the Dorsal Digital–metacarpal Flap Versus the Free Medial Plantar Artery Flap: A Comparative Study

2020 ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Wenrui Qu ◽  
Xiaolan Ou ◽  
Rui Li ◽  
...  
Keyword(s):  
Donor Site ◽  
Graft Loss ◽  
Donor Site Morbidity ◽  
Plantar Artery ◽  
Reconstruction Methods ◽  
Finger Reconstruction ◽  
Tissue Defects ◽  
Medial Plantar Artery ◽  
Volar Surface

Abstract Background Few cases are reported on the treatment of defects on the volar surface of the finger, and its utility for digital resurfacing remains unclear. This study compared the outcomes of the free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction. Methods This cohort study was conducted on 24 patients who had soft-tissue defects on the volar side of the finger from March 2014 to March 2017. The patients were divided into the following 2 groups: the MPAF group and the DDMF group. The operative time as well as complications, including flap necrosis, graft loss, infection, paresthesia, donor-site morbidity, and two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire (MHQ) was applied to conduct follow-up assessment. Results After more than 12 months of follow-up, the results were significant. In terms of overall function, MPAF was superior to DDMF (p < 0.005). Conclusion The MPAF and the DDMF are available and reliable for reconstruction of the volar surface of the finger; however, the MPAF offers better functional outcomes with a lower frequency of postoperative complications.

scholarly journals Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

2020 ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Wenrui Qu ◽  
Xiaolan Ou ◽  
Rui Li ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Donor Site ◽  
Graft Loss ◽  
Operation Time ◽  
Donor Site Morbidity ◽  
Plantar Artery ◽  
Significant Difference ◽  
Medial Plantar Artery ◽  
Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference in postoperative complications and the results (2-PD and Modified VSS score) were significant. In terms of overall function, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

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