Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures: a pilot study

Abstract Background Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods Twenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis. Results Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3–36). Conclusions Large autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up. Level of evidence Level III, retrospective cohort study.

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Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures. A pilot study

10.21203/rs.3.rs-46813/v3 ◽

2020 ◽

Author(s):

Dong Li ◽

Jiao Jiao Li ◽

Yuanyuan Zhu ◽

Fushan Hou ◽

Yuan Li ◽

...

Keyword(s):

Donor Site ◽

Outcome Analysis ◽

Pilon Fracture ◽

Implant Fixation ◽

Level Of Evidence ◽

Tibiotalar Joint ◽

Non Union ◽

Joint Reconstruction ◽

Pilon Fractures

Abstract Background: Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis. Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36). Conclusions: Large autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up.Level of Evidence: Level III, retrospective cohort study

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Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures. A pilot study

10.21203/rs.3.rs-46813/v4 ◽

2020 ◽

Author(s):

Dong Li ◽

Jiao Jiao Li ◽

Yuanyuan Zhu ◽

Fushan Hou ◽

Yuan Li ◽

...

Keyword(s):

Donor Site ◽

Outcome Analysis ◽

Pilon Fracture ◽

Implant Fixation ◽

Level Of Evidence ◽

Tibiotalar Joint ◽

Non Union ◽

Joint Reconstruction ◽

Pilon Fractures

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Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures

10.21203/rs.3.rs-46813/v2 ◽

2020 ◽

Author(s):

Dong Li ◽

Jiao Jiao Li ◽

Yuanyuan Zhu ◽

Fushan Hou ◽

Yuan Li ◽

...

Keyword(s):

Donor Site ◽

Outcome Analysis ◽

Pilon Fracture ◽

Implant Fixation ◽

Level Of Evidence ◽

Tibiotalar Joint ◽

Non Union ◽

Joint Reconstruction ◽

Pilon Fractures

Abstract Background: Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis. Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36). Conclusions: Large autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up.Level of Evidence: Level III, retrospective cohort study

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Large Autologous Ilium with Periosteum for Tibiotalar Joint Reconstruction in Rüedi-Allgöwer III Pilon Fractures

10.21203/rs.3.rs-46813/v1 ◽

2020 ◽

Author(s):

Dong Li ◽

Jiao Jiao Li ◽

Yuanyuan Zhu ◽

Fushan Hou ◽

Yuan Li ◽

...

Keyword(s):

Tissue Injury ◽

Donor Site ◽

Soft Tissue Injury ◽

Outcome Analysis ◽

Pilon Fracture ◽

Level Of Evidence ◽

Tibiotalar Joint ◽

Joint Reconstruction ◽

Pilon Fractures

Abstract Background: Management of Rüedi-Allgöwer III or AO type C3 pilon fracture present numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients with soft tissue injury of Tscherne-Gotzen I-II after Rüedi-Allgöwer III pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis.Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36).Conclusions: Large autologous ilium with periosteum in combination with ORIF can be safely performed for tibiotalar joint reconstruction. This method greatly reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III pilon fractures.Level of Evidence: Level III, retrospective cohort study

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A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418808183 ◽

2018 ◽

Vol 44 (3) ◽

pp. 296-303 ◽

Cited By ~ 3

Author(s):

Bien R. Ferrari ◽

Paul M.N. Werker

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Cross Sectional Study ◽

Complication Rates ◽

Skin Grafts ◽

Sectional Study ◽

Level Of Evidence ◽

Cross Sectional ◽

Scar Assessment

Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV

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An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420939379 ◽

2020 ◽

Vol 45 (8) ◽

pp. 842-848

Author(s):

Satoshi Usami ◽

Kohei Inami ◽

Yuichi Hirase ◽

Hiroki Mori

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Soft Tissue Reconstruction ◽

Level Of Evidence ◽

Tissue Reconstruction ◽

The Mean ◽

Lost To Follow Up ◽

Pulp Repair ◽

Sensory Reinnervation

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

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Modified Littler flap for sensory reconstruction of large thumb pulp defects

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417754191 ◽

2018 ◽

Vol 43 (5) ◽

pp. 546-553 ◽

Cited By ~ 3

Author(s):

Hui Wang ◽

Xiaoxi Yang ◽

Chao Chen ◽

Bin Wang ◽

Wei Wang ◽

...

Keyword(s):

Donor Site ◽

Ring Finger ◽

Middle Finger ◽

Donor Site Morbidity ◽

Digital Nerve ◽

Level Of Evidence ◽

Dorsal Branch ◽

Ulnar Aspect ◽

Monofilament Test

The Littler flap has been widely used to repair large pulp defects of the thumb; however, several complications have occurred frequently. In order to reduce these issues, the modified Littler flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve from the ulnar aspect of the middle finger or the radial aspect of the ring finger were devised in 16 consecutive cases. At the donor site, the defect of the proper digital nerve was repaired with a nerve graft from the proximal portion of the ipsilateral dorsal branch of the proper digital nerve. At the final follow-up, the scores for the static two-point discrimination test, Semmes–Weinstein monofilament test and total active motions in both recipient and donor fingers were nearly normal. This modified Littler flap provides a simple and reliable alternative for treatment of large defects of the thumb pulp with low donor-site morbidity. Level of Evidence: IV

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Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Foot & Ankle International ◽

10.1177/1071100719875728 ◽

2019 ◽

Vol 41 (1) ◽

pp. 69-78 ◽

Cited By ~ 1

Author(s):

Xi Liu ◽

Jingjing An ◽

Hui Zhang ◽

Yaxing Li ◽

Yu Chen ◽

...

Keyword(s):

Range Of Motion ◽

Short Form ◽

Young Patients ◽

Joint Surface ◽

Posttraumatic Arthritis ◽

Osteochondral Graft ◽

Tibiotalar Joint ◽

Sf 36 ◽

Pilon Fractures

Background: Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Methods: Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. Results: The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery ( P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Conclusion: Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level of Evidence: Level IV, case series.

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Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414554752 ◽

2014 ◽

Vol 40 (4) ◽

pp. 392-400 ◽

Cited By ~ 8

Author(s):

H. Y. Erken ◽

I. Akmaz ◽

S. Takka ◽

A. Kiral

Keyword(s):

Retrospective Review ◽

Index Finger ◽

Donor Site ◽

Level Of Evidence ◽

Reliable Technique ◽

Flap Loss ◽

Discrimination Testing ◽

The Mean ◽

Donor Site Complication

We performed a retrospective review of 12 patients with dorsal oblique and transverse amputations of the distal thumb who were treated with a volar cross-finger flap from the index finger. The mean patient follow-up period was 28 months postoperatively (range: 19–43 months). There were no instances of flap loss, infection, or donor site complication in our series. The mean Semmes–Weinstein monofilament testing scores on the injured thumb and the donor site were 0.65 g (range: 0.16–2 g) and 0.51 g (range: 0.16–1 g), respectively. The mean 2-point discrimination testing scores on the injured thumb and the donor site were 4.5 mm (range: 3–8 mm) and 4.3 mm (range: 3–7 mm), respectively. This study suggests that the volar cross-finger flap using the index finger is a reliable technique in repairing dorsal oblique and transverse amputations of the distal thumb. Type of study/level of evidence: Therapeutic IV

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Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

Plastic Surgery ◽

10.1177/2292550317731762 ◽

2017 ◽

Vol 26 (2) ◽

pp. 126-133 ◽

Cited By ~ 4

Author(s):

Hani Shash ◽

Becher Al-halabi ◽

Salah Aldekhayel ◽

Tassos Dionisopoulos

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Patient Characteristics ◽

Donor Site Morbidity ◽

Outcome Analysis ◽

Complication Rates ◽

Search Terms ◽

The Mean ◽

Pedicle Flaps

Background: Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods: We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms “omental flaps“ and “breast reconstruction.” Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results: Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.

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