Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

Patella fractures treated with suture tension band fixation

Background Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures. Methods This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution. Results This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material. Conclusions We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

The Use of High Strength Sutures and Anchors in Olecranon Fractures: A Systematic Review

Purpose/Background: Olecranon fractures are common, particularly in the elderly osteoporotic population. Although various techniques of fixation are available, the gold standard—tension band wiring (TBW)—has high complication and reoperation rates. We sought to identify current evidence for the use of high-strength suture tension banding methods to determine whether they reduce complications and reoperation rates while maintaining fixation. Methods: A systematic review of several databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases included Cochrane, PubMed, MEDLINE and Embase. We searched for evidence of at least Level I to IV (according to NHMRC) of the use of tension band suturing or anchors in the surgical treatment of displaced olecranon fractures. We also analyzed the cost of fixation in our institute. Results: Four hundred and forty articles were identified. Of these, 9 met the inclusion criteria. One hundred thirty-one subjects had an average age of 66 years. All the studies showed that high-strength suture tension banding/anchoring maintained fixation with displaced olecranon fractures, reducing the complication rates and showed minimal reoperation rates. There was also a significant cost advantage of the suture tape construct mainly due to avoiding subsequent removal of metal. Conclusion: Tension band suturing or anchoring displaced olecranon fractures may be an alternative cost effective method to TBW in maintaining fixation, reducing metalware complications and reducing re-operation rates. Level of Evidence: IV.

Isometry of Potential Attachment Sites for the Iliotrochanteric Suture in Dogs: an ex vivo Study

Background: Coxofemoral luxation is the most common traumatic luxation in dogs and the iliotrochanteric suture is one of the surgical treatment options. The orthopedic suture aimed at surgically restoring joint movement should be employed in an isometric manner in order to maintain adequate tension throughout the arc of motion. This study aimed to determine the isometric points for the iliotrochanteric suture in dogs during the joint extension and flexion movements. This evaluation was performed both in the intact hip joint and in the luxation model, establishing the best combination, among the determined points, for the reestablishment of normal joint movement.Materials, Methods & Results: Radiographic analyses of 12 canine cadaveric hips, both intact and in craniodorsal luxation model, were performed in a neutral position, flexion at 50°, and extension at 150°. In the trochanteric segment, two parallel lines were drawn, creating the central vertical axis and the secondary vertical axis. Three points were then determined on each axis, from proximal to distal, corresponding to 25, 50, and 75% of the height of the axis, and were labelled as T1, T2, and T3 and T4, T5, and T6, respectively. In the iliac segment, a line perpendicular to the longitudinal axis of the ilium was drawn, and 25, 50, and 75% of this height corresponded to points I1, I2, and I3, respectively. The lengths between the points were measured, with the objective of evaluating which combination of points presented less variation in the joint positions. The central location of the iliac and trochanteric segments, determined respectively by I2 and T2, provided smaller variations during the maximal movements of hip flexion and extension.Discussion: The surgical techniques of iliotrochanteric suture target to maintain the internal rotation of the femoral head inside the acetabulum and abduction of the femur until the soft tissues have healed. The described techniques for the iliotrochanteric suture present a great anatomical variety in the arrangement of the anchor points of the suture. It is known that if during motion, the attachment sites move closer to one another, the suture will become lax and, if the attachment sites move away from one another, the suture will tighten. Therefore, the implantation in isometric sites assists in reducing the variation of the distance between the points of origin and insertion of the suture during joint movement, keeping the suture tension constant and allowing the functional recovery of the joint. This study demonstrates that there are some locations for the origin and insertion of an iliotrochanteric suture that are associated with less length change than others. I2-T2 combination is the point closest to isometry for the iliotrochanteric suture during hip extension and flexion, so that, T2 is the most central point of the greater trochanter, corresponding to 50% of the height of its central vertical axis, as well as I2, which corresponds to the most central point of the ilium, representing 50% of the height of the most caudal portion of its body. The isometric point found by us details the exact location of perforation in all aspects (height and length), both in the ilium and the trochanter. In addition, it is a personalized point created for each patient from its radiographic examination and taking into consideration its anatomical variations, so that there is no damage to the suture during hip extension and flexion movements.

The effect on the electroactivity of the abdominal muscles of the level of connective tissue dysplasia and the method of combined hernioplasty of the inguinal hernia

Introduction. Combined methods of hernioplasty appear to be a promising surgical treatment of inguinal hernias, allowing reducing suture tension due to the contraction and stretching of the abdominal muscles optimized during the operation. This protects the inguinal region from relapse in severe connective tissue dysplasia.The aim of research was to study the influence of the level of connective tissue dysplasia and methods of combined hernioplasty of inguinal hernias on the electroactivity of the abdominal muscles.Methods. The study included 151 patients with inguinal hernias. The electroactivity of the abdominal muscles and the level of severity of connective tissue dysplasia were studied in these patients before and after combined methods of hernioplasty according to Milkovskaya Dmitrova diagnostic scheme; this also includes tension-reducing mechanism.Results. In the preoperative period, the decrease in the parameters of electromyograms compared to the healthy side in the inguinal region was 67.2%, compared to the region over the group of lateral muscles - 55% and compared to the region over the rectus abdominis muscles - 23.6%. The increase in the electrical activity of the rectus muscles against the background of a decrease in the severity of connective tissue dysplasia to the middle and light levels obtained 43.5% and 77.9%, respectively.The average frequency parameters of electromyograms of the abdominal muscles after combined tension-reducing hernioplasty of inguinal hernias seemed to be most significant: in the inguinal regions on the side of the hernia they amounted to 91.95 7.1 vibrations per second, in the region over the group of lateral muscles - 94.61 4.6/s and in the region over the rectus abdominis muscles - 93.7 2.9/s. Moreover, approximately similar rehabilitation of the rectus and lateral abdominal muscles was reported, which allowed balancing oppositely directed tension forces in the abdominal wall.Conclusion. Thus, in patients with inguinal hernias before surgery, the decrease in the electroactivity of the lateral muscle group was more pronounced than the decrease in the electroactivity of the rectus abdominis. The combined tension-reducing hernioplasty of inguinal hernias contributed to the most significant electromyographic rehabilitation of the abdominal muscles.

Maximum Bridging Suture Tension Provides Better Clinical Outcomes in Transosseous-Equivalent Rotator Cuff Repair: A Clinical, Prospective Randomized Comparative Study

Background: Some studies reporting clinical outcomes after transosseous-equivalent (TOE) repair have attributed type II rotator cuff failure to excessive bridging suture tension, as it can cause overloading on the medial row. In a previous biomechanical cadaveric study, increasing bridging suture tension over 90 N did not improve the contact area and ultimate failure load of the TOE construct, despite increasing the contact force and contact pressure. Purpose: To compare the clinical outcomes of different bridging suture tensions after TOE rotator cuff repair based on the results of a previous biomechanical study. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 78 patients who underwent arthroscopic rotator cuff repair for medium- to large-sized tears were prospectively enrolled and randomly divided into 2 groups according to the applied bridging suture tension: optimum tension group (96.3 ± 4.9 N) and maximum tension group (199.0 ± 20.3 N). Bridging suture tension was measured with a customized tensiometer, as used in the previous biomechanical study. The functional outcome was measured at the final follow-up (27.4 ± 5.9 months [range, 24-45 months]) using the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Constant score, and the anatomic outcome was evaluated using magnetic resonance imaging or ultrasonography at least 12 months after surgery. Results: Overall, 64 patients (32 in each group) were analyzed. The functional outcomes improved significantly compared with preoperative values (all P < .05) but did not show significant differences between the 2 groups (all P > .05). Regarding the anatomic outcomes, the maximum tension group (n = 1; 3.1%) had a significantly lower healing failure rate than the optimum tension group (n = 9; 28.1%) ( P = .013). One patient in the maximum tension group had a type II failure. Conclusion: Maximum bridging suture tension in TOE repair for medium- to large-sized rotator cuff tears provided better anatomic healing with less risk of medial rotator cuff failure, which differs from the results of a previous time-zero biomechanical study.