Fascia lata autograft bridging repair reinforced with artificial ligament as an internal brace for arthroscopic management of irreparable massive rotator cuff tears / 中华骨科杂志

Objective:To compare the clinical and imaging outcomes of fascia lata autograft bridging repair reinforecd with an artificial ligament as the internal brace with the autograft bridging repair for the treatment of irreparable massive rotator cuff tears (IMRCTs).Methods:The data of 26 patients with IMRCT who underwent fascia lata autograft bridging repair augmented with artificial ligament as the internal brace (internal brace group) and of 24 patients with IMRCT who underwent bridging autograft repair alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed using shoulder activity, the American Shoulder and Elbow Surgeons (ASES) Score, University of California Los Angeles (UCLA) Score, and visual analogue scale (VAS) for pain. Imaging outcomes were evaluated using acromiohumeral distance (AHD), Goutallier grade, and status of fascia lata grafts according to radiographs or magnetic resonance imaging results.Results:All 50 cases were followed up for 34.2±7.2 months (range 24-45 months). Compared to the control group, the internal brace group showed better ASES score (93.5±5.3 vs. 89.5±5.7, P<0.05), UCLA score (31.7±3.8 vs. 28.5±5.6, P<0.05), improvement in UCLA score (19.6±4.2 vs. 15.9±5.7, P<0.05), active elevation (167.3°±8.4° vs. 159.4°±13.6°, P<0.05), abduction strength (8.9±1.2 vs. 8.2±1.2, P<0.05), improvement in abduction strength (4.1±1.2 vs. 3.3± 1.0, P<0.05), AHD (7.0±1.4 mm vs. 5.9±1.0 mm, P<0.05), improvement in AHD (3.3±1.5 mm vs. 2.0±0.6 mm, P<0.05), and healing rate of fascia lata autografts (92% vs. 54%, P<0.05) at 2-year follow-up. Conclusion:Fascia lata autograft bridging repair reinforced with an artificial ligament as the internal brace improves healing rate of bridging graft and postoperatively short-term clinical outcomes of patients with IMRCT.

Fascia lata autograft bridging combined with long head of biceps tendon transposition for irreparable massive rotator cuff tear / 中华骨科杂志

Objective:To investigate the early clinical effect of fascia lata autograft bridging combined with the long head of biceps tendon transposition for treatment of irreparable massive rotator cuff tear.Methods:All of 31 cases of massive irreparable rotator cuff tear treated in our hospital from March 2016 to March 2020 were analyzed retrospectively. Among them, 17 cases (10 males, 7 females) were repaired with fascia lata autograft bridging under arthroscopy (patch group), the average age was 61.47±6.63 (ranging from 51 to 72) and 14 cases (4 males, 10 females) were repaired with fascia lata autograft bridging combined with the long head of biceps tendon transposition (combined group), the average age was 62.57±6.11 (ranging from 53 to 71). The operation time, intraoperative blood loss, postoperative complications, visual analogue scale (VAS) of pain before operation, at 1 week and 12 months after operation, Constant-Murley score of shoulder joint and American Association of shoulder and elbow Surgeons (ASES) score before operation, at 6 months and 12 months after operation were compared between the two groups. The outcome of rotator cuff healing was evaluated by MRI 1 year after operation.Results:All patients were followed up for 12-27 months (mean 18.33 ±6.8 months). There was no perioperative complication, and there was no significant difference in operation time between the two groups ( P>0.05) . The VAS score in the patch group was significantly higher than the combined group 1 week after operation ( t=2.09, P=0.048) , and there was no significant difference in VAS score 12 months after operation between the two groups. Constant-Murley score and ASES score in the combined group were significantly higher than the patch group at 6 months after operation ( t=5.23, P<0.001; t=4.45, P<0.001) , and there was no significant difference in Constant score and ASES score between the two groups at 12 months after operation. Constant score and ASES score in the two groups were significantly higher than those before operation. One year after operation, the MRI of the affected shoulder showed that the incidence of autograft patch thinning (Sugaya grade III) was 52.94%, the autograft patch structure failure rate (Sugaya grade IV and V) was 17.65% in the patch group, the autograft patch thinning rate (Sugaya grade III) was 35.71%, and the structural failure rate (Sugaya grade IV and V) was 7.14% in the combined group. The difference was statistically significant (χ 2=7.12, P=0.028) . Conclusion:Fascia lata autograft patch bridging combined with long head of biceps tendon transposition technique for treatment of irreparable massive rotator cuff tear has less pain 1 week after operation and better recovery of shoulder function half a year after operation. MRI showed better patch healing 1 year after operation.

Coleta de fáscia lata para uso em retalho ortodrômico temporal no tratamento da paralisia facial / Harvest of fascia lata for use in a temporal orthodromic flap in the treatment of facial paralysis

Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.

Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft / Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

Repair of KuwadaⅡand Ⅲ Achilles tendon defects through modified medial J-shaped approach with autologous fascia lata transplantation / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects.@*METHODS@#From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up.@*RESULTS@#All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.

Repercusión biomecánica derivada de un osteoma en el tercio proximal del fémur: a propósito de un caso / Biomechanical Impact Derived From an Osteoma in the Proximal Third of the Femur: Report of a Case

Introducción: El osteoma osteoide es un tumor óseo benigno, que no tiene potencial de crecimiento por lo que su tamaño no supera 1,5 cm pese a que la esclerosis que lo rodea le da un aspecto mayor. Afecta con mayor frecuencia a los varones jóvenes, y la mayoría de las veces aparece en las tres primeras décadas de la vida. Objetivos: Mostrar las repercusiones biomecánicas derivadas de un osteoma osteoide en el trayecto de la cintilla iliotibial y sus influencias por cadenas musculares descendentes sobre el miembro inferior. Presentación del caso: Se presenta una paciente de 24 años que acude a la consulta por presentar dolor a nivel de la cara externa del fémur derecho desde hace dos años; que se agudiza fundamentalmente con la marcha. Tras realizar las pertinentes exploraciones y pruebas diagnósticas por imagen, no se observan hallazgos clínicos significativos, por tanto se pauta tratamiento antiinflamatorio por vía oral y se efectúa estudio biomecánico y postural en el cual se detecta pie valgos bilaterales, inestables, con mayor relevancia en el pie derecho. La paciente acude nuevamente al no encontrar mejoría, se realiza telemetría del miembro inferior y resonancia magnética del fémur derecho. La imagen para diagnóstico da como resultado la presencia de una masa compatible con un osteoma osteoide de 11 x 4 mm en el tercio proximal lateral del fémur derecho. Conclusiones: Una lesión neoplásica que afecte al trayecto de un grupo muscular con repercusión biomecánica puede realizar compensaciones a diferentes niveles, por tanto, es necesaria la actuación de un equipo multidisciplinario para restablecer la marcha. Las sinergias entre el tratamiento conservador y quirúrgico provocan un mayor porcentaje de éxito(AU)

Introduction: Osteoid osteoma is a benign bone tumor, which has no growth potential, consequently its size does not exceed 1.5 cm despite the fact that the surrounding sclerosis gives it a larger appearance. It most often affects young men, most often appearing in the first three decades of life. Objectives: To show the biomechanical repercussions derived from an osteoid osteoma in the trajectory of the iliotibial band and its influences by descending muscle chains on the lower limb. Case report: We report a 24-year-old female patient who came to the consultation due to pain on the external face of her right femur for two years. This pain worsened mainly by walking. After carrying out the pertinent explorations and diagnostic imaging tests, no significant clinical findings were observed, therefore, oral anti-inflammatory treatment was prescribed and biomechanical and postural study was carried out, which showed bilateral, unstable valgus foot, with higher relevance on the right foot. The patient came again when she had no improvement, telemetry of her lower limb and magnetic resonance imaging of her right femur were performed. The diagnostic image revealed the presence of a mass compatible with an 11 x 4 mm osteoid osteoma in the proximal lateral third of her right femur. Conclusions: A neoplastic lesion that affects the trajectory of a muscle group with biomechanical repercussions can carry out compensations at different levels, therefore, the action of a multidisciplinary team is necessary to restore gait. Synergies between conservative and surgical treatment lead to a higher success rate(AU)

Arthroscopic superior capsular reconstruction of irreparable massive rotator cuff tearsras using "Sandwich" patch graft / 中华骨科杂志

Objective:To investigate the effect of arthroscopic superior capsular reconstruction (ASCR) of irreparable massive rotator cuff tears (RCTs) using the "Sandwich" patch graft (autologous fascia lata + LARS artificial ligament + autologous fascia lata).Methods:The patients with irreparable massive RCTs who underwent ASCR by using "Sandwich" patch graft were retrospectively evaluated between December 2016 and October 2018. All cases were followed up more than two years. The pain and function of the shoulder were evaluated by visual analogue scale (VAS), active forward elevation (aFE), American Shoulder & Elbow Surgeons score (ASES), University of California Los Angeles (UCLA) score, and Constant-Murley score. The acromiohumeral distance (AHD) and patch healing were assessed by shoulder X-ray and MRI scan.Results:Twenty-nine patients (12 males and 17 females) were enrolled for final analysis. The average age was 66.0±5.88 years (range 55-77 years). The average length of follow-up was 35.3±7.20 months (range 24-46 months). The tendon of the subscapularis muscle was intacted in 13 cases and repairable in 16 cases. All patients' teres minor muscles were intact and the function of deltoid muscles was all complete. Based on Hamada classification of massive RCTs, 11 cases with type 2, 14 cases with type 3, and 4 cases with type 4. At the last follow-up visit, the AFE of the surgical shoulder was 158.45°±23.87° (range 70°-180°), which was significantly higher than before the surgery 92.59°±45.99° (range 20°-160°, t=6.190, P<0.001). The ASES score was 92.92±9.08 (range 64-100), UCLA score was 31.62±3.93 (range 19-35), and Constant-Murley score was 85.8±8.44 (range 68-94), which were higher than those before the operation 30.69±12.99 (range 68-95), 10.93±3.43 (range 4-17), 39.62±12.68 (range 14-55). There were significant differences between them, respectively ( t=21.145, P<0.001; t=21.348, P<0.001; t=16.333, P<0.001). The VAS was 0.41±0.57 (range 0-2 points), which was significantly lower than that of 4.90±1.05 (range 3-7 points) before operation ( t=20.267, P<0.001). At the last follow-up visit, MRI showed that the AHD increased from 3.31±1.57 mm (range 1.1-6.6 mm) to 6.94±1.76 mm (range 3.0-10.8 mm) significantly ( t=12.195, P<0.001). Radiological outcomes were evaluated according to MRI, the total healing rate was 89.7% (26/29). There were two cases of complete tears, which including one case of infection and 1 partial tears. Conclusion:ASCR of irreparable massive RCTs using "Sandwich" patch graft showed the high healing rate in the short-term follow-up, which is possible to restore the shoulder functions early. It is an effective method for the treatment of irreparable massive RCTs.

Flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects / 中华创伤杂志

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.

Arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata / 中华骨科杂志

Objective To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.Methods From July 2015 to July 2017,a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed.The age before surgery was 61.3±2.9 years (range 57-67 years).There were 7 patients with right shoulders and 3 with left shoulders.The dominate sides were involved in 7 cases.The trauma history was documented in 2 shoulders.The duration of preoperative symptoms was 14.0±13.5 months (1-48 months).The case with revision surgery was not included.The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week,six months,one year and two years after operation.The motion range of shoulder and the clinical scores,including visual analogue scale (VAS),University of California Los Angeles (UCLA) score,Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score,were measured before surgery and at follow-up duration.Results All cases were reconstrncted the horizontal couple.No perioperative complication was occurred and all surgery were completed safely and successfully.At the end of two years,the score of ASES was 92.2±3.5 (range 88.3-98.3),UCLA 31.6±2.0 (range 28-34),Constant-Murley 85.2± 5.4 (range 78-93) with significant difference (t=11.254,P=0.000;t=12.111,P=0.000;t=8.948,P=-0.00) comparing with that bofore surgery.The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=1 1.326,P=0.000).At 2 years after operation,MRI shows that fascia lata patches healed well in 9 patients.However,one case was with re-tear and patch absorption.The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).Conclusion Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears.The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.

Arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata / 中华骨科杂志

Objective@#To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.@*Methods@#From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration.@*Results@#All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).@*Conclusion@#Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.

Arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata / 中华骨科杂志

Objective@#To investigate the clinical outcomes of arthroscopic bridging reconstruction of irreparable massive rotator cuff tears using autogenous fascia lata.@*Methods@#From July 2015 to July 2017, a total of 10 cases (4 male and 6 female) who were treated with arthroscopic bridging reconstruction for irreparable massive rotator cuff tears using autogenous fascia lata were retrospectively analyzed. The age before surgery was 61.3±2.9 years (range 57-67 years). There were 7 patients with right shoulders and 3 with left shoulders. The dominate sides were involved in 7 cases. The trauma history was documented in 2 shoulders. The duration of preoperative symptoms was 14.0±13.5 months (1-48 months). The case with revision surgery was not included. The patients were examined with magnetic resonance imaging (MRI) to evaluate the healing of fascia lata patch bridging in the joint at one week, six months, one year and two years after operation. The motion range of shoulder and the clinical scores, including visual analogue scale (VAS), University of California Los Angeles (UCLA) score, Constant-Murley score and American Shoulder & Elbow Surgeons (ASES) score, were measured before surgery and at follow-up duration.@*Results@#All cases were reconstructed the horizontal couple. No perioperative complication was occurred and all surgery were completed safely and successfully. At the end of two years, the score of ASES was 92.2±3.5 (range 88.3-98.3), UCLA 31.6±2.0 (range 28-34), Constant-Murley 85.2±5.4 (range 78-93) with significant difference (t=11.254, P=0.000; t=12.111, P=0.000; t=8.948, P=0.00) comparing with that before surgery. The VAS pain score was 0.6±0.5 (range 0-1) which was significantly lower than that preoperatively (t=11.326, P=0.000). At 2 years after operation, MRI shows that fascia lata patches healed well in 9 patients. However, one case was with re-tear and patch absorption. The range of motion of shoulder was significantly improved in all patients but with different degrees of weakness (3-4).@*Conclusion@#Arthroscopic bridging reconstruction using autogenous fascia lata could effectively improve shoulder function in patients with irreparable massive rotator cuff tears. The autogenous fascia lata patch can heal with the help of rotator cuff tissue through bridging reconstruction.

Resolución de úlcera trocantérea mediante colgajo musculocutáneo de fascia lata en isla con cierre en V-Y / Trochanteric ulcer reconstruction by tensor fascia lata musculocutaneous island flap with a V toY closure

Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.

Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease

Turning over rough surface of aponeurosis of gastrocnemius with fascia lata graft for Achilles tendon rerupture / 中国骨伤

OBJECTIVE@#To explore clinical effects of turning over rough surface of aponeurosis of gastrocnemius with fascia graft for Achilles tendon rerupture.@*METHODS@#From July 2013 to April 2017, 11 patients with Achilles tendon reruptures were repaired by turning over rough surface of aponeurosis of gastrocnemius with fascia graft, including 10 males and 1 female aged from 25 to 48 years old. The patients were all manifested weakness of plantar flexion strength injured foot, and positive of single heel rise test before operation. Postoperative complications was observed, and AOFAS score at 6 months after operation was applied to evaluate clinical efficacy.@*RESULTS@#All patients were followed up for 6 to 11 months. All wound were healed at stage I without skin necrosis, wound infection, deep vein thrombosis and rerupture. The length of tendon defect ranged from 4 to 7 cm, the full weight-bearing time ranged from 8 to 11 weeks. Postoperative AOFAS score at 6 months was for 79 to 100, and 9 patients got excellent results, and 2 good.@*CONCLUSIONS@#For patients with recurrent ruptures of Achilles tendon, turning over rough surface of aponeurosis of gastrocnemius with fascia graft has advantages of stable repair, less complications and good recovery of function.

Free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar / 中华显微外科杂志

Objective To explore the surgical technique and clinical effects of free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar.Methods From February,2014 to July,2016,dorsal tendon and soft tissue defect of ophisthenar in 13 cases was repaired by free anterolateral thigh flaps with fascia lata.The area of soft tissue defect was 5.0 cm×6.0 cm-9.0 cm×12.0 cm.Extensor tendon defect and bone exposure occurred in all cases.The area of flap was 6.0 cm×7.0 cm-10.0 cm×13.0 cm,while the area of anterolateral thigh flap was 3.0 cm×4.0 cm-6.0 cm×8.0 cm.The regular post-operatively followed-up was performed.Results All flaps survived.The donor sites healed well without skin graft.The followed-up time was 6-36 months with the average of 13 months.The appearance of the flap was good.The color and texture of flaps was similar to the dorsal skin of ophisthenar.Three female patients who were not satisfied with the flap appearance received the revision and the results were satisfactory.The activity of finger flexion and extension was satisfactory.All patients walked well without difficulty.According to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,the function recovery result was excellent in 8 cases,good in 4 cases,and poor in 1 case.Conclusion It is a good method to use the free anterolateral thigh flaps with fascia lata to repair of dorsal tendon and soft tissue defect of ophisthenar.

Congenital unilateral hypoplasia of depressor anguli oris muscle in adult

Congenital hypoplasia of the depressor anguli oris muscle is a rare cause of asymmetrical crying facies in newborns. The clinical manifestations range from mild to severe asymmetry and may persist up to adulthood. In the current case, the patient did not exhibit other congenital anomalies or paralysis of other branches of the facial nerve. This adult patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth. A chromosomal study for the detection of 22q gene deletion yielded negative results. The electromyography findings of the lower lip were insignificant. Depressor labii inferioris muscle resection was not effective, but bidirectional (horizontal and vertical) fascia lata grafting improved the aesthetic appearance of the asymmetrical lower lip. The patient showed improved lower lip symmetry during full mouth opening at 1 year after the surgery. Therefore, the details of this rare case are reported herein.

Tratamento cirúrgico da ptose palpebral moderada e grave: análise de resultados / Surgical treatment of moderate and severe ptosis: analysis of results

Introdução: A ptose palpebral é uma afecção comum na prática clínica na qual uma perfeita avaliação torna-se mandatória. Definimos ptose quando a margem palpebral encontra-se abaixo de 2 mm da junção córneo escleral e pode ser classificada em leve, moderada e grave. Existem inúmeras técnicas de reparo e a escolha dependerá da classificação da função do músculo levantador. Métodos: Foram analisados de forma prospectiva, no período de março de 2013 a maio de 2015, quatorze (n = 14) pacientes submetidos ao tratamento cirúrgico de ptose palpebral moderada e grave (n = 21). Inúmeros fatores foram estudados, tais como grau de ptose e função do músculo elevador da pálpebra, tipo de técnica de reparo, complicações imediatas e tardias, etc. Resultados: Quatorze pacientes foram opera-dos, totalizando 21 pálpebras, sendo que, 85% foram de etiologia adquirida e 15% congênita. Com relação ao grau de ptose, 64,3% (n = 9) foram moderadas e 35,7% (n = 5) graves. No que tange à função do músculo levantador, encontramos função boa 28,5% (n = 4), moderada 28,5% (n = 4) e pobre 43% (n = 6). Em relação às com-plicações, 2 casos de hiperemia conjutival e um caso de edema. Obtivemos um alto índice de satisfação com 85,7% (n = 12), com baixas taxas de complicações. Conclusão: A ptose palpebral é uma enfermidade comum na prática clínica e exige por parte do cirurgião um perfeito conhecimento anatômico da delicada estrutura palpebral e também de sua fisiopatologia. Uma perfeita avaliação desse paciente torna-se mandatória para o emprego do tratamento mais adequado.

Introduction: Eyelid ptosis is a common condition in clinical practice for which a complete evaluation is mandatory. Ptosis is defined when the eyelid margin is 2 mm below the corneoscleral junction and can be classified as mild, moderate, and severe. There are numerous repair techniques, and the choice will depend on the classification of the function of the levator muscle. Methods: We evaluated prospectively, from March 2013 to May 2015, 14 patients who underwent surgical treatment of moderate and severe ptosis (n = 21). Several factors were studied, such as degree of ptosis and function of the eyelid levator muscle, type of repair technique, and immediate and late complications. Results: Fourteen patients (21 eyelids) underwent operation. The etiology was acquired in 85% of the cases and congenital in 15%. With respect to the degree of ptosis, 64.3% (n = 9) of the cases were moderate and 35.7% (n = 5) were severe. With respect to the muscle function of the levator, good, moderate, and poor functions were observed in 28.5% (n = 4), 28.5% (n = 4), and 43% (n = 6) of the cases, respectively. With regard to complications, 2 cases of conjunctival hyperemia and one case of edema were observed. We obtained a high satisfaction rate of 85.7% (n = 12), with low complication rates. Conclusion: Eyelid ptosis is a common presentation in clinical practice and requires on the part of the surgeon a detailed anatomical knowledge of the delicate structure of the eyelid and its pathophysiology. A complete evaluation of these patients is mandatory for the employment of the most appropriate treatment.

Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited

Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

Analysis of curative effect of reconstruction of annular ligament combined with internal fixation for the treatment of Monteggia fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the curative effect of fascia reconstruction of annular ligament combined with internal fixation for the treatment of Monteggia fracture.</p><p><b>METHODS</b>From December 2014 to October 2016, 30 cases with Monteggia fracture were treated by fascia reconstruction of annular ligament combined with internal fixation including 18 males and 12 females with an average age of 34.6 years old ranging from 6 to 50 years old. Elbow joint function were evaluated according to Mackay efficacy evaluation criteria.</p><p><b>RESULTS</b>All 30 patients were followed up for an average of 12.5 months. No radial head re-dislocation occurred. Internal fixation of reconstructive plate of ulna were all bone healing. According to the evaluation standard of Mackay curative effect, 23 cases were excellent, 5 cases were good, and 2 cases were poor. There were 4 cases of mild elbow pain and no pain in the wrist joint. Functional recovery was the fastest and most satisfactory in the forearm. Eight cases had dysfunction of elbow extension with an average limitation of 9.1 degrees. Six cases delayed injury of radial nerve were recovered for half a year.</p><p><b>CONCLUSIONS</b>For the Monteggia fracture, fascia reconstruction of annular ligament combined with internal fixation can effectively restore the forearm rotation function, the recent effect is satisfactory, further observation is needed for the long-term effect.</p>

Clinical and Radiological Results after Arthroscopic Superior Capsular Reconstruction in Patients with Massive Irreparable Rotator Cuff Tears

BACKGROUND: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. METHODS: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. RESULTS: All patients were men, and the average age was 59.5 ± 4.18 years (range, 53–65 years).The minimum follow-up was 18 months with a mean follow-up was 27.33 ± 7.58 months (range, 18–36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. CONCLUSIONS: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

Fascia lata como alternativa en tratamientos odontológicos / Fascia lata as an alternative in dental treatments

Resumen Introducción: La fascia lata es la parte más externa de la aponeurosis del muslo. Se trata de una membrana gruesa y resistente que posee elasticidad, flexibilidad y memoria. Actualmente es utilizada en el área médica para el tratamiento de defectos abdominales, incontinencia urinaria, ptosis palpebral y, en odontología, se utiliza para regeneración tisular guiada, coberturas radiculares, aumento de reborde y preservación de alveolo. Método: Se ha realizado una búsqueda electrónica en las bases de datos de Medline, PubMed y SciELO con el término fascia lata. Fueron incluidos textos compie-tos en idioma español e inglés que abarcan desde 1983 hasta 2015. La característica principal de estos textos es que exploran el uso de fascia lata en el área médica y odontológica. Discusión: Durante la realización de este trabajo surgieron situaciones limitantes debido a la escasa cantidad de artículos, investigaciones y casos clínicos documentados enfocados al uso de la fascia lata en el área odontológica. Conclusiones: La fascia lata es un material reabsorbible. biocompatible, que es bien tolerado por el lecho receptor, goza de características de seguridad y larga duración en su uso dentro de las especialidades medicas y odontológicas.

Abstract Introduction: Fascia lata is the most extreme section of the thigh's aponeurosis. It is a thick and resistant membrane possessing elasticity, flexibility and memory. It is presently used in the medical world to treat abdominal defects, urinary incontinence, and palpebral ptosis. In dentistry it is used in guided tissue regeneration, root coverage, ridge increase and socket (alveolus) preservation. Method: An electronic search was conducted in the following databases: Medline, PubMed and Sei ELO, with the term fascia lata. Full texts in English and Spanish were included in timeline spanning from 1983 to 2015. Main characteristic selected for these texts was they explored use of fascia lata and medical and dental areas. Discussion: Limiting situations arose during the execution of this project due to the scarcity found in articles and research papers and documented clinical cases targeting use of fascia lata ion dental areas. Conclusions: Fascia lata is a resorbable, biocompatible material, well tolerated by the recipient bed; when used in medical and dental specialties it exhibits characteristics of accuracy (security) and long duration.