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.

The Effect of Fibroblast Growth Factors in Grafted Fascia into the Vocal Fold of Rabbits

Abstract Introduction The human larynx is a very important organ for communication. Many conditions lead to scarring of the vocal folds, decreasing voice quality. Objective We aimed to determine whether fibroblast growth factors (FGFs) may influence tissue integration of grafted fascia into the vocal folds of an animal model. Methods This is an experimental animal study with 12 adult rabbits that were submitted to a grafting fragment obtained from superficial cervical fascia into the vocal fold lamina propria, bilaterally. The right vocal fold was injected with FGFs. The animals were sacrificed after 1 month or 12 months, depending on the group they were assigned to, and a histological analysis of their vocal folds was performed.We analyzed the histological changes (such as the presence of fibrosis and neovascularization) induced by the acute or chronic inflammatory reactions. Results The FGFs induced acute inflammatory changes in all animals after 1 month of the initial experiment. The presence of FGFs triggered more fibrosis than the expected due to the surgical procedure itself when compared with the control side of all animals after 12 months of the initial experiment. Conclusions Fibroblast growth factors alone do not represent a good therapeutic option in phonosurgery, since we observed higher levels of fibrosis in the vocal fold lamina propria. Further studies combining more substances may be necessary to elucidate the best option to be used in this kind of surgery. (AU)

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

Consideration of the Exercise position for Facilitating Gluteus Medius Maximally in Normal Adults

PURPOSE: This study examined the most efficient exercise position to activate the gluteus medius (GM) and tensor fascia latae (TFL) in hip abduction in side-lying (HA-SL), clam in side-lying (CL-SL), and sling bridging in side-lying (SB-SL), which are the most representative GM exercises. METHODS: Twenty-four healthy male adults aged from 20 to 40 years, whose body mass index was under 25, participated in this experiment. While all participants conducted three different positions with a counterbalanced manner, such as in AB, CL, and BR, activation of the GM and TFL was measured using 8-channel wireless EMG. Exercise was performed for 10 seconds three times in total with a five minute-break session. RESULTS: Significant differences in GM and TFL activation were observed among the three positions (p<0.05). The highest activation of 60.69 was observed in BR followed in order by 46.03 and 12.92 in HA-SL and CL, respectively. TFL activation in HA-SL was 42.01, followed in order by 35.98 and 14.01 in BR and CL, respectively. On the other hand, there was no significant difference in TFL muscle activation between BR and HA-SL. CONCLUSION: These findings suggest that both BR and HA-SL in GM can be done selectively. CL has remarkably low muscle activation in GM and TFL, which makes it less valuable in GM and TFL exercise. In conclusion, selective BR and HA-SL exercise should be applied to maximally and effectively activate the GM.

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.

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.

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.

Biotenodesis con tensor de fascia lata. técnica extraarticular / Biotenodesis with fascia lata tensor

Las biotenodesis con tensor de fascia lata para el tratamiento de las inestabilidades por insuficiencia del ligamento cruzado anterior han sido utilizadas con muy buenos resultados durante muchísimos años. Tuvieron su máximo apogeo entre los años 1975 y 1985, siendo prácticamente olvidadas por la mayoría de los cirujanos con la llegada de las técnicas de reconstrucción intraarticulares artroscópicas. En los últimos años luego de la descripción de un “viejo-nuevo” ligamento anterolateral de la rodilla, han tenido un nuevo auge si bien debe mencionarse claramente que la técnica de Lemaire no reconstruye este ligamento. Esta técnica resulta sumamente útil cuando se la asocia con plásticas intraarticulares en revisiones o insuficiencias luego de una plástica primaria del LCA, o como procedimiento único en pacientes de más de 50 años con bajo nivel de exigencia física, en virtud que presentan una muy baja morbilidad y una rehabilitación más rápida en relación a las plásticas intraarticulares. Tipo de estudio: Técnica Quirúrgica. Nivel de evidencia: V.

The biotenodesis with fascia lata tensor for the treatment of instabilities due to insufficiency of the anterior cruciate ligament have been used with very good results for many years. In recent years after the description of an “old-new” anterolateral ligament of the knee have had a new boom although it should be clearly stated that the technique of Lemaire does not reconstruct this ligament. Anatomical repairs and details of surgical technique are described. This technique is extremely useful when it is associated with intraarticular plastics in revisions or insufficiencies after primary plastic surgery of the ACL or as a single procedure in patients over 50 years of age with a low level of physical requirement because they present a very low morbidity and one Rehabilitation in relation to intra-articular plastic. Type of study: Surgical Technique. Level of Evidence: V.

Treatment of Failed Arthrodesis of First Metatarsophalangeal Joint with Tensor Fascia Lata Interposition Arthroplasty: A Case Report / 대한족부족관절학회지

Surgical treatments for arthritis in the first metatarsophalangeal joint include arthrodesis, interposition arthroplasty using silicone or meniscus cartilage, and rarely arthroplasty. Although arthrodesis was performed successfully, pain can persist if the angle of fusion was inappropriate. Interposition arthroplasty can be tried for the treatment of persisting pain after the arthrodesis. Interposition arthroplasty using tensor fascia lata is known that has low risk of adhesions and easy to harvest. Compared to autologous grafts, grafting rates is high and low risk of rejection additionally. Herein, we report a successfully managed arthritis with severe pain with interposition arthroplasty using tensor fascia lata after a failed metatarsophalangeal joint arthrodesis.

Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach / 대한고관절학회지

PURPOSE: The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA). MATERIALS AND METHODS: Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches. RESULTS: The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients. CONCLUSION: Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.

Résultats de la technique de Mac Intosh au Fascia Lata Modifiée par Jaeger dans les instabilités antérieures chroniques du genou

Objectif: Il existe plusieurs techniques de reconstruction des ruptures anciennes du ligament croisé antérieur du genou. Le but de cette étude était d'évaluer à moyen terme les résultats de la technique de Mac Intosh au fascia lata modifiée par Jaeger. Matériel et méthodes: Dans cette étude rétrospective réalisée entre janvier 2005 et décembre 2013, 56 genoux (56 patients) ont été opérés par la technique de Jaeger à ciel ouvert pour des ruptures anciennes du ligament croisé antérieur. Elle a concerné des adultes jeunes masculins. Cinquante (89%) patients étaient sportifs. Un patient avait une arthrose débutante classée stade 2 Alhbäck modifiée. L'évaluation fonctionnelle des résultats a été faite selon le score IKS (globale, genou et fonction). L'examen clinique était basé sur la mobilité du genou, le test de Lachman-Trillat, et la recherche du ressaut. Le positionnement du tunnel tibial a été analysé à la radiographie. Le stade arthrosique a été apprécié selon les critères d'Alhbäck modifié . La ligamentisation du transplant à l'IRM a été étudiée chez quatre patients. Résultats: Au recul moyen de 7 ans, 85% des patients étaient satisfaits du résultat fonctionnel avec un score IKS genou de 96,1 en moyenne, un score IKS fonction de 100, et un score IKS global de 196,1. La mobilité était complète sans flessum résiduel. Le test de Lachman-Trillat était négatif (n= 38 ; 68%). Il était positif avec arrêt dur (n=16 ; 29%) et retardé (n=2 ; 3%). Le ressaut rotatoire a été neutralisé chez tous les patients. L'angle tibial moyen de face était de 61°. Il n'y avait pas de ballonisation des tunnels. Cinquantedeux (93%) patients étaient classés Alhbäck 1 et quatre (7%) Alhbäck 2. La ligamentisation a été constante à l'IRM. Conclusion: La ligamentoplastie du croisé antérieur au fascia lata modifiée par Jaeger donne de bons résultats fonctionnels et anatomiques avec une réduction significative de l'apparition de l'arthrose secondaire

The Keystone Flap in Greater Trochanter Pressure Sore

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a 3×5 cm pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to 5×8 cm in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.

Use of human fascia lata in rat calvarial bone defects

Tooth loss leads to a decrease in alveolar bone volume, and consequently to the need for guided bone regeneration (GBR) techniques to restore bone anatomy, and the adequate choice of therapy. Fascia lata membrane (FLM) has been used in surgical procedures in neurology, orthopedics, otorhinolaryngology, cardiology, vascular surgery, gynecology, and dentistry for guided tissue regeneration. The aim of the present preliminary study was to evaluate bone tissue response in rat calvarial bone defects covered with human fascia lata membrane (FLM). Eight Wistar rats, 230g body weight, were subjected to bone surgery to create a 5x5mm long/ 1mm deep calvarial bone defect on either side of the median suture, using a piezoelectric scalpel and irrigation. The animals were treated according to the following protocol: Group I (GI): placement of a single layer of FLM (Biotar, Rosario, Prov. de Santa Fe, Argentina) to cover the defects; Group II (GII): double layer of FLM to cover the defects; Group III: no membrane; Group IV: control. All the animals were euthanized 60 days post-surgery; the heads were resected, radiographed, decalcified, and processed for embedding in paraffin and Hematoxylin-Eosin and Masson's trichrome staining. All bone defects covered with a single or double layer of FLM showed adequate osteogenesis, and none exhibited an inflammatory response. Groups III and IV Control showed scant osteogenesis and no alterations in soft tissues. The results obtained with this experimental model show biocompatibility of FML with the surrounding tissues at the studied time points. No alterations were observed in osteocytic lacunae or osteocytes in the bone after osteotomy using a piezoelectric scalpel. Further studies need to be conducted to assess bone tissue response to FLM in combination with bone substitutes.

La perdida de piezas dentarias conlleva la disminucion volumetrica del hueso alveolar y la necesidad de recurrir a tecnicas de regeneracion osea guiada (ROG) para restablecer las condiciones anatomicas y aplicar las terapeuticas adecuadas. La membrana de fascia lata (MFL) ha sido utilizada en intervenciones quirurgicas del area neurologica, ortopedica, otorrinolaringologica, cardiologica, vascular, ginecologica y odontologica para regeneracion tisular guiada. El objetivo de este trabajo preliminar fue evaluar la respuesta tisular de defectos oseos en calota de rata recubiertos con MFL. Se utilizaron 8 ratas Wistar de 230 gr de peso, a las que se les realizo en la calota 2 defectos oseos de 5 x 5 mm de lado por 1 mm de profundidad, con bisturi piezoelectrico e irrigacion, a ambos lados de la linea media, segun tecnica estandarizada. Se realizo el siguiente protocolo: Grupo I (G I): colocacion de una sola capa de MFL (Biotar, Rosario, Prov. de Santa Fe, Argentina) para cubrir el defecto; Grupo II (G II): colocacion de MFL en doble capa para cubrir el defecto; Grupo III (G III): sin membrana; Grupo IV (G IV): control. Se les provoco la eutanasia a los 60 dias. Las calotas fueron resecadas, radiografiadas y procesadas, previa descalcifica - cion, para su inclusion en parafina y coloracion con Hematoxilina-Eosina y Tricromico de Masson. En todos los defectos oseos recubiertos con MFL simple o doble se evidencio una adecuada osteogenesis y ausencia de respuesta inflamatoria y macrofagos. El G III y el G Sham evidenciaron escasa osteogenesis y no mostraron alteraciones en el tejido blando. La MFL en el modelo experimental utilizado evidencio una respuesta compatible con el tejido circundante en los periodos estudiados. El tejido oseo remanente a la osteotomia con bisturi piezoelectrico presento las lagunas osteociticas ocupadas con osteocitos y sin alteraciones. En estudios futuros se evaluara la respuesta tisular con MFL y utilizando un sustituto oseo.

Repair of skin and soft tissue defects around the knee joints combined with patellar ligament defects using free anterolateral thigh flaps with iliotibial tracts / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe clinical efficacy of using free anterolateral thigh flaps with iliotibial tracts in repairing skin and soft tissue defects around the knee joints with patellar ligament defects.</p><p><b>METHODS</b>Twelve patients with skin and soft tissue defects around the knee joints and patellar ligament defects were hospitalized from June 2010 to June 2014. The defects of skin and soft tissue ranged from 7 cm × 6 cm to 16 cm × 12 cm in area, and patellar ligament ranged from 5 to 12 cm in length and 2.5 to 4.0 cm in width. Free anterolateral thigh flaps with iliotibial tracts were used to repair these defects. During reconstruction of patellar ligament, both ends of iliotibial tract were successively folded to form tendon-like three-layer structure at first, and then the newly formed structure was wrapped around the broken ends of patellar ligament and fixed with suture. The flap size ranged from 9 cm × 8 cm to 18 cm × 14 cm. The iliotibial tract ranged from 7 to 14 cm in length and 8 to 12 cm in width. The donor sites were closed by grafting with autologous split-thickness skin harvested from thigh or trunk, and parked with gauze. Immediately after operation, the knee joints were fixed in extension with orthosis for 6 weeks. Weight bearing training of affected limbs being kept in extension position was started from 2 weeks after operation, and flexion and extension exercise of affected knee joints was begun from 6 weeks after operation. Before operation and 12 months after operation, the degree of pain around the knee joints and knee joint function were evaluated with the international knee documentation committee knee uation form, and the ranges of flexion and extension of knee joints were also evaluated. The integrity of reconstructed patellar ligament was assessed by color Doppler ultrasound from 6 to 12 months after operation. The occurrence of surgery-related complications was observed in all patients within 12 months after operation.</p><p><b>RESULTS</b>(1) After operation, all flaps survived well, and all wounds healed well. (2) The average score of pain around the knee joint was increased from 31 points before operation to 77 points in 12 months after operation. The average score of knee joint function was increased from 14 points before operation to 65 points in 12 months after operation. Before operation, the average ranges of flexion and extension of knee joint were respectively 89° and 65°, and they were respectively increased to 130° and decreased to 15° in 12 months after operation. From 6 to 12 months after operation, color Doppler ultrasound showed that the condition of reconstructive patellar ligaments in all patients was good without the need for further surgical intervention; the superficial sensation of the flaps was recovered in different degrees. No surgery-related complication was observed in all patients within 12 months after operation.</p><p><b>CONCLUSIONS</b>Free grafting of anterolateral thigh flap with iliotibial tract is an effective and reliable method for repairing skin and soft tissue defects around the knee joints combined with patellar ligament defects, and the surgical procedure can recover function and appearance of knee joint satisfactorily.</p>

Pedicled Anterolateral Thigh Flaps for Reconstruction of Recurrent Trochanteric Pressure Ulcer

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.

Functional Reconstruction of a Combined Tendocutaneous Defect of the Achilles Using a Segmental Rectus Femoris Myofascial Construct: A Viable Alternative

The composite anterolateral thigh flap with vascularized fascia lata has emerged as a workhorse at our institution for complex Achilles defects requiring both tendon and soft tissue reconstruction. Safe elevation of this flap, however, is occasionally challenged by absent or inadequate perforators supplying the anterolateral thigh. When discovered intraoperatively, alternative options derived from the same vascular network can be pursued. We present the case of a 74-year-old male who underwent composite Achilles defect reconstruction using a segmental rectus femoris myofascial free flap. Following graduated rehabilitation, postoperatively, the patient resumed full activity and was able to ambulate on his tip-toes. At 1-year follow-up, active total range of motion of the reconstructed ankle exceeded 85% of the unaffected side, and donor site morbidity was negligible. American Orthopaedic Foot and Ankle Society and Short Form-36 scores improved by 78.8% and 28.8%, respectively, compared to preoperative baseline assessments. Based on our findings, we advocate for use of the combined rectus femoris myofascial free flap as a rescue option for reconstructing composite Achilles tendon/posterior leg defects in the setting of inadequate anterolateral thigh perforators. To our knowledge, this is the first report to describe use of this flap for such an indication.

Reparation and restitution of head tissue deletion with fascia lata and local flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effect of reparation and restitution of head tissue deletion with autologous fascia lata and local flap.@*METHOD@#The clinical data of 8 cases with scalp squamous celled carcinoma from 2003 to 2010 were summarized retrospectively. All patients carcinoma were removed almost, cerebral dura mater deletion and skin deletion from 5 cm to 15 cm, repaired cerebral dura mater with autologou fascia lata; and restitution scalp with local flap, the area of local flap were planted with free skin graft.@*RESULT@#The outcomes of the treatment with fascia lata were very well, and the local flap of all cases were survival the free skin graft were survival from 85% to 100%. There was no leakage of cerebrospinal fluid or intracranial infection during follow-up.@*CONCLUSION@#The method of repairation and reconstruction of head tissue deletion with fascia lata and local flap is effective, the out comes are satisfying.