Distal Fibular Reconstruction Using Iliac Grafting and Emslie-Vidal's Ligamentoplasty after Exeresis of Single Renal Carcinoma Metastasis.

Introduction. Restoring lateral ankle stability following distal resection of the fibula is a difficult procedure for which several surgical techniques have been proposed. Each of these techniques has potential drawbacks. This report presents a new option for fibular reconstruction. Case Study. We report the case of a 68-year-old male with evolving pain in the left ankle throughout the past 3 months. Three years prior to consultation, he underwent left nephrectomy for clear-cell adenocarcinoma. A swelling on the external side of the left ankle was noticed upon clinical examination, with no signs of inflammation. The ankle was stable with normal mobility. Radiographic examination revealed a 4 cm lytic lesion on the lateral malleolus with internal and external cortical damages as well as invasion of the soft tissues. Neither lower peroneotibial nor tibiotarsial joints were invaded. Needle biopsy confirmed the presence of metastatic renal clear-cell adenocarcinoma. Consequently, large exeresis of this single metastasis was indicated while preserving functional integrity of the ankle. Following block resection of the distal fibula including the lower tibioperoneal joint, a bicortical autograft was positioned to abut against the external side of the talus. Emslie-Vidal's ligamentoplasty procedure was performed with half of the short peroneal passed under the pedal flexor, then in the bone abutment, and finally through a calcaneal bone tunnel. Peroneus muscles were stabilized using a fragment sampled from the Achilles tendon. Pain decreased in 3 months, and the ankle was stable with normal functionality at a 5-year follow-up. Discussion. Reconstruction of the lateral ankle following fibular resection is possible by reconstructing the external facet of the malleolus using an autograft associated with Emslie-Vidal's ligamentoplasty procedure, hence stabilizing both tibiotalar and subtalar joints. This surgical procedure allowed the patient to return to his daily activities with neither instability nor evolution towards short-term tibiotalar arthrosis.

Results and complications of superficialis-to-profundus tendon transfer in brain-damaged patients, a series of 26 patients.

INTRODUCTION: In hemiplegic patients with a spastic clenched fist deformity, one of the goals of surgery is to address the hygiene, nursing and appearance problems. Transfer of the flexor digitorum superficialis (FDS) to the flexor digitorum profundus (FDP), initially described by Braun and colleagues, opens the non-functional hand in these patients. The primary objective of our study was to confirm the effectiveness of this technique for correcting these deformities. The secondary objectives were to demonstrate potential functional gains and to identify potential complications. MATERIAL AND METHODS: A Braun procedure was performed in 26 patients (9 women, 17 men, ranging in age from 36 to 79 years). The overall appearance of the hand was graded using the Keenan classification system. Complications related to the surgery were documented. The hand's function was evaluated with the House score. RESULTS: The average follow-up was 47 months. Preoperatively, all patients had a class V hand: severe clenched-fist deformity with zero pulp-to-palm distance. Postoperatively, 10 patients had a type I hand (open hand, with less than 20° spontaneous extension deficit of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints) and 12 patients had a type II hand (20° to 40° spontaneous extension deficit of the MCP and PIP joints). The mean House score for all patients went from 0 to 0.88, and seven patients had functional improvements. Four patients had a forearm supination posture, 10 had intrinsic deformity with spontaneous MCP flexion and 6 had a swan-neck deformity. CONCLUSION: Superficialis-to-profundus tendon transfer (STP) provides satisfactory outcomes in terms of hand opening, with some patients also experiencing improved hand function. However, the complications cannot be ignored. LEVEL OF EVIDENCE: IV-retrospective or historical series.

Secondary restoration of fingertip sensation with Littler's heterodigital neurovascular island flap after ring avulsion injury: report of two cases.

Treatment of ring avulsion injuries is technically challenging. Surgical success depends not only on revascularization and anatomic restoration but also on functional recovery. A functional finger is mobile and sensible. We report two cases of secondary restoration of the finger pulp's sensibility with Littler's heterodigital neurovascular island flap after a ring avulsion injury. Two patients (47-year-old physiotherapist and 21-year-old student) suffered a degloving injury of the 4th finger on the left hand, classified in Urbaniak class III and Kay-Adani class IVd. The emergency treatment consisted in replantation with suture repair of the ulnar proper palmar digital artery; the nerve was not repaired due to its avulsion from the pulp. Four months later, once the vascularization was stable, restoration of the fingertip's sensibility was done using Littler's heterodigital neurovascular island flap. The 3rd finger's ulnar palmar digital pedicle was dissected using a hemi-Bruner incision. The pedicled flap was brought to the host site after being tunneled through the 4th finger's base. A split skin graft was performed at the donor site. After three years of follow-up, two-point discrimination on the 4th finger's radial pulp was 5mm and cortical integration was satisfactory. The donor site had only tactile sensitivity. The DASH (Disabilities of the Arm, Shoulder and Hand) score was 13.3 and 11.7, and the total arc of motion was 90° and 180°, respectively. Littler's flap seems to be appropriate for restoring sensation at fingertip after ring avulsion injuries. Donor site complications seem acceptable.