Y-Shaped Tendon Graft-A Technique in the Reconstruction of Posttraumatic Chronic Boutonniere Deformity.

PURPOSE: Current reconstruction strategies for chronic posttraumatic boutonniere deformities have variable outcomes and are prone to complications. This study aimed to describe the clinical outcomes of a Y-shaped tendon graft technique. METHODS: In this retrospective case study, we reviewed the files of 18 patients treated with the Y-shaped tendon graft between January 2010 and January 2017. The technique involves release of the central slip, lateral bands, and transverse retinacular ligaments at the proximal interphalangeal (PIP) joint, total excision of scar tissue in the central slip and at the insertion site, and construction of 3 1.5-mm unicortical holes at the base of the middle phalanx, through which a Y-shaped graft of the palmaris longus is inserted to reconstruct the central slip and stabilize the lateral bands in a dorsal position. Clinical evaluations included measuring the active range of motion in the PIP joint and distal interphalangeal (DIP) joint, grip strength, Souter score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. RESULTS: The mean age of patients was 36.1 years, and 12 of the 18 patients were men. The average follow-up period was 23 months (range, 13-38 months). The preoperative PIP joint extension deficit was 48.0° ± 5.0° compared with 10.9° ± 9.3° after surgery. The preoperative DIP joint active flexion was 34.4° ± 8.0° compared with 71.4° ± 8.6° after surgery The outcomes based on the Souter score were 11 excellent, 5 good, and 2 poor. The QuickDASH score was 17.7 ± 6.4 before surgery and 11.2 ± 7.2 after surgery. CONCLUSIONS: The Y-shaped tendon graft can be a useful procedure for the correction of chronic boutonniere deformity; in our patient series, this provided good or excellent results in 16 of 18 patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A novel blood supply method for free jejunal transfer with the third jejunal artery as vascular pedicle.

PURPOSE: To assess the effective distribution of blood supply in jejunal graft with the 3rd intestinal artery as pedicle and to afford a reliable theoretic base for clinical esophageal reconstruction. METHODS: Thirty-two formalin-preserved and 21 fresh cadaver specimens were studied with anatomic measurement, acetic ester perfusion, and Acrylonitrile butadiene styrene (ABS) vascular casting specimen. RESULTS: Results demonstrate there is no significant variation of vascular in the two groups. The inner diameter of the 3rd intestinal artery is comparatively larger among five intestinal arteries. There is a wider distribution of efficient blood supply in the 3rd intestinal artery. The mean (SD) length of homogenously stained jejunum segment, and the mean (SD) ABS effective distributing length of extended arches are 142.2 (62.3) cm and 30.8 (7.3) cm, respectively. CONCLUSIONS: The 3rd intestinal artery as pedicle can afford adequate blood supply to the jejunum segment and has effective arterial arch with enough length; thus it meets the need of esophageal reconstruction.