Philippe Valenti, Julieta Puig Dubois, Jean-David Werthel, Efi Kazum
The therapeutic management of the paralytic shoulder after an obstetric brachial plexus injury is complex. When nerve repair or neurotization fail, or if the biological times for nerve reconstruction is over, tendon transfer to restore active external rotation of the shoulder becomes the main surgical alternative. The purpose of this manuscript is to describe the surgical technique of the lower trapezius muscle transfer to the infraspinatus muscle, to restore active shoulder external rotation in the child with paralytic shoulder, step by step with details and pearls...
April 28, 2021: Techniques in Hand & Upper Extremity Surgery
Felix Strübing, Maliha Sadick, Stefan Porubsky, Leila Harhaus, Amir Bigdeli, Ulrich Kneser
Alomari and colleagues described in 2014 for the first time a distinct combination of vascular malformation, fibrofatty muscular infiltration and contracture which was termed fibroadipose vascular anomaly (FAVA) (J Pediatr Orthoped 34, 109 117 (2014). So far only few publications (J Pediatr Orthoped (2014) 34, 109 117; J Hand Surg (2020). 45, 68.e1, 68.e13; Ann Vasc Dis (2014) 7, 316-319; Pediatr Radiol 46, 1179-1186 (2016)) concerning this newly described disease have been published, covering only a limited number of cases...
April 5, 2021: Annals of Plastic Surgery
Chih-Hung Lin
Daily walking stance benefits the health, whereas lower extremity reconstruction aims to accomplish balanced walking and posture control. If local flap or tendon transfer cannot provide the basic function, microsurgical reconstruction is indicated for bony, soft tissue, and sensation restoration. Wound repair can use every modality and can achieve varying wound coverage results. However, all reconstruction should have functional goals using either local flap or free flap to restore the lost function. With less recipient site secondary damage, microsurgery can provide healthy composite tissue with like-replaces-like approach to create more stable long-term results...
April 2021: Clinics in Plastic Surgery
Cheng-Hung Lin, Yun-Huan Hsieh, Chih-Hung Lin
Medial sural artery perforator (MSAP) flap is a thin, pliable, and versatile flap. It is a fasciocutaneous flap with chimeric design capacity. The donor site permits the synchronous harvesting of nonvascularized tendons and nerves. Free MSAP flap is suitable for foot, ankle, and distal one-third of the leg reconstructions. Pedicled MSAP flap is an alternative flap for knee and proximal two-thirds of leg defects, covering classical lower limb reconstruction territories of soleus, medial, and lateral gastrocnemius muscle flap...
April 2021: Clinics in Plastic Surgery
Lijuan Yuan, Zhiying Zhao
BACKGROUND: Lower extremity trauma is one of the most common emergency presentations. It may cause skin and muscle tissue defects, and in severe cases, it may also be accompanied by bone, tendon, and neurovascular exposure. Pedicled flap transfer is the most important treatment for this type of lower extremity trauma. The purpose of the study is to investigate the relevant factors affecting resilience and provide a theoretical basis of improving resilience in patients after skin flap transplantation...
January 2021: Annals of Palliative Medicine
João R Afonso, Daniel B Lopes, Diogo Soares, Rui M Matos, Rui P Pinto
Post-traumatic dystonia is an underrecognized condition that can present with bizarre symptoms after trauma, usually out of proportion to the trigger event. We describe the case of a 31-year-old man with a severe lower extremity deformity, gradually developed after minor trauma. An interdisciplinary treatment was tried without any improvement and surgery was performed as a rescue approach. Tibialis anterior tendon transfer and hindfoot triple arthrodesis were carried out, successfully achieving a plantigrade foot and a functional gait...
January 2, 2021: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Michael D Liette, Peter A Crisologo, Lance J Johnson, Jordan A Henning, Edgardo R Rodriguez-Collazo, Suhail Masadeh
The management of pedal ulcerations is often challenging because of a failure to correct underlying biomechanical deformities. Without correcting the biomechanical driving force creating the increased plantar pressures, it is unlikely for routine wound care to provide lasting solutions to pedal ulcerations. Patients with diabetes often experience glycosylation of their tendons, leading to contracture and pursuant deformity, creating imbalanced pressure distributions and eventual plantar ulceration. This article evaluates the efficacy of various lower extremity tendon transfers to balance the foot and redistribute plantar pressures to prevent or heal ulceration...
January 2021: Clinics in Podiatric Medicine and Surgery
Christopher S Crowe, Vincent S Mosca, Marisa B Osorio, Sarah P Lewis, Raymond W Tse
Peroneal nerve palsy with resultant foot drop has significant impacts on gait and quality of life. Traditional management includes ankle-foot-orthosis, tendon transfer, and arthrodesis-each with certain disadvantages. While nerve transfers for peroneal nerve injury have been reported in adults, with variable results, they have not been described in the pediatric population. We report the use of partial tibial nerve transfer for foot drop from deep peroneal nerve palsy in three pediatric patients. The first sustained a partial common peroneal nerve laceration and underwent transfer of a single tibial nerve branch to deep peroneal nerve 7 months after injury...
September 22, 2020: Microsurgery
Lance Johnson, Michael D Liette, Chris Green, Pedro Rodriguez, Suhail Masadeh
The reverse sural artery flap is a distally based fasciocutaneous or adipofascial flap used for wound coverage of the distal one-third of the lower extremity, ankle, and posterior heel. The flap harvest can be performed without sacrificing major arteries of the lower extremity. It can be elevated and mobilized with relative ease and a short operative time. It provides a good alternative to free tissue transfer in complex lower-extremity wounds with exposed bone, tendon, or hardware. The surgeon must be familiar with the management of venous congestion to improve the success of the flap...
October 2020: Clinics in Podiatric Medicine and Surgery
Bruno Battiston, Davide Ciclamini, Jin Bo Tang
Novel and combined tissue transfers from the lower extremity provide new tools to combat soft tissue defects of the hand, foot, and ankle, or fracture nonunion. Flaps can be designed for special purposes, such as providing a gliding bed for a grafted or repaired tendon or for thumb or finger reconstruction. Propeller flaps can cover soft tissue defects of the leg and foot. In repairing severe bone and soft tissue defects of the lower extremity, combined approaches, including external fixators, one-stage vascularized bone grafting, and skin or muscle flap coverage of the traumatized leg and foot, have become popular...
October 2020: Clinics in Plastic Surgery
Nidal F Al Deek, Jo-Chun Hsiao, Nicolas T Do, Huang-Kai Kao, Chung-Chen Hsu, Chih-Hung Lin, Cheng-Hung Lin
BACKGROUND: The medial sural artery perforator flap is a versatile option in reconstructive microsurgery. However, most reports of this flap have been limited by sample size. This study reviews the experience of a single large-volume center using the medial sural artery perforator flap and its variants for a variety of reconstructive purposes. METHODS: A retrospective review of all patients who received the medial sural artery perforator flap reconstruction between March of 2006 and July of 2014 was performed...
November 2020: Plastic and Reconstructive Surgery
Stanley Bazarek, Justin M Brown
Spinal cord injury (SCI) often results in devastating effects on function and quality of life. The majority of SCIs occur in the cervical region with restoration of arm and hand function being the highest priority by patients. Current restoration strategies rely on maximizing and optimally redistributing residual muscle functions that remain under volitional control. The polio epidemic and World Wars led to the development and refinement of tendon transfers, which has long been the standard reconstructive approach for the upper extremity following SCI...
July 30, 2020: Experimental Neurology
Rifali Patel, Grace Y Gombolay, Allan E Peljovich, Jessica Conklin, Laura S Blackwell, Robyn Howarth, David S Wolf, Saila R Upadhyayula, Sumit Verma
BACKGROUND: Acute flaccid myelitis has emerged as the leading cause of acute flaccid paralysis in children. Acute flaccid myelitis leads to significant physical disability; hence, objective outcome measures to study disease severity and progression are desirable. In addition, nerve transfer to improve motor function in affected children needs further study. METHODS: Retrospective study of acute flaccid myelitis subjects managed at Children's Healthcare of Atlanta from August 2014 to December 2019...
November 2020: Journal of Child Neurology
İlker Abdullah Sarıkaya, Sema Ertan Birsel, Ali Şeker, Ozan Ali Erdal, Barış Görgün, Muharrem İnan
OBJECTIVE: The aim of this study was to analyze the results of the split anterior tibialis tendon transfer (SPLATT) to peroneus tertius (PT) for equinovarus foot deformity in children with cerebral palsy (CP). METHODS: The medical records of 25 ambulatory CP patients (mean age: 8.7±3.2 years, range: 4-16 years) with equinovarus foot (33 feet), who underwent SPLATT to PT surgery between 2014 and 2016, were retrospectively reviewed. A senior surgeon performed all the surgical procedures...
May 2020: Acta Orthopaedica et Traumatologica Turcica
Sang Wha Kim
Objectives. Lower extremity ulcers are quite common in patients with autoimmune diseases. Due to chronic use of immunosuppressants, these wounds may develop into deeper wounds resulting in exposure of bone or tendon, which in turn may require free tissue transfers for coverage. The author reviewed perforator free flap transfers performed in this group of patients and analyzed the results. Methods. A retrospective review was performed on all patients who underwent perforator free flap transfer for coverage of lower extremity ulcers without trauma, over a 10-year period...
May 17, 2020: International Journal of Lower Extremity Wounds
Owen N Johnson, Michael Nelson, Ivy Estabrooke, Nikolai Sopko, Edward W Swanson
Extremity injuries are common in contemporary combat and have become more prevalent as fatality rates have dropped to historic lows. Traumatic extremity wounds, especially those sustained in theater, often present with exposed structures such as tendon, bone, and joint, preventing the use of split-thickness skin grafts (STSG) for coverage. Traditional reconstructive options for these complex wounds include skin substitute with delayed STSG, local flaps, debridement of tendons, pedicled distant flaps (such as cross-leg flap), free tissue transfer, and amputation...
May 4, 2020: Curēus
Leighton T McCabe, Jason W Stoneback, Jeniann A Yi, William R Hiatt, Mary K Jesse, Max V Wohlauer
BACKGROUND: Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a non-atherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old female presenting with foot pain upon plantarflexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon. METHODS: The patient was a 17-year-old female who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position...
April 22, 2020: Annals of Vascular Surgery
Dan Mircea Enescu, Simona Stoicescu, Maria Tomiţă, Iulia Nacea, Dan Ioniţă, Raluca Tatar
INTRODUCTION: Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department. METHOD: We performed a retrospective study for the period 2016-2019, in order to identify patients having suffered injuries of the ankle and foot, for who NPWT was used in the therapeutic protocol...
March 9, 2020: Injury
Joseph P Scollan, Jared M Newman, Neil V Shah, Erika Kuehn, Steven M Koehler
Objectives  Elbow flexion loss is a debilitating upper extremity injury. Surgical treatment options include nonfree muscle transfers (tendon transfers, nerve transfers, Steindler procedure, Oberlin transfers, and pedicled muscle transfers) or free muscle transfers. We sought to determine if free muscle transfers and nonfree muscle transfers have similar outcomes for elbow flexion reanimation. Materials and Methods  A literature search for studies evaluating free and nonfree muscle transfers for elbow flexion reanimation was performed...
April 2020: Journal of Hand and Microsurgery
Sameer Shakir, Charles A Messa, Robyn B Broach, Irfan A Rhemtulla, Brett Chatman, Albert D'Angelantonio, L Scott Levin, Stephen J Kovach, Joseph M Serletti, John P Fischer
BACKGROUND: Little is known about the efficacy of newer skin substitute scaffolds to reconstruct complex lower extremity wounds. The investigators present a multihospital experience of reconstructive surgeons utilizing collagen-GAG bilayer wound matrix in lower extremity soft-tissue reconstruction with the goals to (1) characterize a suitable patient population, (2) categorize failures to optimize patient selection, and (3) determine wound factors affecting success. METHODS: Subjects underwent collagen-GAG-based lower extremity wound reconstruction from May of 2010 to June of 2017...
March 2020: Plastic and Reconstructive Surgery
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