Orthoplastic Surgery最新文献

{"title":"The malnourished consult: A quiet prevalence in complex musculoskeletal patients","authors":"Katelyn Lewis ,&nbsp;Sara Islam ,&nbsp;Martin J. Carney ,&nbsp;Alexandra Junn ,&nbsp;Christopher A. Schneble ,&nbsp;David Colen ,&nbsp;Adnan Prsic","doi":"10.1016/j.orthop.2022.09.006","DOIUrl":"10.1016/j.orthop.2022.09.006","url":null,"abstract":"<div><h3>Background</h3><p>Malnutrition is associated with major perioperative complications including delayed wound healing and dehiscence following orthopedic procedures. This study will review all arthroplasty and elective spinal fusion patients with complications requiring a plastic surgery consultation. We seek to elucidate patient risk factors predisposing this population to wound complications.</p></div><div><h3>Methods</h3><p>A retrospective chart review at a single academic center was performed on a series of knee arthroplasty, hip arthroplasty, and spinal fusion patients with a documented plastic surgery consultation between January 1, 2001 and October 22, 2021. Patient demographics, time to consultation, nutritional laboratory studies, comorbidities, and complications were all considered. Statistical analysis included t-tests, chi-square analysis, and multivariate logistic regression models.</p></div><div><h3>Results</h3><p>Ninety patients met inclusion criteria. Fifty-three patients (58.8%) qualified as malnourished according to an albumin of &lt;3.5 g/dL or prealbumin of &lt;15 mg/dL. Only 70% (n = 63) of patients had nutritional work-up and 36% (n = 33) had documented consultation with a nutritionist. All but 6 patients (6.7%) suffered complications with a mean of at least 3 (+/− 1.59) complications per patient. Wound infections and breakdown were especially common: 18 patients (20.0%) developed wound infections, 30 patients (33.3%) developed wound dehiscence, 26 patients (28.9%) developed a combination of wound infection and breakdown, and only 16 patients (17.8%) had no wound-related complications.</p></div><div><h3>Conclusion</h3><p>Optimizing patient risk factors and interdisciplinary cooperation are crucial prior to high-risk surgeries such as knee arthroplasties, hip arthroplasties, and spinal fusions. These patients often necessitate early plastic surgery and nutrition involvement to mitigate morbidity and improve surgical outcomes.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 57-63"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000446/pdfft?md5=9780da6c29fefd8919bc213aafdd6923&pid=1-s2.0-S2666769X22000446-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90621725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of surgical management of closed periprosthetic distal femur fractures above total knee arthroplasties: A case series","authors":"Joshua R. Labott,&nbsp;Samuel W. Carlson,&nbsp;Krystin A. Hidden,&nbsp;Brandon J. Yuan","doi":"10.1016/j.orthop.2022.08.002","DOIUrl":"10.1016/j.orthop.2022.08.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Periprosthetic distal femur fractures present difficult treatment challenges and are expected to become more prevalent as the number of total knee arthroplasties (TKAs) continues to rise. The purpose of this study is to determine the functional outcomes and rate of re-operation following surgical treatment of closed distal femoral periprosthetic fractures above a TKA.</p></div><div><h3>Methods</h3><p>We performed a retrospective review of 56 patients (45 females) who underwent surgical management of distal femur fractures (AO/OTA 33) above an ipsilateral TKA with a mean follow-up of 21 months (range, 12–78 months). Forty-three (77%) patients were treated with a lateral plate and screw construct, and 13 (23%) patients were treated with a retrograde intramedullary nail.</p></div><div><h3>Results</h3><p>There were 2 (4%) deep infections at a mean of 6 months (range, 5–7 months) post-operatively. At final follow-up, TKA components were retained in 53 (93%) patients, demonstrating a survivorship free of component revision following fracture treatment of 93% at 6.5 years. Survivorship free of any re-operation following fracture treatment was 86% at 6.5 years. Mean anatomic lateral distal femoral angle (aLDFA) was 84° (range, 72–89°) and mean anatomic posterior distal femoral angle (aPDFA) was 83° (range, 67–89°). There were 8 nonunions (14%) at 6 month follow-up, and no patients underwent a re-operation for malunion.</p></div><div><h3>Conclusion</h3><p>This case series demonstrates increased revision rates and decreased survivorship of TKA components after surgical management of periprosthetic distal femur fractures. Surgeons must be aware of these potential complications when treating patients with periprosthetic distal femur fractures and counsel their patients appropriately.</p></div><div><h3>Level of Evidence</h3><p>Therapeutic Level IV. See instructions for all others for a complete description of levels of evidence.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 1-3"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X2200029X/pdfft?md5=95ed0fdc3553f01375b57f8bdf6d77a5&pid=1-s2.0-S2666769X2200029X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89329610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled chimeric muscle and anterolateral thigh fasciocutaneous flap reconstruction of trochanteric pressure wounds: Presentation of two cases","authors":"Charles Lee,&nbsp;Sameer Massand,&nbsp;Caroline M. Mclaughlin,&nbsp;Mikayla Borusiewicz,&nbsp;T Shane Johnson,&nbsp;John M. Ingraham","doi":"10.1016/j.orthop.2022.08.006","DOIUrl":"10.1016/j.orthop.2022.08.006","url":null,"abstract":"<div><h3>Background</h3><p>Trochanteric pressure wounds are a significant cause of morbidity among paraplegic and comorbid patients. Their surgical management requires femoral head ostectomy followed by robust soft tissue coverage both for dead space obliteration and for skin and subcutaneous tissue replacement. Many flap options and their variations have been presented for this purpose. We present a unique methodology utilizing a chimeric pedicled muscle and anterolateral thigh (ALT) flap for reconstruction.</p></div><div><h3>Cases</h3><p>First, we present a paraplegic 39-year-old male who underwent a right Girdlestone procedure followed by a pedicled chimeric vastus lateralis and ALT flap for trochanteric pressure wound reconstruction. Secondly, we present a 55-year-old paraplegic male with a similar pathology on the left, who underwent a pedicled chimeric rectus femoris and ALT flap reconstruction. Both surgical courses were uncomplicated and with no wound recurrence.</p></div><div><h3>Discussion</h3><p>Our cases demonstrate that this modification of previously described reconstructions is a viable option for the reconstruction of trochanteric pressure wounds. The literature abounds with reconstructive options for trochanteric wound reconstruction, but none without limitations. We add another durable and robust coverage modality to the reconstructive surgeon's armamentarium.</p></div><div><h3>Conclusion</h3><p>The chimeric pedicle muscle and ALT flap surgical reconstruction is a viable technique in management of trochanteric pressure wound reconstruction.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 4-9"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000331/pdfft?md5=96fbcb8f1452c20805092c7a1af468ea&pid=1-s2.0-S2666769X22000331-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76512839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the anatomical position of the superficial and deep femoral arteries during internal fixation of intertrochanteric fractures","authors":"Adam Coughlan ,&nbsp;Shu-Kay Ng ,&nbsp;Iulian Nusem","doi":"10.1016/j.orthop.2022.08.007","DOIUrl":"10.1016/j.orthop.2022.08.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Fixation for intertrochanteric proximal femoral fractures are increasing globally, one of the risks with surgical treatment is injury to the deep and superficial femoral arteries (DFA and SFA, respectively). The anatomic path of these vessels has been previously described, though the effect of reduction techniques, such as traction over a perineal post has not been well defined. This study addresses the question of: do closed reduction maneuvers on an orthopaedic trauma traction table affect the anatomical relationship of superficial and deep femoral arteries to the proximal femur in intertrochanteric proximal femoral fractures?</p></div><div><h3>Patients and methods</h3><p>Prospective observational single centre study of seventeen patients with pertrochanteric femoral fractures examined before and after applying traction for closed reduction. Doppler ultrasound was used to determine the proximity of these arteries to the proximal medial femoral cortex at three different levels.</p></div><div><h3>Results</h3><p>Our data demonstrates that internal rotation of the injured limb during reduction draws the arteries statistically closer to the medial cortex of the proximal femoral shaft at 3.5 cm and 10.5 cm distal to the lesser trochanter (SFA: 3.5 cm – 38.0 mm vs 34.7 mm p 0.004, 10.5 cm–30.4 mm vs 21.0 mm p 0.02; DFA: 3.5 cm–26.4 mm vs 22.3 mm p 0.003, 10.5 cm – 21.5 mm vs 14.1 mm p 0.007). No significant change in the artery position was noted in patients who did not require internal rotation to achieve fracture reduction.</p></div><div><h3>Conclusion</h3><p>Surgeons performing these internal fixation procedures need to be aware of the anatomical changes to ensure patient safety and avoid complications including intramuscular haematomas and pseudoaneurysms.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 28-34"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000343/pdfft?md5=281b74e8e285bd371e7e3ebf053fdde2&pid=1-s2.0-S2666769X22000343-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78922589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foot fracture may predict poor patient reported functional outcomes in lower extremity reconstruction of the traumatically injured lower extremity: A case–control study","authors":"Orr Shauly ,&nbsp;Karen Burtt ,&nbsp;Troy Marxen ,&nbsp;Daniel J. Gould ,&nbsp;Anna Howell ,&nbsp;Ido Badash ,&nbsp;Alexis Rounds ,&nbsp;Hyuma Leland ,&nbsp;Ketan M. Patel ,&nbsp;Joseph N. Carey","doi":"10.1016/j.orthop.2022.08.004","DOIUrl":"https://doi.org/10.1016/j.orthop.2022.08.004","url":null,"abstract":"<div><h3>Background</h3><p>A paucity of evidence currently exists regarding factors affecting the success of lower extremity reconstruction at restoring a functional limb. We aim to determine the effect of foot fracture on outcome measures of ambulatory success after lower extremity salvage in a trauma population.</p></div><div><h3>Methods</h3><p>A retrospective chart review was performed on 63 patients presenting to an urban level 1 trauma center between 01/2007 and 01/2015 who received soft tissue coverage of a lower extremity traumatic wound. Demographics, injury, and perioperative data were recorded. Patients were administered the Lower Extremity Functional Scale (LEFS) questionnaire via phone. The LEFS is out of 80 possible points. Ambulatory success is measured on a scale of 0–4 across 20 activities, with 0 indicating “extreme difficulty or inability to perform activity”, and 4 indicating “no difficulty”. Functional outcomes were compared using a two-tailed two-sample unequal variances t-test.</p></div><div><h3>Results</h3><p>This study represents data on the 63 unique patients treated with vascularized flaps whom we attempted to contact. A total of 21 patients completed the LEFS questionnaire, representing an overall response rate of 33%. Responders to the surveys included 4 (19%) patients with foot fractures and 17 (81%) without foot fractures. Average total LEFS scores were significantly lower in patients with foot fractures (23.8 ± 5.9) than in patients without (36.2 ± 19.2) foot fractures (p = 0.04). With respect to the SF36 functional scale, patients with foot fractures paradoxically reported significantly higher measures of physical functioning (81 ± 11) in comparison to those without a foot fracture (59 ± 25) at a p-value of 0.02, and role limitation due to physical health (98 ± 3) versus those with no foot fracture (74 ± 37) at a p-value of 0.02.</p></div><div><h3>Conclusion</h3><p>Sustaining a foot fracture during severe traumatic injury that necessitates lower extremity reconstruction may result in significantly decreased ambulatory success scores. Fractures of the foot may predict poor patient reported functional outcomes following lower extremity reconstruction and should be considered as a factor in the pre-operative risk and benefit assessment when deciding whether to attempt reconstruction of the mangled limb.</p></div><div><h3>Level of Evidence</h3><p>III.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 14-20"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000318/pdfft?md5=4b9530568a6547dcfe01b95262f36e87&pid=1-s2.0-S2666769X22000318-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92033803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularized pedicled fibula flap with split periosteal overlay for ankle arthrodesis: Modification of technique and case report","authors":"Maritza Kelesis ,&nbsp;Jacob Berkowitz ,&nbsp;Maxwell Vest ,&nbsp;Kongkrit Chaiyasate ,&nbsp;Jeff DeSano ,&nbsp;Ryan Lubbe ,&nbsp;Brian G. Kissel ,&nbsp;Erik C. Kissel ,&nbsp;Joshua Goldman","doi":"10.1016/j.orthop.2022.09.005","DOIUrl":"10.1016/j.orthop.2022.09.005","url":null,"abstract":"<div><p>Defects of the distal tibia, ranging from infectious to neoplastic origins, are difficult lesions to repair given their proximity to the ankle joint. Surgical repair options have often been limited, as ankle replacements and ankle arthrodesis generally require more tibial bone stock to achieve positive outcomes and avoid loss of function in the affected joint. Here we present a case of a distal tibial defect being reconstructed using a pedicled fibula flap and ankle arthrodesis technique that allowed for a sufficient range of mobility of the joint post-operatively. Our patient was a 52-year-old female with a history of myelodysplastic syndrome treated with a stem-cell transplant; fifteen months following the transplant, she was diagnosed with osteonecrosis of the distal tibia and calcaneus after developing severe swelling and pain in her left ankle. Despite conservative treatment measures, her symptoms continued to worsen, and ankle reconstruction was chosen as the only viable option for recovery. She underwent distal tibial reconstruction and tibiotalar arthrodesis using an ipsilateral vascularized pedicled fibular flap. The patient was ambulating well eight weeks post-op; she reported being able to painlessly bear full weight on the left ankle 14 weeks post-op. One-year post-op the patient was able to demonstrate an adequate range of motion of the affected joint, reduced relative to the unaffected limb but still allowing for suitable and comfortable ambulation. A 21-month post-op X-ray showed complete radiographic union of the distal tibia to the fibula flap and tibiotalar arthrodesis. As evidenced in our patient, an extremely positive postoperative outcome can be achieved with the utilization of this technique.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 10-13"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000434/pdfft?md5=77a2966c71c2b4e249f43e2274e1ce8a&pid=1-s2.0-S2666769X22000434-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76320930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of Upper Extremity, face, and uterus transplantation: A Summit Conference","authors":"Scott Tintle ,&nbsp;Jaimie T. Shores ,&nbsp;Kodi Azari ,&nbsp;Andreas Tzakis ,&nbsp;Marissa Dearden ,&nbsp;Paige Porrett ,&nbsp;Liza Johannesson ,&nbsp;Sue McDiarmid ,&nbsp;Bohdan Pomahac ,&nbsp;L. Scott Levin","doi":"10.1016/j.orthop.2022.08.008","DOIUrl":"10.1016/j.orthop.2022.08.008","url":null,"abstract":"<div><p>A panel of over 60 experts in the field of vascular composite allotransplantation from around the United States gathered on November 8, 2019 at the Uniformed Services University of the Health Sciences, in Bethesda MD. Experts in the field were recruited and invited through a collaborative effort of the American Society for Reconstructive Transplantation, the American Society of Transplantation, the American Society for Reproductive Medicine, and the American Society of Transplant Surgeons in order to discuss <em>The Value of Upper Extremity, Face, and Uterus Transplantation: A Summit Conference</em>. All sessions were directed by a moderator and focused on indications and contraindications, outcomes and costs of vascular composite allotransplantations in order to evaluate and discuss the state of the art science in the field.</p><p>Representatives of major vascular composite allotransplantation centers in North America (Cleveland Clinic, University of Pennsylvania, Brigham and Women's Health, New York University, the Mayo Clinic, Baylor, John Hopkins University, the University of Louisville) collaborated in order to present the combined experience of the major transplant centers in the United States. The panel members developed consensus guidelines for publication demonstrating success and unity amongst the vascular composite allotransplantation and solid organ transplantation communities.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 41-46"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000392/pdfft?md5=42541e43764a37dbe9ce8e32fb7d7d0f&pid=1-s2.0-S2666769X22000392-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88567271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spare-parts free flap reconstruction in polytrauma with limb amputation: Pearls, pitfalls, and an illustrative case report","authors":"William R. Moritz ,&nbsp;Austin Y. Ha ,&nbsp;Giorgio Giatsidis ,&nbsp;Lauren M. Tatman ,&nbsp;Marschall Berkes ,&nbsp;Christopher McAndrew ,&nbsp;Joani M. Christensen ,&nbsp;Mitchell A. Pet","doi":"10.1016/j.orthop.2022.09.003","DOIUrl":"10.1016/j.orthop.2022.09.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Spare-part free-flap reconstruction involves free tissue transfer from an unsalvageable extremity for reconstruction of a separate defect. In the setting of traumatic injury, spare-part surgery requires special attention to donor site zone of injury assessment and multidisciplinary coordination. Here we describe a case of upper extremity reconstruction using a free flap harvested from a lower extremity which was indicated for transfemoral amputation. Key pearls and pitfalls are reported in an effort to facilitate collaborative interdisciplinary reconstructive opportunities in cases where amputation is planned in the setting of multi-limb trauma.</p></div><div><h3>Case</h3><p>A 53-year-old male presented after a motorcycle collision with open fractures of the right elbow and tibia/fibula. After initial fracture stabilization and serial debridement, the upper extremity wound required flap coverage for the indication of exposed implants. Extensive bone and soft tissue loss of the lower limb indicated the patient for transfemoral amputation, and spare-part free flap reconstruction of the upper extremity defect was planned. Intra-operative venous pedicle thrombosis caused failure of an initial flap based on the posterior tibial artery. A second spare-part flap based on the anterior tibial artery was successfully transferred under the same anesthetic.</p></div><div><h3>Conclusion</h3><p>When amputation is planned in the context of the multiply traumatized patient, coordinated orthopedic trauma and microsurgical care can facilitate spare-parts free-flap reconstruction. Though these cases require careful planning and intra-operative flexibility to accomplish flap harvest adjacent to a zone of injury, spare-part reconstruction worth pursuing as this strategy obviates the need for an additional donor site.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"10 ","pages":"Pages 47-56"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000409/pdfft?md5=e29445bc323dd1454fbe8483c7673c71&pid=1-s2.0-S2666769X22000409-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88075658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported and clinical outcomes of skin graft-based digital Mohs reconstructions","authors":"Ankoor A. Talwar ,&nbsp;Nikhita J. Perry ,&nbsp;Carlos Barrero ,&nbsp;Abhishek A. Desai ,&nbsp;Phoebe B. McAuliffe ,&nbsp;Robyn B. Broach ,&nbsp;Benjamin Chang ,&nbsp;Ines C. Lin","doi":"10.1016/j.orthop.2022.06.004","DOIUrl":"10.1016/j.orthop.2022.06.004","url":null,"abstract":"<div><h3>Background</h3><p>Mohs resection of digital skin cancer permits digital salvage over amputation, but exposed bone in wounds presents a challenge to reconstruction. We evaluated single-stage and two-stage skin graft-based reconstruction techniques in terms of clinical and patient-reported outcomes.</p></div><div><h3>Methods</h3><p>A retrospective review was conducted of patients who received skin graft-based reconstruction following digital Mohs surgery between 2014 and 2021. Patient demographics, cancer information, and outcomes were analyzed. Outcomes included infection, seroma, hematoma, dehiscence, cyst formation, nail spicule, contracture, necrosis, graft failure, need for secondary amputation, reoperation, and recurrence. The PROMIS Upper Extremity patient-reported outcome instrument was used post-operatively. An intention-to-treat paradigm was used for analysis.</p></div><div><h3>Results</h3><p>Fifty reconstructions were included. Twenty-three reconstructions were single-stage (46%), and 27 reconstructions were two-stage (54%). There were no differences in preoperative demographics or comorbidities between those who had single or two-stage reconstructions. Patients with disrupted periosteum were more likely to have two-stage reconstruction (p &lt; 0.05). Overall, there were no differences in postoperative complications or reoperations between single-stage and two-stage reconstructions (22.7% vs. 16.7%). Current smokers had a greater risk of postoperative contracture (p &lt; 0.05). There was no difference in mean PROMIS T-score between single-stage and two-stage reconstructions. Patients with hypertension had worse postoperative PROMIS T-scores (p &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>Single-stage and two-stage skin graft reconstruction for digital skin cancer reconstruction appear to be equivalent in clinical and quality-of-life outcomes. Two-stage reconstruction is indicated for more complicated defects. Patient factors, such as smoking status, need to be considered for counseling on outcomes.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"9 ","pages":"Pages 56-60"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000185/pdfft?md5=551a61601cf39565420cb16ab174badc&pid=1-s2.0-S2666769X22000185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82413710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed reconstruction of a missed Extensor Pollicis Brevis and Abductor Pollicis Longus injury using tendon transfers and an onlay tendon graft: a case report","authors":"Tobias J. Bos ,&nbsp;Ton A.R. Schreuders ,&nbsp;Berbel J.R. Sluijter ,&nbsp;Miriam C.J. De With","doi":"10.1016/j.orthop.2022.05.003","DOIUrl":"10.1016/j.orthop.2022.05.003","url":null,"abstract":"<div><p>Delayed presentation of extensor tendon injury comes with unique challenges due to retraction of tendons, adhesions and problems of disuse of the muscles. We present a case report of tendon reconstruction eight months after a sharp injury to the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL) tendon in zone VIII. The EPB was reconstructed by using an Extensor Indicis Proprius (EIP) to EPB transfer. The APL was found slack due to a large section of pseudotendon. After tenolysis the proximal tendon stump of the EPB was sutured to the APL, thus combining the impaired EPB and APL muscles for APL function. The slack section of pseudotendon of the APL was plicated to restore tension and reinforced with an onlay tendon graft (left-over from the EIP transfer). Outcomes were excellent. This is the first publication to discuss delayed repair of a combined EPB and APL injury and gives insights into the anatomical and biomechanical balance of the thumb extensors.</p></div>","PeriodicalId":100994,"journal":{"name":"Orthoplastic Surgery","volume":"9 ","pages":"Pages 22-26"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666769X22000112/pdfft?md5=61fcf864ba372c826bc6acc5c126f531&pid=1-s2.0-S2666769X22000112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83175275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}