International Journal of Orthoplastic Surgery最新文献

{"title":"Double Axonal Crush, Transection, and Implantation of Deep Peroneal Nerve for Intractable Pain","authors":"D. Hoeft, Henry D. Spingola, E. Rodriguez-Collazo","doi":"10.29337/IJOPS.32","DOIUrl":"https://doi.org/10.29337/IJOPS.32","url":null,"abstract":"Introduction: Intractable pain following calcaneal fracture is a rare, but debilitating complication for a patient. The aim of this study was to assess if a double axonal crush with deep peroneal nerve (DPN) implantation is effective in alleviating residual intractable pain following surgical repair of Sanders III and IV calcaneal fractures. Methods: Eleven patients underwent DPN resection, double axonal crush, and bone implantation for entrapment of the distal portion of the DPN confirmed via EMG with a mean follow-up period of 26 months. The Visual Analog Scale and Quality of Life were used as scoring systems. Results: Results show a statistically significant (p Discussion: DPN resection, double axonal crush, and implantation into the tibia offers promising results, and further studies may be warranted to confirm as a valid treatment option.","PeriodicalId":297072,"journal":{"name":"International Journal of Orthoplastic Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117068580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularised Composite Allotransplantation – Basic Science and Clinical Applications","authors":"C. Honeyman, C. Fries","doi":"10.29337/IJOPS.28","DOIUrl":"https://doi.org/10.29337/IJOPS.28","url":null,"abstract":"Vascularised Composite Allotransplantation (VCA) is the top rung of the reconstructive ladder, offering ‘like-for like’ functional reconstruction for the most devastating tissue loss. There are established centres across Europe, the USA and Asia. Clinical outcomes now extend beyond 20 years. To-date over 130 upper limb and 37 craniofacial VCA’s have been performed, with encouraging graft survival and clinical outcomes. Beyond hand and face transplantation novel VCA’s have been performed including: functioning allotransplantation of neck organs, penis, uterus and skull and scalp transplants. Like solid organ transplant (SOT) patients, VCA recipients are submitted to the significant side effects of lifelong immunosuppression, however in this case surgery is considered life improving rather than life saving. As clinical feasibility is now well established research focus has shifted to improve the safety profile of VCA. This has included exploring strategies to enable early detection and treatment of acute rejection, defining and better understanding chronic rejection in VCA, and ultimately aiming to induce tolerance. The aim of this review article is to give a concise overview of the clinical and basic science advances in the field of VCA, with particular relevance to the orthoplastic surgeon.","PeriodicalId":297072,"journal":{"name":"International Journal of Orthoplastic Surgery","volume":"316 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123232674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Surgical Management of Boney Mallet Fractures: A Single-Centre Study of Outcomes in 141 Patients","authors":"M. Moustaki, J. Mennie, G. Orfaniotis, J. Ahmed","doi":"10.29337/IJOPS.24","DOIUrl":"https://doi.org/10.29337/IJOPS.24","url":null,"abstract":"Mallet fractures are traditionally treated surgically when greater than one third of the articular surface is involved. We aimed to investigate outcomes in a cohort of 141 patients with Doyle Type IV closed mallet injuries, treated with conservative splint therapy. Pearson chi-squared test was used to investigate the significance of subluxation and articular surface greater than one third. Articular surface was also investigated as a continuous variable using Spearman-rank correlation. Sixty-five patients had involvement of less than one third of the articular surface, and 75 had involvement of one third to two thirds. Subluxation was present in 53. Crawford outcomes were excellent in 54% of patients, good in 37%, and fair in 9%. Percentage of articular surface involvement and presence of subluxation were both independent of outcomes. Our findings support non-surgical treatment of closed mallet injuries in the presence of up to two thirds of articular surface involvement.","PeriodicalId":297072,"journal":{"name":"International Journal of Orthoplastic Surgery","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133988160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Medial Sural Artery Perforator Island Flap as a Simpler Alternative for Prophylactic Skin Augmentation Prior to Total Knee Arthroplasty","authors":"G. Hallock","doi":"10.29337/IJOPS.26","DOIUrl":"https://doi.org/10.29337/IJOPS.26","url":null,"abstract":"Total knee arthroplasty is a common orthopaedic procedure of great benefit in restoring unimpeded and pain free ambulation with rare complications [1]. However, subsequent soft tissue compromise and/or joint infection can be disastrous if prosthesis salvage is impossible requiring instead knee fusion or even amputation [1]. The pre-operative presence of tenuous soft tissues, most obvious if a skin graft covers the knee region; or the existence of multiple or problematic scars should be indications for consideration of prophylactic soft tissue replacement with a flap so as to avoid these endpoints [1, 2]. This is a proven and beneficial concept where usually the medial gastrocnemius muscle or distal-based anterolateral thigh flap as a local flap has been selected, or else even a free tissue transfer [1–3]. With the advent of perforator-based cutaneous pedicled flaps, the medial sural artery perforator flap as a local island flap should be considered as another alternative to fulfill this orthoplastic approach for minimizing untoward events [4].","PeriodicalId":297072,"journal":{"name":"International Journal of Orthoplastic Surgery","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124188122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve Conduit Enhancement with Vomeronasal Organ Improves Rat Sciatic Functional Index in a Segmental Nerve Defect Model","authors":"W. Eward, C. Lipton, Jonathan C. Barnwell, Thomas L. Smith, Matthew M. Crowe, L. Koman, D. Ruch","doi":"10.5005/JP-JOURNALS-10017-1002","DOIUrl":"https://doi.org/10.5005/JP-JOURNALS-10017-1002","url":null,"abstract":"Background: Segmental nerve loss presents a challenge to the reconstructive surgeon. The best regenerative results are obtained by using autologous interpositional nerve grafts. While this method can be successful, it necessitates a second surgical step, sacrifices donor nerve function and depends upon a finite supply of potential donor nerves. Collagen nerve conduits are commercially available for reconstruction of segmental nerve defects. However, no conduit-based reconstructive strategy has been as successful as autograft reconstruction. We hypothesized that collagen nerve conduits used to bridge a sciatic nerve defect may be enhanced by grafting with vomeronasal organ (VNO), owing to the unique capacity for regeneration of this mammalian olfactory tissue. Methods: 21 rats underwent resection of a 1.0 cm segment of sciatic nerve. Seven rats underwent repair of the resultant nerve defect using a commercially available collagen nerve conduit (NeuraGen, Integra Life Sciences, Plainsboro NJ, USA). Seven rats underwent immediate repair of the nerve defect using the conduit filled with freshly harvested VNO allograft. An additional Seven rats underwent resection of a 4 mm segment of sciatic nerve and direct epineural repair. At 14 weeks postoperatively, all animals underwent walking track analysis. Toe prints were analyzed morphometrically to permit calculation of sciatic functional index (SFI). At 16 weeks postoperatively, rats were sacrificed and tissues were processed for histomorphometric analysis. This analysis included quantification of the number and diameter of myelinated axons as well as calculation of the axon density. Results: All animals survived treatment without any serious surgical complications. All sciatic nerves were in continuity at sacrifice. All animals showed signs of sciatic denervation (decubitus ulcers, muscle atrophy) postoperatively. At 14 weeks, the mean sciatic functional index (SFI) was significantly higher in the VNO-enhanced group (p = 0.006) and the epineural repair (ER) groups (p = 0.004) than the conduit-only (CO) group. SFI was equivalent between VNO and ER groups (p = 0.338). Axon density was greater in the VNO (p = 0.013) and ER groups (p = 0.048) than in the CO group. Axon density was equivalent between the VNO and ER groups (p = 0.306). Conclusions: In a rat sciatic nerve segmental defect model, modification of collagen nerve conduits to contain the pluripotent neuroepitheilial tissue vomeronasal organ (VNO) improves functional recovery and offers increased axon density relative to reconstruction with an empty conduit (CO).","PeriodicalId":297072,"journal":{"name":"International Journal of Orthoplastic Surgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114621436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}