Acta orthopaedica Belgica最新文献

{"title":"Overcoming Therapeutic Bottlenecks of Infected Bone Defects via 3D-Printed Scaffolds Integrated with Antibacterial, Osteogenic and Angiogenic Synergistic Functions.","authors":"P Zhao, Z Qiao","doi":"10.52628/92.3.15682","DOIUrl":"https://doi.org/10.52628/92.3.15682","url":null,"abstract":"<p><p>Infected bone defects (IBDs) triggered by open fractures, implant-related infections, chronic osteomyelitis and bone tumor resection remain intractable orthopedic complications, contributing to elevated disability rates, recurrent infection, prolonged treatment courses and heavy social-economic costs. Conventional treatments such as bone grafting and antibiotic-loaded bone cement are plagued by donor shortage, immune rejection, uncontrolled antibiotic leakage and poor anatomical matching, incapable of synchronously eradicating bacteria, inducing osteogenesis and reconstructing blood vessels. Benefiting from personalized shaping, accurate structural modulation, tunable porous structures and broad material adaptability, 3D printing has become an advanced manufacturing method for patient-specific bone scaffolds. The construction of triple-functional scaffolds integrating antibacterial, osteogenic and angiogenic effects is critical to overcome current IBD treatment limitations and facilitate the clinical transformation of bone engineering materials. This review first addresses clinical drawbacks of IBD management and the superiority of 3D printed scaffolds. We systematically recapitulate matching materials, prevailing printing techniques, biomimetic design schemes and biological assessment systems, compare various antibacterial modalities, summarize translational achievements and analyze existing clinical transformation obstacles. Future orientations covering responsive intelligent scaffolds, 4D printing and combined therapies are proposed. This work delivers theoretical guidance for basic research and clinical application of 3D printed antibacterial bone scaffolds.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ilizarov Circular Fixation for High-Velocity Firearm Injuries Causing High-Energy Tibial Fractures: A Prospective Cohort Study.","authors":"A Tawfeek, M M Fayed, M Elgebeily, A R Ahmed","doi":"10.52628/92.3.15617","DOIUrl":"https://doi.org/10.52628/92.3.15617","url":null,"abstract":"<p><p>High-velocity gunshot tibial fractures present major reconstructive challenges owing to extensive contamination, soft-tissue devitalisation, and segmental bone loss that render early internal fixation hazardous. We aimed to document outcomes of a structured Ilizarov-based protocol for this injury type and describe a reproducible treatment framework for resource-constrained settings. Between January 2019 and December 2023, we prospectively enrolled 20 adult male patients with open tibial fractures from high-velocity firearm injuries at three Cairo trauma centres; all were treated definitively with an Ilizarov circular external fixator, with distraction osteogenesis and fibular autografting were employed selectively for segmental bone loss. The primary outcome was fracture union rate; secondary outcomes included fixation duration, surgical burden, and complications. Mean age was 29.7 ± 8.4 years. Fourteen fractures (70%) were Gustilo-Anderson type IIIA and six (30%) type IIIB; bone defects were present in 50% after debridement. Union was achieved in 19 of 20 patients (95%), and the single non-union resolved after frame revision and supplementary grafting. Mean fixation duration was 12.3 ± 7.28 months. Superficial pin-tract infection (Checketts-Otterburn Grade 1 or 2) occurred in 17 patients (85%) and deep surgical site infection in one (5%); ankle stiffness, axial malalignment, and limb length discrepancy each affected a minority of patients. structured Ilizarov protocol can reliably achieve union in Gustilo type III gunshot tibial fractures with an acceptable complication profile; these findings are descriptive and do not establish superiority over alternative fixation strategies but support the Ilizarov circular frame as a suitable option for high-grade contaminated injuries in resource-limited environments.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Extent of Skin Preparation Influence Contamination During Direct Anterior Total Hip Arthroplasty? A Fluorescent Tracer Proof-of-Concept Study.","authors":"L Verhelst, L Follet, J Lambrechts, T Braeckevelt, A Poelmans, K Liekens","doi":"10.52628/92.3.15885","DOIUrl":"https://doi.org/10.52628/92.3.15885","url":null,"abstract":"<p><p>There is currently no evidence-based consensus regarding the optimal extent of skin preparation when performing total hip arthroplasty (THA) through the direct anterior approach using dedicated anterior-approach draping systems (DAA Drapes). The purpose of this study was to evaluate the contamination risk associated with different disinfection and draping strategies for anterior-approach THA using a proof-of-concept contamination model. Six commonly used skin preparation protocols were evaluated using a standardized fluorescent contamination model. Protocols ranged from extensive bilateral lower-limb preparation to limited ipsilateral preparation excluding the foot or distal leg. After draping, the operative field was assessed under ultraviolet light for contamination. Contamination rates and distances from the surgical field were recorded and analyzed using non-parametric statistics. No contamination was observed in the four most extensive preparation strategies. Contamination occurred in 28.6% of trials when the ipsilateral foot and ankle were excluded from preparation and in 57.1% of cases when preparation was limited to above the knee. Lifting the leg to disinfect the posterior aspect and disinfecting the contralateral limb did not reduce contamination risk. In this proof-of-concept study, limited skin preparation of the ipsilateral lower limb-particularly omission of the foot and distal leg was associated with a substantially increased risk of surgical field contamination. More extensive measures, such as lifting the leg or disinfecting the contralateral limb, did not confer additional benefit. These findings should be considered hypothesis-generating and require validation through microbiological and clinical outcome studies.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Gefitinib on Traumatic Fracture Healing in Rats via the OPG/RANKL/RANK Signaling Pathway.","authors":"X Wu, Z Tao, W Cheng","doi":"10.52628/92.3.15610","DOIUrl":"https://doi.org/10.52628/92.3.15610","url":null,"abstract":"<p><p>This study investigates how gefitinib (Gef), an epidermal growth factor receptor (EGFR) inhibitor, affects traumatic fracture healing in rats, particularly through the OPG/RANKL/RANK signaling pathway, which regulates osteoclast and osteoblast activity. Sixty Sprague-Dawley rats were divided into different treatment groups, including fracture only, fracture plus gefitinib, fracture plus functional OPG antagonist (i.e., recombinant mouse RANKL protein), and combinations of both. After 28 days of treatment, bone healing was evaluated using techniques such as micro- CT, histological staining, and molecular analysis. Additionally, in vitro experiments on bone marrow mesenchymal stem cells (BMSCs) were conducted. The results showed that rats treated with gefitinib had significantly higher bone density and better bone structure compared to the fracture-only group. The effects were diminished when the functional OPG antagonist was added. Histological analysis revealed that gefitinib promoted better callus formation and more organized trabecular bone, effects that were reversed by the functional OPG antagonist. Further analysis indicated that gefitinib inhibited osteoclast activity and enhanced osteoblast function. At the molecular level, gefitinib increased the expression of OPG and bone-related proteins while reducing the levels of RANKL and osteoclast markers. In contrast, the functional OPG antagonist had the opposite effect.In vitro, gefitinib increased osteogenic activity and gene expression in BMSCs, but this was blocked by RANKL. The findings suggest that gefitinib promotes fracture healing by upregulating OPG and suppressing RANKL/RANK signaling, reducing inflammation, and this effect can be completely negated by exogenous RANKL.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Lifetime Cumulative Surgical Exposure and Total Body Bone and Muscle Mass in Older Adults.","authors":"L Ashour, M Alsholi, H B Nasar, I Sadaqa, M Zaita, A M Zaqout, A Alsarkhi, A Okasha, A Hammad, H Abuissa","doi":"10.52628/92.3.15693","DOIUrl":"https://doi.org/10.52628/92.3.15693","url":null,"abstract":"<p><p>| laithashour100@gmail.com The relationship between recurrent surgical exposure and musculoskeletal health in older adults remains insufficiently characterized. This study aimed to investigate the association between the cumulative number of surgical procedures and total body bone mass (TBBM) and total body lean mass (TBLM) in an older adult population. Data were analyzed from the 2017-2022 biomarker wave of the Midlife in the United States (MIDUS 3) study. TBBM and TBLM were measured using dual-energy X-ray absorptiometry (DXA) with Lunar systems. The number of prior surgeries (minor or major) was retrospectively obtained through structured medical history interviews. Multiple linear regression models were used to evaluate associations between surgical history and body composition measures. Models were adjusted for age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), triglyceride levels, smoking history, dietary habits, medication use, physical activity, and serum creatinine levels. The final analytic sample included 327 participants (41% male) with a mean age of 64.5 ± 9.3 years. Regression analyses showed that a higher number of prior surgeries was significantly associated with lower TBBM (β = -0.094; 95% CI: -0.175 to -0.013; P = 0.021). Further sensitivity analyses including participants with higher threshold of cumulative major surgeries supported this association with a higher effect size. No significant association was observed between number of surgeries and TBLM (P = 0.33), even after conducting sensitivity analysis on cohort who underwent major recurrent surgeries. Healthier dietary habits were significantly associated with higher TBLM (β = 0.073; 95% CI: 0.017 to 0.129; P = 0.011), but not with TBBM (P = 0.507). In conclusion, recurrent surgical exposure was associated with lower total body bone mass but not lean mass in older adults. However, further longitudinal research is needed to fully adjust for potentially-related underlying morbidities.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Joint Position Sense with Two Different Electrogoniometers in Carpal Tunnel Syndrome.","authors":"S Yenil, A Kitis, C Erdogan","doi":"10.52628/92.3.12908","DOIUrl":"https://doi.org/10.52628/92.3.12908","url":null,"abstract":"<p><p>Carpal tunnel syndrome causes changes hand proprioception but there are a limited number of studies on joint position sense in patients with CTS. The aim of the study was to investigate the validity and reliability of the ® KForce Sens for the evaluation of wrist joint position sense in individuals with CTS. Wrist joint position sense ® ® ® was assessed with KForce Sens and Baseline electrogoniometer. The validity and reliability of the KForce Sens for wrist position sense evaluation were investigated by comparing the two data sets. The study was conducted in 35 patients (29 females, 6 males) with CTS and 35 healthy individuals (29 females, 6 males). In test-retest ® measurements of the KForce Sens , a significant correlation was found in 60° flexion (ICC=0.730), 30° extension (ICC=0.904), 60° extension (ICC=0.849), 15° ulnar deviation (ICC=0.834) and 10° radial deviation (ICC=0.952). ® ® significant correlation was found between KForce Sens and Baseline electrogoniometer in 30° flexion, 60° flexion, 30° extension, 60° extension, 15° ulnar deviation and 10° radial deviation (p<0.05). The difference in joint position sense was significant in 30° flexion (p<0.001), 60° flexion (p=0.023), 30° extension (p=0.003), 60° extension (p=0.037) compared to the healthy controls. There was no significant difference in ulnar deviation and ® 10° radial deviation movements (p>0.05). The KForce Sens device is a valid and reliable tool for the assessment of wrist joint position sense in patients with CTS. Even if the severity of CTS was mild, joint position sense was lower than that of healthy controls.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight-bearing impact after surgically treated proximal femur fracture in patients aged 65 years and older: systematic review.","authors":"M Dekoster, J-F Kaux","doi":"10.52628/92.3.14104","DOIUrl":"https://doi.org/10.52628/92.3.14104","url":null,"abstract":"<p><p>The incidence of proximal femur fractures is increasing among older adults. Although surgical treatment is often required to restore pre-fracture functional status, the optimal postoperative weight-bearing strategy remains controversial. This systematic review aimed to evaluate the impact of early weight-bearing after surgically treated proximal femur fractures in patients aged 65 years and older. A systematic search of Medline (via Ovid and PubMed), Embase, Scopus, Google Scholar, and the grey literature was conducted in accordance with the PRISMA 2020 guidelines for studies published between 1 January 2003 and 7 June 2024. Studies written in English or French including patients aged 65 years and older and comparing postoperative weight-bearing strategies following surgical treatment of proximal femur fractures were eligible for inclusion. The methodological quality of the included studies was assessed using the ROBINS-I and RoB tools. Of the 695 studies identified, seven met the inclusion criteria. The available evidence addressed functional outcomes, length of hospital stay, mortality, medical complications, and orthopaedic complications. Overall, early weight-bearing was associated with lower mortality, shorter hospital stay, fewer medical complications, and improvements in some functional outcomes, without an apparent increase in orthopaedic complications. However, the available evidence is limited, predominantly observational, and subject to substantial heterogeneity; therefore, causality cannot be established.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High C1r expression is associated with cartilage damage in post-traumatic osteoarthritis.","authors":"B O Dong, Kui Ma, Q I Dong, Guangyou Yang, Xiaofei Li, Jianchao Gui","doi":"10.52628/92.3.15644","DOIUrl":"https://doi.org/10.52628/92.3.15644","url":null,"abstract":"<p><p>.</p><p><strong>Background: </strong>The complement system undergoes extensive activation in osteoarthritis. Nevertheless, the specific function of C1r, a constituent of this system, in post-traumatic osteoarthritis (PTOA) remains unclear.</p><p><strong>Purpose: </strong>To explore the clinical value and function of C1r in PTOA.</p><p><strong>Methods: </strong>Synovial fluid was obtained from 90 patients diagnosed with PTOA and 86 patients with knee joint injuries. Three specimens were randomly selected from each group for proteomic examination. The expression of C1r in all these specimens was determined via RT-qPCR, followed by ROC curve analysis and logistic regression analysis. The expression of C1r, apoptosis, and cytokine levels in chondrocytes and mouse cartilage tissues were detected through Western blotting/immunohistochemistry, flow cytometry/TUNEL, and ELISA.</p><p><strong>Results: </strong>Proteomic analysis unveiled 51 proteins that exhibited down-regulation in PTOA and identified 309 up- regulated proteins, among which C1r was included. RT-qPCR analysis of all samples indicated that C1R was significantly up-regulated in the PTOA cohort and demonstrated a moderate discriminatory ability between PTOA patients and non-PTOA individuals (AUC = 0.777). After adjustment for other confounding factors, C1R was determined to be potentially related to PTOA occurrence. High expression of C1R was correlated with a higher Kellgren-Lawrence grade and a lower Knee Injury and Osteoarthritis Outcome Score. C1r was overexpressed in PTOA cells and mouse cartilage tissues, and its silencing led to a reduction in apoptosis, as well as the levels of inflammatory factors (IL-6/IL-8) and matrix catabolic enzymes (MMP-13/ADAMTS-4) in chondrocytes and cartilage tissues.</p><p><strong>Conclusion: </strong>C1r serves as a potential candidate biomarker for PTOA and warrants further in-depth exploration. In experimental models, targeting C1r may contribute to the mitigation of cartilage damage.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compression therapy in the prevention of thromboembolic disease following total knee arthroplasty with a fast recovery protocol: A systematic review.","authors":"L Depraetere, M Gillijns, P Berger, H Vandenneucker","doi":"10.52628/92.3.15562","DOIUrl":"https://doi.org/10.52628/92.3.15562","url":null,"abstract":"<p><p>Thromboembolic disease (TED), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a serious postoperative risk after total knee arthroplasty (TKA). Enhanced recovery after surgery (ERAS) protocols emphasize early mobilization, warranting reassessment of mechanical prophylaxis, such as compression therapy. This systematic review evaluates the benefits of compression therapy in preventing TED in TKA patients under ERAS protocols combined with pharmacological prophylaxis. A systematic review was conducted, analyzing seven studies comparing combined mechanical and pharmacological prophylaxis with pharmacological prophylaxis alone. Primary outcomes included DVT and PE incidence, compliance, adverse events, and efficacy. Seven studies were included in this systematic review, including 871 patients. Combined mechanical and pharmacological prophylaxis reduced DVT rates. Continuous enhanced circulation therapy (CECT) with enoxaparin lowered DVT from 19.5% to 6.6% (relative risk reduction (RRR) 66.2%, p=0.018), while intermittent pneumatic compression (IPC) with rivaroxaban reduced rates from 18.3% to 8.3% (RRR 54.5%, p<0.01). Pneumatic plantar compression (PPC) decreased DVT from 67% to 27% in unilateral and 52% to 28% in bilateral TKA (combined RRR 54.2%, p<0.001). Graduated compression stockings (GCS) with anticoagulation reduced DVT from 13.0% to 6.0% (RRR 53.8%, p=0.0872). IPC with nadroparin lowered DVT from 3.9% to 2.6% (RRR 33.3%, p=0.65). PE incidence remained minimal across studies. When combined with anticoagulants, mechanical prophylaxis may have an additional role in diminishing DVT incidence while alleviating postoperative swelling and pain. However, optimizing compliance, standardizing protocols, and tailoring thromboprophylaxis to patient-specific risks remain key challenges. Future research should refine mechanical and pharmacological strategies to enhance safety, efficacy, and recovery in TKA patients.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Biodegradable Temporizing Matrix for Donor and Recipient Site Wound Healing in Delayed Reverse Sural Flap: A Case Report.","authors":"H Ho Man, D Kai Siang Chong, P Tiwari, Y Lin Yap, J Lim, T Chye Lim, O-Wern Low, V Nallathamby","doi":"10.52628/92.3.15475","DOIUrl":"10.52628/92.3.15475","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction of distal third leg soft tissue defects is challenging, particularly in patients with multiple co-morbidities. Whilst the reverse sural artery (RSA) flap remains a viable reconstructive option, flap failure due to torsion, congestion, and necrosis persists.</p><p><strong>Case presentation: </strong>This case report presents a patient who underwent a staged RSA flap surgery, with initial application of a biodegradable temporising matrix (BTM) over both the donor site and the heel defect. This was performed with three aims: to create a physical interface as an adjunct to surgical delay; to improve donor site granulation tissue quality in preparation for skin grafting; and to establish a granulation tissue layer over the bony defect to promote a granulating wound bed suitable for definitive reconstruction.</p><p><strong>Conclusions: </strong>The application of BTM appeared to facilitate an effective adjunct to surgical delay and improved flap donor site contour. This case report suggests that the use of BTM across both donor and recipient site wound beds may represent a feasible and promising adjunct in staged RSA flap reconstruction, though further studies are required to substantiate these findings. 1,8 INTRODUCTION lower limb . Flap delay has been shown to improve 7 flap viability . However, complications including Reconstruction of soft tissue defects in the marginal necrosis, partial flap loss, and total flap distal third of the leg is a technically demanding failure - attributable to pedicle torsion, venous procedure, particularly in patients with multiple congestion, or hypoperfusion, have reported rates of 1,2 2,9,10 co-morbidities . The relative scarcity of local soft up to 33% . In addition, donor sites requiring skin tissue, combined with poor regional vascularity, grafting have been associated with scar contracture, 3,4 11 predisposes this anatomical zone to complications . dysaesthesia, and aesthetic problems . On top of that, timely and reliable soft tissue The biodegradab.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":"92 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}