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Kelada MN, Salem RR, Eltohfa YA, Ghozlan NA, Kholosy HM. "Posterior interosseus artery flap for hand reconstruction: anatomical basis and clinical application". BMC Musculoskelet Disord 2022; 23:662. [PMID: 35820834 PMCID: PMC9275144 DOI: 10.1186/s12891-022-05630-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Summary Flap options for upper limb reconstruction have increased due to better understanding of its vascular anatomy. The posterior interosseus artery flap (PIAF) is used to cover defects of the wrist, hand, proximal thumb, and first web space. This flap has many advantages but requires good knowledge about the anatomy of the posterior interosseus artery (PIOA) and its perforators. Methods Twenty upper extremity cadaveric specimens were injected with red latex, Fine dissection of the PIOA and its perforators took place; the perforators were counted, measured, described and photographed. Twenty patients with dorsal hand defects, had PIAF. Cases have Post-operative care and followed up for 6 months post-operative. Results The PIOA was constant in all cadaveric dissections and gave off 4–8 septocutaneous perforators along its course between the extensor carpi ulnaris (ECU) and extensor digitorum (EDM) muscles. The mean distance of the distal most perforator in the middle third forearm from the ulnar styloid was 10.39 ± 1.54 cm. The anastomosis between the PIOA and the anterior interosseus artery (AIOA) was there in all specimens. Venous congestion occurred in 10% of the cases and was managed conservatively. Necrosis of the distal third of the flap was inevitable in one case; excellent results were obtained in the other cases 90%. Conclusions The posterior interosseus artery flap is an excellent perforator flap for hand reconstruction preserving the ulnar and radial artery; but it has a possible complications such as venous congestion or partial flap necrosis that could be managed conservatively. Level of evidence II.
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Affiliation(s)
- Melad N Kelada
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Alexandria, N.B. 15 Hussein kabadaya street from El Bitash main, El Agamy, Alexandria, Egypt.
| | - Rasha R Salem
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Alexandria, N.B. 15 Hussein kabadaya street from El Bitash main, El Agamy, Alexandria, Egypt
| | - Youssef A Eltohfa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Naser A Ghozlan
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Hassan M Kholosy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Hsu YH, Yu YH, Lee D, Chou YC, Wu CK, Lu CJ, Liu SJ. Pharmaceutical-eluting hybrid degradable hydrogel/microparticle loaded sacs for finger joint interpositional arthroplasty. Biomater Adv 2022; 137:212846. [PMID: 35929275 DOI: 10.1016/j.bioadv.2022.212846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Despite recent advances in medical technology, treatment of chronic osteomyelitis in the small joint of the hand remains challenging. Here, we exploited hybrid biodegradable hydrogel/microparticle/polycaprolactone (PCL) sacs for finger joint interpositional arthroplasty via electrospraying and rotational molding techniques. Degradable Pluronic F127, poly(lactic-co-glycolic acid) (PLGA), and PCL were starting materials for the hydrogels, microparticles, and sac, respectively. Vancomycin, ceftazidime, and lidocaine were the embedded pharmaceuticals. The in vitro and in vivo drug release behaviors of hybrid drug-eluting sacs were assessed. The empirical outcomes show that the size distribution of the electrosprayed vancomycin/ceftazidime/lidocaine PLGA microparticles was 8.25 ± 3.35 μm. Biodegradable PCL sacs offered sustainable and effective release of vancomycin, ceftazidime, and lidocaine, respectively, after 30, 16, and 11 days in vitro. The sacs also discharged high levels of anti-microbial agents for 56 days and analgesics for 14 days in a rabbit knee joint model. The blood urea nitrogen (creatinine) levels remained normal at various time points: 16.5 ± 2.5 mg/dL (0.85 ± 0.24 mg/dL), 20.0 ± 1.4 mg/dL (1.0 ± 0.16 mg/dL), 19.3 ± 2.4 mg/dL (1.13 ± 0.15 mg/dL), and 20.0 ± 2.16 mg/dL (1.0 ± 0.16 mg/dL) at days 7, 14, 21, and 35, respectively. The empirical outcomes of this study suggested that the hybrid biodegradable drug-eluting sacs with extended liberation of pharmaceuticals may find applications in the small joints for post-operative pain relief and infection control.
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Affiliation(s)
- Yung-Heng Hsu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan
| | - Demei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan
| | - Chen-Kai Wu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chia-Jung Lu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Jung Liu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital-Linkou, Taoyuan 33305, Taiwan; Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan.
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Costa AL, Colonna MR, Vindigni V, Bassetto F, Tiengo C. REVERSE POSTERIOR INTEROSSEOUS FLAP: DIFFERENT APPROACHES OVER THE YEARS. SYSTEMATIC REVIEW. J Plast Reconstr Aesthet Surg 2022; 75:4023-4041. [DOI: 10.1016/j.bjps.2022.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
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Liu ZB, Li Q, Liu WX, Li XH, Ma K, Huo YB, Wang JG, Wang QH, Yu YD. Comparison of Clinical Effects of the Modified Masquelet Technique and Kirschner Wire External Fixation-Assisted Autogenous Bone Transplantation in the Treatment of Segmental Metacarpophalangeal Bone Defects. Int J Gen Med 2022; 15:1619-1635. [PMID: 35210833 PMCID: PMC8858955 DOI: 10.2147/ijgm.s343617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aims to explore the (1) clinical effects of the modified Masquelet technique, whose improved Masquelet technique innovates the in vitro plasticity of the bone cement module and prefabricated hollow design, and the Kirschner wire external fixation-assisted autologous bone transplantation technique in the treatment of segmental metacarpophalangeal bone defects and (2) the differences between the two techniques. Methods The clinical data of 32 patients with segmental metacarpophalangeal bone defects (15 patients treated with the modified Masquelet technique and 17 patients treated with the self-made Kirschner wire external fixation technique) admitted to our department between January 2012 and January 2020 were retrospectively analyzed. The postoperative bone healing time, hand function, and complications were compared between the two groups. Results The two groups were comparable; there were no significant differences in age, sex, length of bone defect, and time from injury to operation between the two groups (P > 0.05). All patients were followed up with for 6–24 months (average = 13.7 months), and all patients with segmental metacarpophalangeal bone defects achieved fracture healing. The postoperative hospital stay, fracture healing time, functionary scores of the affected limb, and incidence of severe complications were better in the modified group than in the external fixation group (P < 0.05). Conclusion Compared with the Kirschner wire external fixation stent assisted autologous bone transplantation, the improved Masquelet technique has the advantages of simple operation, fast healing, accurate effect, wide indications, and less complications, making it more worthy of clinical promotion.
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Affiliation(s)
- Zeng-Bing Liu
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
- Correspondence: Zeng-Bing Liu, Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, No. 485 of Xinhua West Road, Taocheng District, Hengshui, 053000, People’s Republic of China, Tel +86 318 2173010, Email
| | - Qiang Li
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Wen-Xia Liu
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Xin-Hai Li
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Kai Ma
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Yu-Bao Huo
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Jin-Guang Wang
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Qing-He Wang
- Department of Hand and Foot Surgeries, The No. 4 People’s Hospital of Hengshui, Hengshui, 053000, People’s Republic of China
| | - Ya-Dong Yu
- Department of Hand Surgeries, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
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金 文, 张 子, 吴 祥, 全 辉, 祁 建, 魏 在. [Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:891-895. [PMID: 34308599 PMCID: PMC8311205 DOI: 10.7507/1002-1892.202102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of lateral circumflex femoral artery chimeric flap transplantation in repair of complex wounds of foot and ankle. METHODS A retrospective study was conducted to analyze the clinical data of 20 patients with complex wounds of foot and ankle treated with lateral circumflex femoral artery chimeric flap between June 2017 and June 2020. There were 14 males and 6 females with an average age of 42.8 years (range, 21-65 years). Among them, 8 cases had dorsalis pedis tendon defect with or without bone exposure, 4 cases had partial or total Achilles tendon defect without bone exposure, and 8 cases had deep cavity and bone exposure. The wound area ranged from 10 cm×6 cm to 21 cm×11 cm. The time from injury to operation ranged from 6 to 22 days, with an average of 9.4 days. The lateral femoral circumflex artery flap was used in 6 cases with fascia lata flap, 6 cases with rectus femoris aponeurosis flap, and 8 cases with lateral femoral muscle flap. The flap area ranged from 12.0 cm×6.5 cm to 35.0 cm×7.5 cm. All flap donor sites were sutured directly. The survival, appearance, texture, sensation of the flap, and complications of the donor site were observed. The foot and ankle function was evaluated by Kofoed score. RESULTS All patients were followed up 8-24 months (mean, 14.2 months). On the 3rd day after operation, 1 case had partial necrosis of 1 flap with fascia lata flap and healed after dressing change; 1 case of chimeric muscle flap developed venous crisis at 12 hours after operation; the chimeric flaps survived successfully in the other 18 patients and the wounds were primary healing. The color and texture of the flaps were good, the flaps recovered protective sensation. Only linear scar remained in the donor site of thigh. There was no sensory disturbance around the incision or walking disturbance. The Kofoed score of the foot and ankle function at last follow-up was 75-96, with an average of 89.8. Among them, 15 cases were excellent, 4 cases were good, and 1 case was qualified. The excellent and good rate was 95.0%. CONCLUSION The application of lateral circumflex femoral artery chimeric flap can accurately and stereoscopically repair the complex wounds of foot and ankle and achieve satisfactory effectiveness.
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Affiliation(s)
- 文虎 金
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 子阳 张
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 祥奎 吴
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 辉 全
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 建平 祁
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563000)Department of Plastic Surgery and Burns, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
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