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Baek G, Kim JG, Baek GR, Hui AT, McGarry MH, Baek CH, Lee TQ. Biomechanical Comparison Between Superior Capsular Reconstruction and Lower Trapezius Tendon Transfer in Irreparable Posterosuperior Rotator Cuff Tears. Am J Sports Med 2024; 52:1419-1427. [PMID: 38544363 DOI: 10.1177/03635465241235544] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures. PURPOSE To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft. RESULTS Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction (P = .042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction (P < .037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles (P < .039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition (P < .014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction (P = .019 and P = .048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles (P < .023), whereas LTT did not increase the contact area. CONCLUSION SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT. CLINICAL RELEVANCE These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region.
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Affiliation(s)
- Gyuna Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Gyu Rim Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Aaron T Hui
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
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Ben H, Kholinne E, Guo J, Kim D, Je MG, Koh KH, Jeon IH. Does body mass index affect outcomes following arthroscopic superior capsular reconstruction using fascia lata autograft for massive irreparable rotator cuff tear? Int Orthop 2024; 48:1079-1088. [PMID: 38147071 DOI: 10.1007/s00264-023-06065-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of increased body mass index (BMI) on patient-reported outcomes (PROs) and clinically significant outcomes (CSOs) obtained > two years postoperatively following arthroscopic superior capsular reconstruction (ASCR). METHODS A retrospective study was conducted on patients who underwent ASCR with a minimum two year follow-up. All patients were divided into normal (BMI < 25.0), overweight (BMI 25-30.0), and obese (BMI ≥ 30) according to preoperative BMI. Patients were assessed using the PROs preoperatively and at six months, one year, and two years postoperatively, including the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores. The time required to achieve each CSO was analyzed and compared. Multivariate analyses evaluated the predictor variables and time required to achieve CSOs. RESULTS This study included 63 patients with a mean age of 64.8 ± 8.6 years, including 31 normal BMI, 25 overweight, and seven obese patients. Significant improvements in VAS and ASES scores after ASCR were observed in all three groups. Normal and overweight patients had significant improvements in the Constant score; however, no difference was observed in obese patients. No significant difference was observed in the probability distributions of CSOs between the BMI groups. Similarly, no significant differences were observed in the probability distributions of the CSOs, ASES, and Constant scores at each time point, among the BMI groups. CONCLUSION Patients in the normal and overweight groups had significant improvements in the VAS, ASES, and Constant scores after ASCR. Patients in the obese group had a significant improvement in VAS score; however, there is no difference for the ASES and Constant scores in the obese group. However, no differences were observed in all PROMs and the likelihood of achieving CSOs among the different BMI groups.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Jia Guo
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Dohun Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Min Geol Je
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea
| | - In Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, Korea.
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Ohta S, Ueda Y, Komai O. Postoperative results of arthroscopic superior capsule reconstruction using fascia lata: a retrospective cohort study. J Shoulder Elbow Surg 2024; 33:686-697. [PMID: 37619926 DOI: 10.1016/j.jse.2023.07.021] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) was developed to improve shoulder function and alleviate pain in patients with primary irreparable rotator cuff tears. Although suitable clinical results of SCR have been reported, only a few studies have investigated the clinical outcomes of arthroscopic superior capsule reconstruction (ASCR) using tensor fascia at a minimum follow-up period of 2 years after surgery. METHODS Among 100 consecutive patients who underwent ASCR since April 2010, this retrospective cohort study included 49 patients with a Hamada classification of ≤3 who were available for at least 2-year follow-up after surgery. The mean follow-up period was 34.5 (24-74) months. We analyzed preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, University of California at Los Angeles (UCLA) shoulder scores, preoperative and postoperative active elevation angles, external and internal rotations with the arms in the anatomical position, manual muscle test (MMT) scores, preoperative and postoperative acromiohumeral distance (AHD), and cuff integrity on postoperative magnetic resonance imaging using the Hasegawa classification. We compared 27 pseudoparalyzed (elevation of <90°) shoulders with 22 nonpseudoparalyzed shoulders. We also evaluated the treatment of patients with subscapularis tendon tears and compared the outcomes of patients with good graft repair and those with graft retear. RESULTS The JOA score, UCLA score, active elevation angle, internal and external rotation angles, and muscle strength (MMT) significantly improved at the time of investigation preoperatively and 2 years postoperatively. The mean AHD also improved from 5 ± 2.6 mm preoperatively to 9 ± 2.8 mm postoperatively. No significant difference in graft tear rate was observed between pseudoparalyzed shoulder and nonpseudoparalyzed shoulder groups. The subscapularis tendon was torn in 26 of 49 (53%) patients, and all patients underwent repair. The graft repair group showed a significant improvement in JOA scores, UCLA shoulder scores, joint range of motion, MMT, and AHD postoperatively, but not in internal rotation strength. In contrast, the graft tear group did not show any significant improvement. All patients could return to work, except for those performing heavy labor. Complications included graft tear in five patients, postoperative infection in two patients, and progressive postoperative arthropathic changes in one patient. CONCLUSION Good clinical results of ASCR were obtained using tensor fascia lata at 2 years after surgery, with few complications and low graft tear rates.
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Affiliation(s)
- Satoru Ohta
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital.
| | - Yoshiyuki Ueda
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital
| | - Osamu Komai
- Department of Orthopaedic Surgery, Shinseikei Toyama Hospital
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Hudelist B, Idriceanu T, Moya-Plana A, Herman P, Bresson D. The "Gift Wrap" Technique - A Method that Simplifies the Placement of Fascia Lata in the Reconstruction of the Skull Base Following Endoscopic Endonasal Surgery: A Technical Note. World Neurosurg 2024; 183:41-44. [PMID: 38092352 DOI: 10.1016/j.wneu.2023.12.035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND With the advancement of endoscopic endonasal surgery in the treatment of anterior skull base (ASB) pathologies, extended, watertight reconstructions are needed to prevent cerebrospinal fluid (CSF) leakage. This often involves the use of multilayers closure, with free fascia lata (FL) graft frequently used as an in- and/or outlay. However, positioning the FL properly can be challenging and time-consuming, particularly on wider defects. In this technical note, we present an easier and faster way to position FL using a silicone sheet. METHODS FL graft is harvested using a standard technique. The required dimensions are evaluated depending on the extent of the dural defect taking in consideration that FL graft should exceed the edges of the dural defect especially laterally. It is then wrapped around a semi rigid pattern (Silastic sheet) and secured with several monofilament 5/0 sutures. The "package" is transferred through the endonasal corridor to the defect. The sutures are divided and taken out; the fascia is unfolded, and its edges are inserted into the subdural space without any twisting or folding of the flap. Finally, the silicone sheet is withdrawn from the nasal cavity, leaving the FL well-stretched in perfect position. RESULTS We illustrate this technique in the management of a large anterior skull base chondrosarcoma, which necessitated significant bone and dural resection. CONCLUSIONS The "Gift wrap" technique offers an alternative approach for positioning the FL, which is less time-consuming compared to the traditional technique. Moreover, it enables improved placement of the FL, enhancing its efficacy.
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Affiliation(s)
- Benoit Hudelist
- Neurosurgery Department, GHU, Sainte-Anne Hospital, Paris, France.
| | - Tania Idriceanu
- Neurosurgery Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | | | | | - Damien Bresson
- Neurosurgery Department, Foch Hospital, Suresnes, France
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Liu SW, Frost A, Fritz MA. Supraorbital Rim and Roof Reconstruction with Vascularized Fascia Lata and Autogenous Rib Graft. Laryngoscope 2024; 134:654-658. [PMID: 37318100 DOI: 10.1002/lary.30819] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Describe a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof. METHODS Retrospective chart review and description of surgical technique. RESULTS Four patients underwent tumor resection with neurosurgery (2 intraosseous hemangioma, 1 meningioma, and 1 ossifying fibroma), with mean tumor size of 42.6 cubic centimeters on preoperative imaging. All defects involved supraorbital rim and orbital roof. Patients were reconstructed with autogenous osseous rib graft for structure and contour and anterolateral thigh fascia lata (ALTFL) free flap to provide robust vascularity to rib bone and as a barrier between skull base dura and the orbit and/or sinonasal cavities. Two patients underwent resection and reconstruction using minimal access incisions, and two underwent major cranial and skull base resections. All flaps are vascularized via superficial temporal vessels. On postoperative follow-up (mean 33.5 months, range 8-48), all patients report no vision change or diplopia, with excellent contour symmetry to contralateral orbit. Follow-up imaging (mean 29.5 months, range 3-48) demonstrated maintained orbital volume and retention of rib bone graft compared to immediate postoperative imaging. There were no complications related to graft use. Minor complications include 1 patient with cerebrospinal fluid leak managed with lumbar drain placement and 1 patient with mild enophthalmos at 7-month follow-up. CONCLUSION We describe a series of patients who underwent a novel technique for reconstruction of complex defects involving supraorbital rim and orbital roof with autogenous osseous rib and vascularized ALTFL-free flap with excellent functional and cosmetic outcomes. This can be accomplished using minimal access techniques to minimize patient morbidity. LEVEL OF EVIDENCE 4 Laryngoscope, 134:654-658, 2024.
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Affiliation(s)
- Sara W Liu
- Cleveland Clinic, Head and Neck Institute, Section of Facial Plastic and Microvascular Surgery, Cleveland, Ohio, U.S.A
| | - Ariel Frost
- Cleveland Clinic, Head and Neck Institute, Section of Facial Plastic and Microvascular Surgery, Cleveland, Ohio, U.S.A
| | - Michael A Fritz
- Cleveland Clinic, Head and Neck Institute, Section of Facial Plastic and Microvascular Surgery, Cleveland, Ohio, U.S.A
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Ribeiro FR, Nogueira MP, Costa BM, Tenor AC, Costa MPD. Mini-Open Fascia Lata Interposition Graft Results In Superior 2-Year Clinical Outcomes When Compared to Arthroscopic Partial Repair for Irreparable Rotator Cuff Tear: A Single-Blind Randomized Controlled Trial. Arthroscopy 2024; 40:251-261. [PMID: 37453724 DOI: 10.1016/j.arthro.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To evaluate and compare the results of surgical treatment for irreparable rotator cuff tear (IRCT) by the mini-open interposition procedure using fascia lata autograft against outcomes of the arthroscopic partial repair technique. METHODS An interventional, prospective, controlled, randomized, single-blinded study involving 2 study groups was conducted. The graft group (n = 20) underwent the mini-open interposition procedure using fascia lata autograft. The control group (n = 22) underwent arthroscopic partial repair. Patients were evaluated using the University of California Los Angeles (UCLA) Shoulder scale, the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley (Constant) score, the visual analogue scale (VAS) pain score, active range of motion, frontal flexion strength, retear rates evaluated by magnetic resonance imaging analysis, occurrence of complications, and the minimal clinically important difference (MCID). RESULTS The graft group had better UCLA (31.5 vs 28.18, P = .035) (100% exceeded the MCID for the graft group and 95% for the control group), ASES (88.62 vs 77.06, P = .016) (100% exceeded the MCID for both groups), Constant (78.85 vs 61.68, P < .001), and VAS (0.95 vs 2.59, P = .01) scores at the 24-month follow-up. For active forward elevation range, both groups showed no statistically significant differences (168.5 vs 164.54, P = .538). The results for active external and internal rotation were better in the graft group (60.25 vs 40, and 9.1 vs 6.9, P < .001), as was frontal flexion strength (4.24 vs 2.67, P = .005). The graft group also had lower retear rates (15% vs 45.5%, P = .033). No complications were reported. CONCLUSIONS Outcomes of surgeries for IRCT by the mini-open interposition procedure using fascia lata autograft and by the arthroscopic partial repair technique showed good results in both groups over time and exceeded the MCID. However, most comparative outcomes between groups showed better results for the interposition procedure. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
| | | | - Bruno Marcus Costa
- Institute of Medical Assistance to the State Public Servant, Sao Paulo, Brazil
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Ahmad R, Rehman U, Sohaib Sarwar M, Ahmed Z, Adebayo O, Brennan PA. Use of autogenous fascia lata slings in the surgical correction of ptosis: a systematic review of the literature and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:128-139. [PMID: 38290862 DOI: 10.1016/j.bjoms.2023.11.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
Ptosis is an abnormally low-positioned upper eyelid. Management depends on severity, aetiology, and function of the levator palpebrae superioris muscle (LPS). This review evaluates the success of autogenous fascia lata slings (AFLS) in the surgical management of ptosis, together with complication and reoperation/revision rates. A literature search was conducted on PubMed, Google Scholar PROSPERO, Dynamed, DARE, EMBASE, Cochrane, and BMJ databases (PROSPERO registration: CRD42023475090), and 30 studies (3690 patients and 5059 eyes) were included. The average age of the patients was 14.2 years with a ratio of male:female patients of 1:0.7. A total of 2532 eyes had undergone a fascial sling with autogenous fascia lata. The average follow-up period was 32.6 months. Improvement in the margin to reflex distance 1 (MRD1) with fascial sling surgery was 2.79 mm. The rate of complications from surgery involving autogenous fascia lata was 21.3%. The most common complications included lagophthalmos (19.8%), residual ptosis (11.5%), and corneal damage (10.4%). The reoperation rate was 13.4%. Most common indications for reoperation were cosmetic, with asymmetry (18%), lid crease abnormalities (30%), and upper eyelid trimming (18%). The overall complication rate in AFLS patients was 20% (95% CI: 6 to 35, p < 0.01; I2 = 89%) versus 27% (95% CI: 14 to 40, p < 0.01; I2 = 90%) in non-AFLS patients. AFLSs are prudent in the surgical management of ptosis. The results of this review demonstrate that their use is associated with similar complication rates but fewer reoperations than other traditional techniques.
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Affiliation(s)
- Reddin Ahmad
- Core Surgical Trainee 1, Plastic Department, University Hospitals Leicester NHS Trust, Leicester, United Kingdom.
| | - Umar Rehman
- Clinical Research Fellow, UCL Division of Surgery and Interventional Sciences, UCL, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Locum Clinical Fellow, Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Zahra Ahmed
- Medical Student, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
| | - Oluwasemilore Adebayo
- Foundation Doctor, Department of Surgery, Lister Hospital, Stevanage, United Kingdom.
| | - Peter A Brennan
- Honorary Professor of Surgery, Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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La Padula S, Ponzo M, Lombardi M, de Gregorio L, D'Andrea F, Coiante E, Pensato R, Hersant B, Meningaud JP. Assessment of deep plane facelift combined with fascia lata graft for the static treatment of facial palsy: A preliminary report. J Plast Reconstr Aesthet Surg 2024; 88:457-465. [PMID: 38091689 DOI: 10.1016/j.bjps.2023.11.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 01/02/2024]
Abstract
Addressing facial palsy (FP) presents intricate challenges in achieving natural expressions. Although free functional muscle transfers (FFMT) offer effective smile restoration, age impacts their efficacy. The optimal FFMT age range of 5-55 years is limited by physical fitness, which extends beyond age boundaries. Unilateral FP demands vary; younger patients require dynamic solutions like FFMT, whereas older individuals prioritize public appearance due to baseline distortion. The aim of this study is to describe and to assess a new static technique combining deep plane facelift and fascia lata graft for FP treatment. We conducted a prospective pilot study enrolling unilateral FP patients aged >55 and declining FFMT. Exclusions encompassed prior FP surgery, recent injections, uncontrolled diabetes cognitive deficits, and patients unable to quit smoking. To evaluate this technique, the Glasgow Benefit Inventory (GBI), along with two objective scales, the Face- and Neck-Lift Objective Photo-Numerical Assessment Scale and the eFACE scale, were used. Interrater reliability and intrarater reliability were assessed. Fifteen patients (mean age: 60.9 years) underwent the procedure. Both static and dynamic symmetry significantly improved (p < 0.05), including check volume and position, oral commissure, and jawline. Notably, eye closure enhancement was observed. GBI scores also significantly increased (p < 0.05). Interrater reliability and intrarater reliability were minimal (p = 0.12 and p = 0.13). This combined approach offers a static FP treatment option, especially for the elderly or FFMT-ineligible patients. The relatively brief procedure yields immediate and satisfactory results, suggesting its potential value in FP management. Further comprehensive studies are encouraged to validate the technique's long-term efficacy and applicability across larger populations.
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Affiliation(s)
- Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy; Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
| | - Martina Ponzo
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Mariagiovanna Lombardi
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Ludovica de Gregorio
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Edoardo Coiante
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Barbara Hersant
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Jean Paul Meningaud
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
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Ueno K, Shirakawa Y, Uemura K, Kumegawa S, Wada Y, Asamura S. Surgical results of retroauricular fascia graft in frontalis suspension surgery: A case series study. J Plast Reconstr Aesthet Surg 2024; 88:266-272. [PMID: 38016263 DOI: 10.1016/j.bjps.2023.10.133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/30/2023]
Abstract
Frontalis suspension surgery is commonly used for the repair of congenital ptosis and involutional blepharoptosis with poor levator function. Grafts for this procedure have been developed using a variety of different materials, each with advantages and disadvantages. The retroauricular fascia graft might be beneficial in this surgery. This article reports the surgical results of blepharoptosis, who were treated with the retroauricular fascia, which is a new autologous graft for the frontalis suspension technique. This case series study targeted patients with ptosis who underwent frontalis suspension surgery with the retroauricular fascia graft at Wakayama Medical University in Japan between May 2016 and May 2023. Patients with insufficient follow-up (<6 months) were excluded from the study. Eligible patients were categorized into one of the following three assessment groups: "good" (improvement of palpebral fissure height without laterality, Margin reflex distance-1 gap between right and left side <0.5 mm), "fair" (improvement of palpebral fissure height with laterality), or "poor" (poor improvement of palpebral fissure height). Thirty-five eyes in 25 patients were treated with the retroauricular fascia graft. The mean postoperative follow-up was 27 months. Eight patients were classified as good (32%), 15 as fair (60%), and two as poor (8%). Two patients (8%) had postoperative lagophthalmos. No patients had eyelash inversion, tarsal deformity, or recurrence of ptosis. Scars along the edge of the hairline were inconspicuous and there were no hypertrophic scars. Functional reconstruction of the eyelids using the retroauricular fascia graft technique is described here for the first time. This grafting technique may be a useful alternative for frontalis suspension surgery because it can be harvested with easy access and without leaving conspicuous scars.
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Affiliation(s)
- Kazuki Ueno
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan.
| | - Yuji Shirakawa
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Kazuhisa Uemura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Shinji Kumegawa
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Yoshitaka Wada
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
| | - Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8509, Japan
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Cho K, Kang J, Eun S. Various soft tissue defect reconstructions using anterolateral thigh and vascularized fascia lata composite free flap. Medicine (Baltimore) 2023; 102:e36578. [PMID: 38115317 PMCID: PMC10727578 DOI: 10.1097/md.0000000000036578] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The anterolateral thigh flap (ALT) is versatile for soft-tissue reconstruction of various body defects because of its thick and vascularized fascia component. We present our clinical experience with the functional one-stage reconstruction of complicated soft-tissue defects using ALTs with vascularized fascia lata (FL). Between April 2018 and February 2022, we transferred ALTs with FL components for various soft-tissue defects in 15 patients. The FL component was used for reconstruction of hand & forearm tendon, medial and lateral patellar synovial membrane, plantar aponeurosis, abdominal wall, dura and Achilles tendon. Functional outcomes were evaluated in each patient. Partial flap necrosis occurred in 2 patients and were treated successfully with minimal surgical debridement and dressing. The vascularized fascia could replace a tendon and fascial component and all the patients achieved satisfactory results without major postoperative complications. Anterolateral thigh flaps with vascularized FL provide reliable fascial and tendon components for single-stage reconstruction of complex soft tissue defects.
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Affiliation(s)
- Kyusang Cho
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jiwon Kang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Seokchan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Charters E, Low THH. Improving the oral function of patients with upper and lower lip tensor fascia lata slings for patients with flaccid facial nerve palsy. Oral Oncol 2023; 147:106601. [PMID: 37925897 DOI: 10.1016/j.oraloncology.2023.106601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Facial nerve paralysis (FNP) often causes decreased quality of life and may lead to significant facial dysfunction. Oral competence is frequently raised as a concern by patients as it impacts nutrition, hydration, social participation, and mental health. This can result in social isolation and reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact that facial nerve static and dynamic reanimation has on oral competence, with a specific focus on speech intelligibility and the oral phase of the swallow. MATERIALS AND METHODS Patients who had a static or dynamic facial reanimation at Chris O'Brien Lifehouse due to facial nerve paralysis were recruited consecutively between September 2020 and October 2022. Their speech and swallow were analysed using patient reported outcome measures including the speech handicap index and the oral competence questionnaire, and speech intelligibility rated by the patient and their speech pathologist at baseline (up to 2-weeks prior to surgery), then at 6- and 12- months post-surgery. Outcomes were evaluated firstly by a paired analysis (pre- compared to post-operative oral competence outcomes), and secondly by a cohort analysis of static, compared to dynamic reanimation. RESULTS 19 participants underwent a facial nerve reconstruction (10 static, 9 dynamic and static) due to pre-operative facial nerve paralysis. At 12-months improvements in both the oral competence questionnaire (OCQ) and the speech handicap index (SHI) (score reduced at a rate of 0.3 points per week and the 0.2 points respectively) and that this change met statistical significance (OCQ; p = p < 0.003, SHI; p < 0.001). Patient rated intelligibility increased 0.3 and clinician rated intelligibility increased 0.2 points per week which also significantly improved (p = 0.001 and p < 0.001 respectively). CONCLUSIONS Both static and dynamic facial reanimation procedures significantly improved both speech and swallowing measures for oral competence at 6- and 12- months post-procedure. There was not a significant difference found between static and dynamic procedures.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Maruccia M, Tedeschi P, Caizzi G, Palmiotto F, Di Summa PG, Vicenti G, Moretti B, Giudice G, Elia R. Graft and Flap: Orthoplastic Approach to Achilles Tendon Secondary Rupture. Plast Reconstr Surg 2023; 152:1359-1364. [PMID: 37092978 DOI: 10.1097/prs.0000000000010566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
SUMMARY Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Michele Maruccia
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Pasquale Tedeschi
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Gianni Caizzi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Florianna Palmiotto
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Pietro G Di Summa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro"
| | - Giuseppe Giudice
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
| | - Rossella Elia
- From the Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari
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Nishimura H, Yamaura K, Stetzelberger VM, Garcia AR, Hollenbeck JFM, Brown JR, Mologne MS, Uchida S, Philippon MJ. Biomechanical Comparison of Proximal Hamstring Reconstruction Using Distal Hamstring Graft Versus Fascia Lata Graft for Treatment of Chronic Hamstring Injury. Am J Sports Med 2023; 51:3756-3763. [PMID: 37975438 DOI: 10.1177/03635465231206464] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Surgical reconstruction using autografts is often required in treating chronic proximal hamstring injuries where the hamstring has retracted >5 cm. There is a paucity of evidence that evaluates reconstructive procedures using the 2 most popular autografts, distal hamstring and fascia lata. PURPOSE To (1) compare failure load and elongation at failure between the proximal hamstring tendon reconstruction with distal hamstring and fascia lata grafts and (2) compare the stiffness between these reconstructions and the native state. STUDY DESIGN Controlled laboratory study. METHODS Seven pairs of human cadaveric hemipelvises (mean age, 60.4 ± 5.0 years; 6 male, 1 female) with no evidence of previous injury or abnormality were dissected to the proximal hamstring origin. Through use of a dynamic tensile testing system, each specimen underwent preconditioning followed by a distraction test to determine the native specimen stiffness. Each pair of specimens was assigned to undergo proximal hamstring reconstruction with distal hamstring and reconstruction with fascia lata. Each specimen then underwent preconditioning followed by pull to failure. The failure load, elongation at failure, mode of failure, and stiffness were determined for each repair. RESULTS The distal hamstring group exhibited a greater failure load (mean, 334 ± 108 N; P = .031) and higher stiffness (mean, 47.6 ± 16.0 N/mm; P = .009) compared with the fascia lata group (mean, 179 ± 78 N and 23.0 ± 11.2 N/mm, respectively). Although the stiffness of the repair state in the distal hamstring group (mean, 61.4 ± 13.4 N/mm) was not significantly different from that of the native state (mean, 47.6 ± 16.0 N/mm), the stiffness of the repair state in the fascia lata group (mean, 23.0 ± 11.2 N/mm) was significantly lower than that of the native state (mean, 60.1 ± 17.7 N/mm) (P < .0001). The elongation at failure of the distal hamstring graft group (mean, 33.0 ± 6.6 mm) was not significantly different from that of the fascia lata graft group (mean, 29.2 ± 14.9 mm) (P = .58). The most common modes of failure for the distal hamstring group (29% each) were at the repair site, at the graft-muscle interface, and at the muscle, while the most common modes of failure for the fascia lata graft were at the tendon-graft interface. CONCLUSION The distal hamstring group achieved higher failure load and stiffness than the fascia lata group, and stiffness of the distal hamstring group was not significantly different from that of the native tendon. Elongation at failure was not different between repair techniques. Although distal hamstring graft failure predominantly occurred in 3 distinct locations, failure of the fascia lata repair occurred predominantly at the tendon-graft interface. These cadaveric results suggest that it may be more clinically appropriate to use distal hamstring versus fascia lata for proximal hamstring reconstruction. CLINICAL RELEVANCE Our time-zero study suggests that the proximal hamstring reconstruction with distal hamstring could be the preferred surgical treatment for chronic hamstring injury over reconstruction with fascia lata. The failure load of reconstruction with distal hamstring was inferior to that of primary suture anchor, suggesting that rehabilitation after reconstruction should not be more aggressive than the standard postoperative rehabilitation protocol for acute repair.
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Affiliation(s)
| | - Kohei Yamaura
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | | - Justin R Brown
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital University of Occupational and Environmental Health, Kitakyusyu, Fukuoka, Japan
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Ma L, Gou X, Zhou B. Clinical effectiveness of supraspinatus tendon reconstruction using autogenous fascia latas for irreparable posterosuperior massive rotator cuff tears: study protocol for a randomized, controlled clinical trial. Trials 2023; 24:702. [PMID: 37907996 PMCID: PMC10617144 DOI: 10.1186/s13063-023-07741-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Supraspinatus tendon reconstruction (STR) was recently introduced as a new treatment option for irreparable posterosuperior massive rotator cuff tears (IPMRCT). STR was thought to be more advantageous than superior capsule reconstruction (SCR) for restoring supraspinatus (SSP) dynamics. However, there has been no prospective randomized controlled study on the early clinical efficacy of STR. METHODS A single-site, prospective, observers and patients double-blinding randomized controlled trial was designed. Fifty-eight patients aged 50-85 years with IPMRCT will be randomized 1:1 to receive either STR or SCR. The clinical outcomes were evaluated using the American Society for Shoulder and Elbow Surgery (ASES) score, range of motion (ROM), visual analogue scale (VAS) for pain, acromiohumeral distance (AHD), Goutlliar grade for fatty infiltration in the SSP, Sugaya grade for the autogenous fascia latas, isokinetic muscle strength testing and surface electromyography (EMG) testing for shoulder abduction muscle strength and complications. DISCUSSION The results of this study will contribute to the treatment algorithm of IPMRCT and assist surgeons in making treatment decisions. This is the first randomized controlled trial to compare the effects of STR and SCR for the treatment of IPMRCT. TRIAL REGISTRATION We registered the trial in chictr.org.cn on July 17, 2023 (register number: ChiCTR2300073716). Items from the WHO trial registry were found within the protocol.
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Affiliation(s)
- Lin Ma
- Department of Sports Medicine, Southwest Hospital, Army Medical University, No. 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Xiaoli Gou
- Department of Sports Medicine, Southwest Hospital, Army Medical University, No. 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Binghua Zhou
- Department of Sports Medicine, Southwest Hospital, Army Medical University, No. 30 Gaotanyan Main Street, Chongqing, 400038, China.
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15
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Hoerdemann M, Yarbrough T. Long-term outcome of autologous fascia lata grafting with conjunctival flap overlay in horses with ulcerative keratitis and keratomalacia. Vet Surg 2023; 52:1032-1040. [PMID: 37309748 DOI: 10.1111/vsu.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe the technique, postoperative complications, and outcome after autologous fascia lata grafting with conjunctival flap overlay in horses with ulcerative keratitis and keratomalacia. STUDY DESIGN Retrospective case series. ANIMALS Eleven horses with ulcerative keratitis and keratomalacia. METHODS Horses included had undergone fascia lata grafting with conjunctival flap overlay due to impending or recent corneal perforation. Preceding therapy, lesion characteristics, postoperative complications, and short- and long-term outcomes were recorded. RESULTS Postoperative complications included complete (1/11) or partial (2/11) dehiscence of the conjunctival flap and fascia lata graft, postoperative pneumonia (1/11), intermittent hypercreatinemia (2/11) and mild uveitis after trimming of the conjunctival flap (9/10). The donor sites healed without complications (11/11). A satisfactory short-term outcome (at cessation of medical therapy) was achieved in all horses (11/11). Long-term follow-up (median 29 months, range 7-127 months) was available for 10/11 horses. A comfortable eye with functional vision was achieved in 9/10 horses with long-term follow-up, including 3/4 horses with prior corneal perforation and 1/11 horses in which the fascia lata graft completely dehisced 15 days after surgery. Enucleation was required in a single horse (1/10) after phthisis bulbi developed 7 months postoperatively. CONCLUSION Fascia lata grafting with conjunctival flap overlay appears to be a viable solution for globe preservation in horses with ulcerative keratitis and keratomalacia. Long-term ocular comfort with functional visual outcomes can be achieved in most cases with limited concerns for donor site morbidity while bypassing acquisition, storage or lesion-size limitations related to other biomaterials.
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16
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Wang Y, Yuan Y, Pang L. Reconstruction of Medial Canthal Ligament With Autogenous Fascia Lata Graft. J Craniofac Surg 2023; 34:e604-e607. [PMID: 37427931 PMCID: PMC10445627 DOI: 10.1097/scs.0000000000009537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 05/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND An eyelid malignant tumor invading the medial canthus is a serious eyelid disease that requires extensive resection and complex destruction. The medial canthus ligament is especially difficult to repair because its reconstruction often requires special materials. In this study, we described our reconstruction technique using autogenous fascia lata. METHODS Data from 4 patients (4 eyes) who had medial canthal ligament defects after Mohs resection of eyelid malignant tumors were reviewed from September 2018 to August 2021. The reconstruction of the medial canthal ligament using autogenous fascia lata was performed in all of the patients. If combined with the upper and lower tarsus defects, autogenous fascia lata was split into 2 branches to repair the tarsal plate. RESULTS The pathologic diagnosis was basal cell carcinoma in all patients. The mean follow-up time was 13.6±3.51 months (range, 8-24 mo). There was no tumor recurrence, infection, or graft rejection. All patients achieved good eyelid movement and function and were satisfied with their medial angular shape and cosmetic contour. CONCLUSIONS Autogenous fascia lata is a good material to repair medial canthal defects. It is easy to take and effectively maintains eyelid movement and function with satisfactory postoperative effects.
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Hasegawa A, Mihata T, Yamamoto N, Takahashi N, Takayama K, Uchida A, Neo M. Postoperative graft integrity affects clinical outcomes after superior capsule reconstruction using fascia lata autograft in posterior-superior rotator cuff tears: a multicenter study. J Shoulder Elbow Surg 2023; 32:1476-1485. [PMID: 36681104 DOI: 10.1016/j.jse.2022.12.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/24/2022] [Accepted: 12/11/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing clinical outcomes of superior capsule reconstruction (SCR) for patients with irreparable rotator cuff tears (RCTs). However, the relationship between postoperative graft integrity and clinical outcomes after SCR remains unclear. We aimed to assess the relationship between postoperative graft integrity, including graft thickness and size of graft tear, and clinical outcomes after SCR in patients with irreparable RCTs. METHODS This retrospective multicenter study included 188 patients (86 women, 102 men; mean age, 69.2 years; range, 49-87 years) with irreparable RCTs who underwent arthroscopic SCR using fascia lata autografts. Using magnetic resonance imaging, the graft integrity was evaluated postoperatively at or after 1 year and was classified, according to Hasegawa's classification, into 4 categories: type I-II, intact graft of sufficient thickness; type III, thinned graft without discontinuity; type IV, presence of a minor discontinuity; and type V, presence of a major discontinuity. We compared (1) baseline characteristics, (2) visual analog scale (VAS) for pain, (3) American Shoulder and Elbow Surgeons (ASES) score, (4) active shoulder range of motion, and (5) acromiohumeral distance (AHD) among 4 groups based on postoperative graft integrity. RESULTS Magnetic resonance imaging scans revealed 152 shoulders (80.9%) with type I-II graft, 13 (6.9%) with type III graft, 13 (6.9%) with type IV graft, and 10 (5.3%) with type V graft. VAS and ASES scores significantly improved after SCR in all graft types (P < .0001 to P = .02). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES scores compared to those with type I-II grafts (P = .001 and P < .0001, respectively). Shoulders without graft tears (types I-II and III) showed significant improvements in shoulder elevation and internal rotation after SCR (P < .0001 to P = .02). In contrast, shoulders with large graft tears (type V) showed no significant improvement in shoulder range of motion. Postoperative acromiohumeral distance significantly increased only in shoulders with type I-II grafts (P < .0001). CONCLUSION Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after SCR using a fascia lata autograft. Patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact grafts of sufficient thickness, although arthroscopic SCR provided pain relief even in patients with graft tears. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes than those with graft thinning or tears.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Norimasa Takahashi
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
| | - Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Ben H, Kholinne E, Zeng CH, So SP, Lee JB, Sun Y, Koh KH, Jeon IH. Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction. Am J Sports Med 2023; 51:912-918. [PMID: 36786289 DOI: 10.1177/03635465231151927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Recently, a polypropylene mesh has been introduced and reported to improve clinical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft (FLA). However, mesh-related events such as a foreign body response may trigger inflammation, which might affect graft healing and remodeling. PURPOSE/HYPOTHESIS The aim was to investigate whether the healing and remodeling of an FLA were affected by the use of a mesh by comparing the signal intensity of an FLA-alone group vs an FLA + Mesh group on postoperative magnetic resonance imaging (MRI). The hypothesis was that the use of a mesh would decrease the MRI signal intensity of FLA during the early postoperative phase. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had undergone SCR using an FLA with or without a mesh between March 2013 and August 2021 were retrospectively analyzed. Follow-up MRI was performed at 3 months. A total of 78 patients (24 in the FLA group and 54 in the FLA + Mesh group) with intact grafts were included. Graft remodeling was evaluated by analyzing the signal-to-noise quotient (SNQ) at the humeral, mid-substance, and glenoid sites. Theoretically, lower SNQ ratios indicate higher strength and better healing of the graft. RESULTS The mean SNQ was 30.603 (range, 11.790-72.710) in the FLA group and 18.367 (range, 4.464-69.500) in the FLA + Mesh group (P < .001). Furthermore, significant differences were found between the 2 groups at the humeral and mid-substance sites (37.863 [range, 5.092-81.187] vs 15.512 [range, 1.814-80.869], P < .001; and 29.168 [range, 6.103-73.900] vs 16.878 [range, 2.454-92.416], P = .003; respectively). However, there was no difference between the 2 groups at the glenoid site (25.346 [range, 7.565-86.353] vs 20.354 [range, 3.732-88.468], P = .057). CONCLUSION At the 3-month follow-up, the FLA + Mesh group showed a lower MRI signal intensity than the FLA group. The healing and remodeling of an FLA may be enhanced when a mesh is used.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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19
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Takayama K, Shiode H, Ito H. Acromial and humeral head osteolysis following superior capsular reconstruction using autologous tensor fascia lata graft. J Shoulder Elbow Surg 2022; 31:1479-1487. [PMID: 35065292 DOI: 10.1016/j.jse.2021.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Graft tear is a critical complication following superior capsular reconstruction (SCR) as it directly links with clinical outcomes. No previous reports have described acromial and humeral head osteolysis following SCR. Acromial and humeral head osteolysis may incidentally occur after SCR using autologous tensor fascia lata graft. This study aimed to demonstrate the incidence of osteolysis following SCR using autologous tensor fascia lata graft and investigate the factors that affect osteolysis. METHODS This retrospective cohort study included patients who underwent SCR for irreparable rotator cuff tears between June 2014 and June 2019. The patients were divided into 2 groups-those with no osteolysis and those with osteolysis-and were compared. For subanalysis, patients in the osteolysis group were further divided into 3 groups according to the location of the osteolysis-acromial osteolysis, humeral head osteolysis, and acromial and humeral head osteolysis-to clarify the factors determining the location of osteolyses. The shoulder range of motion was evaluated preoperatively and 24 months postoperatively. Additionally, the following items were evaluated: condition of the subscapularis tendon, Hamada classification (grade 2 or 3), critical shoulder angle, acromiohumeral distance measured preoperatively and 24 months postoperatively, graft size, and graft thickness. In addition, the graft condition was evaluated using magnetic resonance imaging 12 months postoperatively. RESULTS In total, 57 patients were enrolled and followed up for a minimum of 2 years (follow-up rate, 92% [57 of 62 cases]). Overall, the incidence of osteolysis following SCR was 35.1% (20 of 57 cases; acromial osteolysis in 7, humeral head osteolysis in 3, and acromial and humeral head osteolysis in 10). Compared with the group with no osteolysis, the osteolysis group had no inferior clinical outcomes or higher graft tear rates. The proportions of Hamada grade 3 (P = .041) and involvement of the subscapularis tendon (P = .020) were significantly higher in the osteolysis group. The relative risks of subscapularis involvement and Hamada grade 3 for osteolysis were 2.9 and 5.1, respectively. In the subanalysis, the factors determining the location of the osteolysis could not be clarified. CONCLUSIONS This study suggested that the progression of the Hamada classification and condition of the subscapularis tendon affect the occurrence of osteolyses. However, these osteolyses were not associated with clinical outcomes, including graft tear rate and shoulder range of motion.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan.
| | - Hayao Shiode
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
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Aliotta RE, Meleca J, Vidimos A, Fritz MA. Free vascularized fascia lata flap for total columella reconstruction. Am J Otolaryngol 2022; 43:103226. [PMID: 34782174 DOI: 10.1016/j.amjoto.2021.103226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite their relatively small size, columellar defects, including both external and internal elements, are exceedingly difficult to reconstruct. Local, regional, and distant flaps have been described for reconstruction. Herein, we present a novel technique for reconstruction of the columella using vascularized free fascia lata from the anterolateral thigh with structural replacement and skin grafting. METHODS This novel technique utilizes a small anterolateral thigh flap, formed into vascularized fascia lata without the overlying subcutaneous fat or skin. The fascia lata is inset into the columellar and caudal septal defect after a cartilage framework is constructed and is microsurgically anastomosed to either distal facial or angular vessels. A skin graft from the ALT donor site is then secured over the fascia. RESULTS This technique has been applied successfully in patients with either isolated columella or in multi-subunit reconstruction following total rhinectomy with no flap or reconstructive failures. Given the low morbidity of flap harvest and minimal access incisions, this has been reliably accomplished with short (1-2 day) hospital stays. CONCLUSION Rapid and aesthetically acceptable reconstruction of total nasal columella defects in isolation or with additional nasal subunit reconstruction, is possible utilizing this novel technique. Here we discuss pearls and pitfalls of its use following surgical resection of malignancy.
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Affiliation(s)
- Rachel E Aliotta
- Department of Plastic & Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Joseph Meleca
- Division of Facial Plastic and Microvascular Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Allison Vidimos
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH, United States of America
| | - Michael A Fritz
- Division of Facial Plastic and Microvascular Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
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21
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Cabañas Weisz LM, Guarin DL, Townley WA. A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy. Ann Plast Surg 2021; 87:669-675. [PMID: 34117139 DOI: 10.1097/sap.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy causes devastating disability due to loss of facial function as well as social and psychological impairment. Cheek slings are a secondary technique that provide static support to the midface. This study aimed to describe our technique and compare a traditional sling material (tensor fascia lata) with a porcine-derived acellular dermal matrix alternative (Strattice). METHODS A 5-year case-control retrospective review of consecutive static cheek slings in a tertiary cancer and facial palsy center was performed. Demographic data, risk factors, and complications were collected and compared. Improvement in static smile position was assessed by Emotrics (Massachusetts Eye and Ear Infirmary, Boston, MA) at 3 months. Long-term sling failure was assessed by need for reoperation. RESULTS The study group comprised 41 patients on which 33 autogenous fascia lata slings and 12 Strattice slings were performed. Medium-term improvement in static smile position was similar between the 2 groups (judged by the Emotrics software), as was complication rate (P = 0.496). Need for revision due to stretching was higher in the Strattice group but did not achieve significance (P = 0.087). Mean follow-up was 38.02 ± 19.17 months. Twelve of 41 patients were deceased at study conclusion. CONCLUSIONS Fascia lata and Strattice slings provide satisfactory results in restoring symmetry at rest and functional oral competence. Our results suggest that Strattice is a safe sling material with an acceptable risk profile and comparable medium-term maintenance of tensile strength to fascia lata, and should be considered where life expectancy, donor site morbidity, and procedure length are important considerations.
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Affiliation(s)
- Laura M Cabañas Weisz
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and Department of Plastic Surgery and Burns Unit, Cruces University Hospital, Baracaldo, Spain
| | - Diego L Guarin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - William A Townley
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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22
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Sathyamurthy R, Manjunath KN, Waiker V, Shanthakumar S, Kumaraswamy M. Free tensor fascia lata flap - a reliable and easy to harvest flap for reconstruction. Acta Chir Plast 2021; 63:57-63. [PMID: 34404218 DOI: 10.48095/ccachp202157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Flaps are the essence of reconstructive surgery. The ability to successfully design, execute and manage the flaps makes plastic surgery an outstanding speciality. The choice of flap is mainly guided by the type of the defect. However, certain factors like technique feasibility, duration of the surgery and patient factors do have a role in decision making. The primary type of free flap (whether a muscle or a fasciocutaneous flap) is dictated by the defect or the wound characteristics. However, the choice of flap depends on various factors like the component of flap, pedicle length required, the ease of harvest and donor site morbidity. Tensor fascia lata (TFL) is one myocutaneous flap, which has well developed components other than a muscle. MATERIALS AND METHODS The patients admitted to a tertiary care hospital with the diagnosis of composite tissue defect in any region of the body were enrolled for this study from November 2016 to November 2018. Patients undergoing free TFL flap reconstruction are studied. The duration of flap harvest, the anatomical site of pedicle, flap outcome and the need of secondary surgery were analysed. RESULTS Totally 14 patients were reconstructed with a free TFL flap. The anatomic location of the defect was more frequent on lower limbs - 8 cases (58%), followed by the upper limb and the head and neck area (3 cases, each 21%). The mean flap harvest time was -62.07 (45-80) min. The mean size of pedicle entry was 8.7 cm from the anterior superior iliac spine. Out of the 14 flaps, there were 10 (71%) flaps successful completely and 4 (29%) of them had partial loss. CONCLUSION A free TFL flap harvest time is very short compared to any other flaps and hence makes it the flap of choice in patients who are critical and cannot withstand long operating time.
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Marcheggiani Muccioli GM, Lullini G, Grassi A, Macchiarola L, Cammisa E, Maccaferri B, Rinaldi VG, Di Paolo S, Zaffagnini S. Good results are reported at 60-month follow-up after medial patello-femoral ligament reconstruction with fascia lata allograft for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:1191-1196. [PMID: 32651802 DOI: 10.1007/s00167-020-06142-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of a new minimally invasive surgical technique for the reconstruction of the medial patellofemoral ligament (MPFL) with fascia lata allograft at 60-month minimum follow-up. METHODS Nineteen consecutive patients with chronic recurrent patellar dislocation were treated with MPFL reconstruction (53% isolate procedure, 47% in combination with other treatments). Seventeen patients (11 males/6 females) were available at 60-month follow-up and were clinically evaluated with validated scores. New episodes of patellar dislocation were considered failures. Radiographic and CT scan evaluation were executed preoperatively and at 60-month follow-up. RESULTS All clinical scores improved from preoperative assessment to 24-month and 60-month follow-up (p < 0.001). Kujala score increased from 61.2 ± 18.1 to 86.7 ± 8.7 and 82.1 ± 10.2; KOOS increased from 54.5 ± 19 to 86.8 ± 9.6 and 84.3 ± 7.6; VAS for pain decreased from 5.1 ± 2.2 to 2.4 ± 1.5 and 1.7 ± 1.2; Tegner score increased from 3 [2-4] to 5 [3-8] and 5 [3-9], respectively. Objective IKDC improved too. No significant improvements between the 24-month and 60-month follow-up evaluations were recorded. Anterior knee pain was reported in two patients (12%). Treatment failure, a new episode of patellar dislocation 25 months after the surgery, was observed in one patient (6%). Radiographic OA changes were not statistically significant between preop and 60-month follow-up. Tuberosity-troclear groove (TT-TG) distance and the patellar tilt angle were subjected to significant changes due to MPFL reconstruction and associated procedures. CONCLUSION MPFL reconstruction with fascia lata allograft, alone or combined with other procedures, is a reliable treatment option for recurrent patellar dislocation with a success rate of 94% and without cartilage deterioration at 60-month follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giulio Maria Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy.
| | - Giada Lullini
- Laboratorio di Analisi del Movimento e di Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Bruna Maccaferri
- Medicina Fisica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
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Norwich-Cavanaugh A, Kim S, Panse G, Saberski E, Hsia HC, Narayan D. Prelamination of Vascularized Tensor Fascia Lata for Complex Abdominal Wall Reconstruction. Ann Plast Surg 2021; 86:S332-S335. [PMID: 33443881 DOI: 10.1097/sap.0000000000002690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT There are 2 to 5 million laparotomies performed in the United States annually. Of these, 250,000 to 350,000 will undergo a ventral hernia repair. Repairs are often complicated by recurrence and infection. These risks are significantly increased in previously infected repairs, with reported recurrence rates varying from 17% to 28% after repair of infected ventral hernias, double the rates reported for first-time uninfected repairs. We describe here a novel treatment strategy involving the creation then use of bilateral prelaminated permanent mesh-reinforced tensor fascia latae flaps for abdominal wall reconstruction in patients who have recurrent ventral hernias and had undergone previous repairs complicated by infection. Previous repairs included anterior components separation, thereby making subsequent fascial release techniques and achievement of a reinforced repair extremely unlikely. Three patients were treated by a single surgeon using this 2-stage technique. There have been no incidences of recurrence and no infections after 2 to 10 years. In these patients, the only conventional option would have been a bridged repair with absorbable mesh. Combining the advantages of permanent mesh and well-vascularized autologous tissue optimizes the repair's tensile strength while mitigating the chance of recurrent infection associated with the use of permanent mesh. We propose that this strategy may be an appropriate treatment option for patients with recurrent ventral hernias that have not responded to other conventional modalities of treatment.
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Affiliation(s)
| | - Samuel Kim
- From the Division of Plastic Surgery, Department of Surgery
| | - Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Ean Saberski
- From the Division of Plastic Surgery, Department of Surgery
| | - Henry C Hsia
- From the Division of Plastic Surgery, Department of Surgery
| | - Deepak Narayan
- From the Division of Plastic Surgery, Department of Surgery
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Tiengo C, Sonda R, Monticelli A, Messana F, Crema A, Toninello P, Bassetto F. Achilles Tendon Region Defects: Delayed Composite Anterolateral Thigh Flap With Stripping of Fascia Lata: A Case Series. Wound Manag Prev 2020; 66:13-22. [PMID: 33290249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Defects of the Achilles tendon that include the surrounding soft tissue represent a challenge due to complex functionality and biomechanics. PURPOSE The purpose of this study was to evaluate the functional and physical functioning score out-comes of patients following microsurgical reconstruction of the yarrow region, using a combination of objective, subjective, and semi-subjective measurements. METHODS Between 2007 and 2018, 15 patients underwent delayed Achilles tendon region reconstruction with different anterolateral thigh flap types. Seven (7) patients underwent tendon and soft tissue re-construction with a chimeric anterolateral thigh flap (ALT) and rolled-up fascia lata, and 8 patients underwent soft tissue reconstruction and only tendon coverage with fascia lata. Follow-up assessments included maximal range of motion (MROM) (plantarflexion and dorsiflexion), the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale score, and the Med-ical Outcomes Study 36-item Short-Form Health Survey physical functioning subscore. RESULTS A total of 15 patients (11 males and 4 females with a mean age of 39.86 years) were evaluated during a mean follow-up time of 23 months (SD = 7.12). The MROM for plantarflexion and dorsiflexion was 42.71 degrees (SD = 2.9) and 24.8 degrees (SD = 4.29), respectively, in patients who underwent composite ALT with a rolled-up fascia lata. The MROM for plantarflexion and dorsiflexion was 43 degrees (SD = 5.37) and 27.37 degrees (SD = 3.2), respectively, in patients who underwent fasciocutaneous ALT. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 82 for the first group and 86.87 for the second, whereas the mean Medical Outcomes Study 36-item Short-Form Health Survey scores were 82.57 and 81.5, respectively, for the 2 groups. Statistical analysis showed no significant difference between the 2 groups. CONCLUSIONS The results of this case series suggest that the single-stage composite reconstruction with a fasciocutaneous flap with or without a strip of fascia lata is a safe and reliable strategy for composite reconstruction of the Achilles tendon region. Additional studies to evaluate these outcomes and instruments to evaluate functioning are necessary.
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Smeets K, Bellemans J, Truijen J. A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions. Acta Orthop Belg 2020; 86:447-452. [PMID: 33581029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft , leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament.
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27
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Kagaya Y, Arikawa M, Higashino T, Miyamoto S. Letter of response to comments on publication: "Autologous abdominal wall reconstruction using anterolateral thigh and iliotibial tract flap after extensive tumor resection: A case series study of 50 consecutive cases''. J Plast Reconstr Aesthet Surg 2020; 74:223-243. [PMID: 32826182 DOI: 10.1016/j.bjps.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Yu Kagaya
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Masaki Arikawa
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takuya Higashino
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
| | - Shimpei Miyamoto
- Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Youngerman BE, Kosty JA, Gerges MM, Tabaee A, Kacker A, Anand VK, Schwartz TH. Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches. Acta Neurochir (Wien) 2020; 162:863-873. [PMID: 32048039 DOI: 10.1007/s00701-019-04200-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. OBJECTIVE To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. METHODS A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. RESULTS ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8-13.3 cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. CONCLUSIONS Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.
| | - Jennifer A Kosty
- Department of Neurosurgery, Ochsner Louisiana State University Shreveport, Shreveport, LA, USA
| | - Mina M Gerges
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
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Favreau H, Eichler D, Bonnomet F, Lustig S, Adam P, Ehlinger M. Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft. Eur J Orthop Surg Traumatol 2020; 30:1033-1038. [PMID: 32221680 DOI: 10.1007/s00590-020-02661-y] [Citation(s) in RCA: 2] [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: 08/04/2019] [Accepted: 03/20/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature. METHODS The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2 years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times. RESULTS At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3 mm. One persistent distal hypoesthesia at 2-year follow-up was observed. CONCLUSION The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed. LEVEL OF EVIDENCE Retrospective case series, level IV.
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Affiliation(s)
- Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France.
- Laboratoire INSERM-UNISTRA UMR 1260, 11 rue Humann, 67085, Strasbourg, France.
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
| | - Sébastien Lustig
- Département de Chirurgie Orthopédique, Centre Albert-Trillat, Hôpital de la Croix-Rousse, 103 boulevard de la Croix-Rousse, 69004, Lyon, France
| | - Philippe Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
- Laboratoire ICube, CNRS, UMR 7357, 30 Bd Sébastien Brant, 67400, Illkirch, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg Cedex, France
- Laboratoire ICube, CNRS, UMR 7357, 30 Bd Sébastien Brant, 67400, Illkirch, France
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Gan W, Xiang Y, Lv D, Liu J, Wang H, Deng D, Wang J, Li L, Ma T, Liu S, Chen F. Complex reconstruction technique applied in advanced head and neck cancer. Medicine (Baltimore) 2020; 99:e18810. [PMID: 32000381 PMCID: PMC7004775 DOI: 10.1097/md.0000000000018810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Complex reconstruction skills in advanced head and neck cancer (HNC) could resolve the key problem of large defects after tumor resection. We combined the anterolateral thigh free flap, fascia lata flap, and greater saphenous vein graft in the reconstruction process of salvage surgery. Seven patients suffering from advanced HNC who experienced the failure of multiple therapeutic methods were enrolled in our study between June 2017 and January 2018. They all agreed to voluntarily undergo the tumor excision and complex reconstruction procedure we developed. The total flap size ranged from 20 × 13 cm to 30 × 15 cm. The length of the greater saphenous vein graft ranged from 4 to 11 cm. The hospitalization period ranged from 7 to 33 days. All of the flaps were viable, but in 1 patient, oral flap edge infection and necrosis necessitated partial debridement on day 7 postoperatively. All donor sites were closed primarily. We report our experience with this surgical method for complex reconstruction in advanced HNC patients.
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Affiliation(s)
- Weigang Gan
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Yu Xiang
- Morphometric Research Laboratory, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Dan Lv
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Jun Liu
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Haiyang Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Di Deng
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Ji Wang
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Linke Li
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Tengfei Ma
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Shixi Liu
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Fei Chen
- Department of Otorhinolaryngology–Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu
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Clancy R, Lim Z, Ravinsky RA, OʼNeill A, Ferguson P, Wunder J. Use of a Fascia Lata Autograft to Reconstruct a Large Triceps Tendon Defect After En-Bloc Resection of a Soft-Tissue Sarcoma: A Case Report. JBJS Case Connect 2020; 10:e0390. [PMID: 32224670 DOI: 10.2106/jbjs.cc.19.00390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE In this report, we present the case of a patient undergoing en-bloc resection of a large triceps soft-tissue sarcoma, requiring reconstruction of the triceps tendon including its distal insertion. We describe a surgical technique using fascia lata (FL) autograft to reconstruct the patient's extensor mechanism with long-term follow-up and functional results. CONCLUSIONS FL autograft is a viable option for reconstruction of large tendinous defects. It is simple and straightforward to harvest, inexpensive when compared with alternatives, with many potential applications.
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Affiliation(s)
- Rachel Clancy
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada
| | - Zachary Lim
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Ravinsky
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
- The CORE Institute, Phoenix, Arizona
| | - Anne OʼNeill
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada
| | - Peter Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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Singh R, Wadhwani J, Rohilla RK, Kaur K. Proximal femoral resection and Tensor Fascia Lata flap for recalcitrant trochanteric pressure ulcers. Spinal Cord Ser Cases 2019; 5:15. [PMID: 30729039 PMCID: PMC6363780 DOI: 10.1038/s41394-019-0157-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Trochanteric pressure ulcers (PrUs) are difficult to treat and are often complicated by infection spreading to the hip joint. We review three cases from India where proximal femoral resection and pedicled Tensor Fascia Lata (TFL) flapping was used in the management of infected deep trochanteric ulcers communicating to the hip joint. Case presentation Three patients had a total of four trochanteric PrUs communicating to the hip joint. Proximal femoral resection along with radical debridement of the pressure ulcer (PrU) was the first step in our surgical protocol. Serial debridements were performed to make the resulting cavity healthier and ready for the subsequent flap surgery. TFL flapping was done to cover the raw area of the PrU and the donor site was closed either primarily or with a split skin graft. All patients were males with AIS A spinal cord injury (SCI) and stage 4 PrUs in the trochanteric region. One patient had bilateral trochanteric ulcers. There was complete healing of all PrUs with improvement in wheelchair mobility, and general health. Discussion PrUs are a common complication of patients with SCI and are often considered one of the most neglected issues of health care delivery in India. Proximal femoral resection with pedicled TFL muscle flap is a versatile and reliable procedure for the coverage of recalcitrant trochanteric PrU with hip joint involvement. Minimal donor site morbidity occurs.
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Affiliation(s)
- Roop Singh
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Jitendra Wadhwani
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Rajesh Kumar Rohilla
- Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
| | - Kiranpreet Kaur
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak-124001 Haryana, India
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Ângelo ACLPG, de Campos Azevedo CI. Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity. Knee Surg Sports Traumatol Arthrosc 2019; 27:245-250. [PMID: 30069653 DOI: 10.1007/s00167-018-5085-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to prospectively evaluate donor site morbidity in arthroscopic superior capsular reconstruction using a minimally invasive harvested fascia lata autograft. METHODS Fifteen consecutive patients underwent arthroscopic superior capsular reconstruction by the senior author using a fascia lata autograft harvested in a minimally invasive fashion. All patients were prospectively evaluated at 1 week, 6 and 18 months postoperatively. The subjects' body mass index, age, actual or previous corticosteroid therapy history and active smoking habits were evaluated. Functional outcomes were assessed by the non-arthritic hip score applied to the harvested and contralateral thighs. Every patient completed standardized subjective satisfaction questionnaires at all evaluations. The median patient age was 65.5 years (range 47-77). Nine patients (60%) were females, and six (40%) were males. One patient (6.7%) was within the normal range of weight, nine (60%) were overweight, four (27%) were obese, and one (6.7%) was extremely obese. Two patients (13%) were active smokers. No patients had an active or previous record of corticosteroid therapy. No patients required postoperative lower limb physical therapy. RESULTS In terms of overall and cosmetic satisfaction, most patients reported that they were satisfied or very satisfied at all evaluations, and the proportion of very satisfied patients increased over time (p < 0.001). The harvested thigh's functional scores were 91% (p = 0.003) and 94% (p = 0.008) of the healthy thigh's score at 6 and 18 months, respectively. The complications reported were mild, and their proportions decreased in the first 18 months after surgery (p = 0.04). CONCLUSIONS The minimally invasive fascia lata harvesting technique for arthroscopic superior capsular reconstruction leads to donor site satisfactory subjective results and good functional outcomes at 18 months after surgery. According to these findings, donor site morbidity is not a valid argument against the use of this autograft for arthroscopic superior capsular reconstruction. LEVEL OF EVIDENCE Case series, level IV.
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Matuszewski Ł, Tramś M, Ciszewski A, Wilczyński M, Tramś E, Jakubowski P, Matuszewska A, John K. Medial patellofemoral ligament reconstruction in children: A comparative randomized short-term study of fascia lata allograft and gracilis tendon autograft reconstruction. Medicine (Baltimore) 2018; 97:e13605. [PMID: 30558034 PMCID: PMC6319993 DOI: 10.1097/md.0000000000013605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many surgical procedures have been described to treat recurrent patellar dislocation, but none of these techniques has been successful in all patients. The goal of the study was to evaluate the results of medial patellofemoral ligament reconstruction in children. Two operative procedures were evaluated; a fascia lata allograft and an autologous gracilis graft. METHODS Forty-four children (27 girls and 17 boys) between 13 and 17 years of age with unilateral recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction. Patients were operated in two orthopedic centers. The 1st group contained 22 patients and surgery was performed using a fascia lata allograft. In the 2nd group of patients which also contained 22 children and autologous gracilis graft was used. The mean age of the patients was 14.9 years and the mean follow-up was 24 months. Preoperatively, all patients were evaluated clinically (Kujala score questionnaire) and radiologically. The same evaluation was used 18 to 30 months postoperatively to estimate the results of our treatment. RESULTS In 1st group of children operated with cadaver allografts, the Kujala score significantly improved from 73.91 points preoperatively to 94.50 points postoperatively (P < .001). The average duration of operating procedure was 1 hour and 35 minutes. As shown by subjective symptoms, the results in 95% of patients were rated as good or very good. All children returned to full activity. Similar results were obtained in patients in 2nd group, where MPFL was reconstructed with ipsilateral gracilis tendon. Kujala score increased from 70.77 points preoperatively to 94.32 postoperatively (P < .001). Our results were estimated as good or very good in 93% of patients. All patients that were operated returned to full activity. However, median duration of operation was longer and lasted 1 hour and 55 minutes. CONCLUSIONS Both techniques were effective in the short-term (18-30 months) in treatment of recurrent patellar dislocation. The use of cadaver allograft spares the hamstring muscles and reduces the time of surgery. Therefore, such study appears to be useful because it provides valuable information that would help to guide treatment of this condition in children. Level of evidence II-2.
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Affiliation(s)
- Łukasz Matuszewski
- Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin
| | | | - Andrzej Ciszewski
- Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin
| | - Michał Wilczyński
- Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin
| | - Ewa Tramś
- The Center of Sports Medicin Warsaw, Warsaw
| | - Paweł Jakubowski
- Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin
| | - Anna Matuszewska
- Biochemistry Department Maria Curie-Skłodowska University, Lublin, Poland
| | - Kishore John
- Pediatric Orthopedics and Rehabilitation Clinic, Medical University of Lublin
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Azevedo C, Ângelo AC. Arthroscopic Superior Capsular Reconstruction or Reverse Total Shoulder Arthroplasty for Irreparable Bilateral Rotator Cuff Tear: A Case Report. JBJS Case Connect 2018; 8:e96. [PMID: 30489380 DOI: 10.2106/jbjs.cc.18.00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE An active elderly patient with bilateral chronic rotator cuff tear underwent a reverse total shoulder arthroplasty (RTSA) on the right shoulder and an arthroscopic superior capsular reconstruction (ASCR) with a fascia lata autograft on the left shoulder. To our knowledge, this is the first reported case that compares these 2 techniques for irreparable rotator cuff tears in the same patient. CONCLUSION The patient had very good midterm (2 and 8 years of follow-up) functional outcomes with both treatment options. However, the ASCR was found to have superior clinical outcome measures, and it is a valid alternative to RTSA for irreparable rotator cuff tears in the appropriate setting.
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Affiliation(s)
- Clara Azevedo
- Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Hospital dos SAMS, Lisbon, Portugal
| | - Ana Catarina Ângelo
- Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Hospital dos SAMS, Lisbon, Portugal
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Milks RA, Kolmodin JD, Ricchetti ET, Iannotti JP, Derwin KA. Augmentation with a reinforced acellular fascia lata strip graft limits cyclic gapping of supraspinatus repairs in a human cadaveric model. J Shoulder Elbow Surg 2018; 27:1105-1111. [PMID: 29398399 DOI: 10.1016/j.jse.2017.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A reinforced biologic strip graft was designed to mechanically augment the repair of rotator cuff tears that are fully reparable by arthroscopic techniques yet have a likelihood of failure. This study assessed the extent to which augmentation of human supraspinatus repairs with a reinforced fascia strip can reduce gap formation during in vitro cyclic loading. METHODS The supraspinatus tendon was sharply released from the proximal humerus and repaired back to its insertion with anchors in 9 matched pairs of human cadaveric shoulders. One repair from each pair was also augmented with a reinforced fascia strip. All repairs were subjected to cyclic mechanical loading of 5 to 180 N for 1000 cycles. RESULTS All augmented and nonaugmented repair constructs completed 1000 cycles of loading. Augmentation with a reinforced fascia strip graft significantly decreased the amount of gap formation compared with nonaugmented repairs. The average gap formation of augmented repairs was 1.5 ± 0.7 mm after the first cycle vs. 3.0 ± 1.2 mm for nonaugmented repairs (P = .003) and 5.0 ± 1.5 mm after 1000 cycles of loading, which averaged 24% ± 21% less than the gap formation of nonaugmented repairs (7.0 ± 2.8 mm, P = .014). CONCLUSION Cadaveric human supraspinatus repairs augmented with a reinforced fascia strip have significantly less initial stroke elongation and gap formation than repairs without augmentation. Augmentation limited gap formation to the greatest extent early in the testing protocol. Human studies are necessary to confirm the appropriate indications and effectiveness of augmentation scaffolds for rotator cuff repair healing in the clinical setting.
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Affiliation(s)
- Ryan A Milks
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joel D Kolmodin
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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Martin HD. Editorial Commentary: Hip Labral Revision Reconstruction in a Fellowship Training Center: A Report From the Mountains. Arthroscopy 2018; 34:1251-1252. [PMID: 29622259 DOI: 10.1016/j.arthro.2018.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
Hip labral reconstruction has proven to be a successful technique in restoring normal labrum function. However, sometimes revision surgery is required. A recent, well-designed prospective study provides significant support for revision labral reconstruction, showing how it leads to improved hip mechanics and reduction in pain. The success of the study design and this report is a testament to an educational institution dedicated to fellowship training.
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Batailler C, Lustig S, Reynaud O, Neyret P, Servien E. Complications and revision surgeries in two extra-articular tenodesis techniques associated to anterior cruciate ligament reconstruction. A case-control study. Orthop Traumatol Surg Res 2018; 104:197-201. [PMID: 29292120 DOI: 10.1016/j.otsr.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/23/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous techniques of anterior cruciate ligament (ACL) reconstruction associated to extra-articular tenodesis (EAT) have been described, but there have been few comparative studies, especially in terms of complications and revision procedures. The present study sought to compare two ACL reconstruction techniques using the patellar tendon (KJ): associating EAT by fascia lata (KJL2) or by gracilis (KJG). The study hypothesis was that the KJL2 technique incurs no extra risk of complications or surgical revision compared to the KJG technique. METHOD A prospective case-control study compared 41 patients undergoing KJL2 and 41 controls undergoing KJG. Complications, reconstruction failure and revision procedures were assessed at a mean 13 months follow-up (range, 6-20 months). RESULTS The KJL2 group showed no extra risk of postoperative complications or reconstruction failure compared to the KJG group: 1 versus 2 re-tears, respectively, not requiring revision. Revision surgery was significantly more frequent in the KJG group (31.7% vs. 7.3%), notably for arthrolysis and meniscectomy. DISCUSSION The KJL2 technique is reliable, without greater risk of complications or early revision surgery than the KJG technique. LEVEL OF EVIDENCE III - Case-control study.
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Affiliation(s)
- C Batailler
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France.
| | - S Lustig
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - O Reynaud
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - P Neyret
- Centre Albert-Trillat, 69004 Lyon, France
| | - E Servien
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
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Oh JH, Kim ST, Jung JH, Han JH, Choi JY, Kang IG. Height Changes of Tutoplast-Processed Fascia Lata Over Time After Dorsal Augmentation During Rhinoplasty. J Oral Maxillofac Surg 2018; 76:1998.e1-1998.e6. [PMID: 29654779 DOI: 10.1016/j.joms.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Tutoplast (Tutogen Medical, Neunkirchen am Brand, Germany)-processed fascia lata (TPFL) has been used for dorsal augmentation in rhinoplasty in the Republic of Korea for approximately 10 years, but few studies have described changes in TPFL in terms of dorsal height over time. We investigated changes in dorsal height after TPFL use as a dorsal implant material during rhinoplasty. MATERIALS AND METHODS The records of 18 rhinoplasty patients who had undergone dorsal augmentation with TPFL were examined retrospectively. The patients had undergone rhinoplasty from March 2008 to June 2012. Two different ear, nose, and throat doctors analyzed the first follow-up photographs (2 lateral views and 2 oblique views) taken at approximately 1 month postoperatively and the last follow-up photographs taken from 18 to 75 months after surgery. The last follow-up photographs were classified as showing no nasal dorsal height change, slight change, and marked change compared with the first follow-up photographs. RESULTS Of the 18 patients enrolled, 50% (n = 9) showed no change in the nasal dorsum whereas 33% (n = 6) showed mild depression and 17% (n = 3) showed marked depression of the nasal dorsum at last follow-up. CONCLUSIONS About half of the patients who had undergone dorsal augmentation using TPFL during rhinoplasty showed mild or marked dorsal depression over time. It is recommended that TPFL be used with another implant during augmentation rhinoplasty or TPFL be used only for a slightly depressed nose. In addition, patients should be informed that TPFL could be resorbed over time.
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Affiliation(s)
- Jae Hwan Oh
- Resident, Department of Otolaryngology-Head & Neck Surgery, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Seon Tae Kim
- Professor, Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Joo Hyun Jung
- Associated Professor, Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Ji Hye Han
- Resident, Department of Otolaryngology-Head & Neck Surgery, Chosun University College of Medicine, Kwangju, Republic of Korea
| | - Ji Yun Choi
- Associated Professor, Department of Otolaryngology-Head & Neck Surgery, Chosun University College of Medicine, Kwangju, Republic of Korea
| | - Il Gyu Kang
- Professor, Department of Otolaryngology-Head & Neck Surgery, Medical Faculty, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
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Lin CZ, Xia X, Wang H, Liu DX. Surgical reconstruction of the fascia lata and posterior tibial artery perforator flap to treat children with simultaneous injury to the Achilles tendon and heel skin. Medicine (Baltimore) 2018; 97:e9834. [PMID: 29419689 PMCID: PMC5944661 DOI: 10.1097/md.0000000000009834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/29/2017] [Accepted: 01/19/2018] [Indexed: 02/05/2023] Open
Abstract
Children with simultaneous injury to the Achilles tendon and heel skin remain a challenge for clinicians. The purpose of this study is to evaluate a combined surgical procedure involving use of the fascia lata to reconstruct the Achilles tendon, and the posterior tibial artery perforator flap to cover the accompanying heel skin injury.Between February 2010 and February 2013, 8 children (3 females and 5 males) between 3 and 12 years of age, with a median age of 7.5 years, were hospitalized in the First Affiliated Hospital of Shantou University Medical College. All injuries involved damage to an Achilles tendon and heel skin. In all patients, the fascia lata was transplanted to reconstruct the Achilles tendon and the posterior tibial artery perforator flap transplanted to cover the skin injury.Hospitalization was 11 to 15 days (mean 13.5 days). Local necrosis (15% of the area) occurred in 1 flap, but healed after changing dressing. All other flaps survived well. At follow-up after 1 to 2 years, all children had recovered good plantar-flexion and supported their weight while walking. Use of the Arner-Lindholm standard to rate clinical efficacy revealed that of the 8 cases, 6 cases showed excellent recovery and 2 were good, with 0 cases ranking moderate or poor. The excellent and good rate was 100%.Child patients with Achilles tendon injury accompanied by heel skin injury are still a challenge for clinicians. Use of the fascia lata, combined with a posterior tibial artery perforator flap, to reconstruct the Achilles tendon and heel skin for children is a feasible, safe, effective method, faster than other methods for recovery, and should be widely applied in the clinic.
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Affiliation(s)
- Chu-Zhao Lin
- Shantou University Medical School Postgraduate Student, Shantou University Medical College
| | - Xue Xia
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Dong-Xin Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, McGarry MH, Itami Y, Limpisvasti O, Neo M, Lee TQ. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg 2017; 26:2158-2166. [PMID: 29146012 DOI: 10.1016/j.jse.2017.07.019] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported. METHODS Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing. Rotational range of motion, superior translation, glenohumeral joint force, and subacromial contact were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Graft dimensions before and after testing were also recorded. Biomechanical parameters were compared using a repeated-measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t-test (P < .05). RESULTS Irreparable supraspinatus tear significantly increased superior translation, superior glenohumeral joint force, and subacromial contact pressure, which were completely restored with the SCR FL allografts. Both SCR HD allograft repairs partially restored superior translation and completely restored subacromial contact and superior glenohumeral joint force. The HD allografts significantly elongated by 15% during testing, whereas the FL allograft lengths were unchanged. CONCLUSIONS Single-layered HD SCR allografts partially restored superior glenohumeral stability, whereas FL allograft SCR completely restored the superior glenohumeral stability. This may be due to the greater flexibility of the HD allograft, and the SCR procedure used was developed on the basis of FL grafts.
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Affiliation(s)
- Teruhisa Mihata
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Christopher N H Bui
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Masaki Akeda
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | | | - Michael Kuenzler
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Alexander B Peterson
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.
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Lorbach O, Haupert A, Efe T, Pizanis A, Weyers I, Kohn D, Kieb M. Biomechanical evaluation of MPFL reconstructions: differences in dynamic contact pressure between gracilis and fascia lata graft. Knee Surg Sports Traumatol Arthrosc 2017; 25:2502-2510. [PMID: 26820966 DOI: 10.1007/s00167-016-4005-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the knee kinematics of the intact, MPFL-ruptured and MPFL-reconstructed knee and, moreover, to compare dynamic patellofemoral contact pressure of the gracilis tendon and the fascia lata as an alternative graft option for reconstruction of the MPFL. METHODS Eight paired human cadaveric knees were fixed in a custom-made fixation device. Patellofemoral contact pressure was assessed during a dynamic flexion movement at 15°-30°-45°-60°-75° and 90° using a pressure-sensitive film (Tekscan). The medial patellofemoral ligament was cut, and measurements were repeated. Finally, reconstruction of the MPFL was performed using the gracilis tendon (group I) or a fascia lata graft (group II). Tunnel localization was performed under fluoroscopic control. Grafts were fixed at 30° of flexion, and pressure measurements were repeated. RESULTS Incision of the medial patellofemoral ligament significantly reduced patellofemoral contact pressure at 15°, 30° and 45° of knee flexion compared to the intact knee (p < 0.05), whereas reconstruction of the MPFL using either gracilis tendon of the fascia lata was able to restore pressure distributions at 15° and 30° of knee flexion. However, in the hamstring group, reconstruction of the MPFL revealed a significantly reduced contact pressure at 45° of flexion (p = 0.038) compared to the intact knee. In the fascia lata group, a significant reduction in patellofemoral contact pressure was observed after MPFL reconstruction at 45°, 60°, 75° and 90° of knee flexion (p < 0.05). CONCLUSIONS Anatomic reconstruction of the MPFL with either a gracilis or a fascia lata graft showed comparable patellofemoral pressure distributions which were closely restored compared to the native knee. Therefore, the fascia lata has shown to be a viable alternative to the gracilis tendon for reconstruction of the MPFL. However, anatomic reconstruction of the MPFL may lead to persistently altered patellofemoral contact pressure during knee flexion compared to the native knee independent of the tested graft.
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Affiliation(s)
- Olaf Lorbach
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany.
| | - Alexander Haupert
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Turgay Efe
- Department of Orthopaedic Surgery, Marburg University, Marburg, Germany
| | - Antonius Pizanis
- Department of Trauma-Hand and Reconstructive Surgery, Saarland University, Homburg (Saar), Germany
| | - Imke Weyers
- Institute of Anatomy, Lübeck University, Lübeck, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany
| | - Matthias Kieb
- Department of Orthopaedic and Trauma Surgery, Klinikum Ernst von Bergmann, Potsdam/Bad Belzig, Germany
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Bednarz W, Żurek J, Gedrange T, Dominiak M. A Preliminary Clinical Comparison of the Use of Fascia Lata Allograft and Autogenous Connective Tissue Graft in Multiple Gingival Recession Coverage Based on the Tunnel Technique. ADV CLIN EXP MED 2016; 25:587-98. [PMID: 27629749 DOI: 10.17219/acem/44849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/18/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The most effective method for treating gingival recessions (GR) is with an autogenous connective tissue graft (CTG) via flap surgery. Often, however, the amount of CTG that can be grafted is insufficient to cover all of a patient's gingival recessions at one time. OBJECTIVES The objective of this study was to provide a 6-month comparative assessment of the results of covering multiple Miller Class I and II gingival recessions with a Fascia Lata Allograft (FL) and a CTG harvested from palatal mucosa. MATERIAL AND METHODS The study comprised a total of 30 people who underwent multiple gingival recession (GR) procedures using a modified, coronally advanced tunnel technique (MCAT). The patients were divided into two groups of 15 according to the type of materials used for gingival augmentation purposes: FL for the test group and CTG for the control group. A clinical assessment was made at baseline, as well as 3 and 6 months following surgery. The following factors were assessed: recession depth, recession width, probing depth, clinical attachment level, height of keratinized tissue (HKT), distance between the cemento-enamel junction and the muco-gingival junction (CEJ-MGJ), API, SBI. The following values were calculated: average root coverage (ARC), complete root coverage (CRC). RESULTS No statistically significant differences were observed between the groups in terms of clinical parameters assessed after 6 months, apart from CRC, which was 94.87 ± 0.14 mm in the control group and 94.24 ± 0.20 mm in the study group (p = 0.034). The average HKT in the control group after 6 months amounted to 2.86 ± 1.60 mm, and in the test group to 3.09 ± 0.95 mm, which translates into an increase in comparison to the baseline values of 0.73 mm (p < 0.001) and 0.48 mm (p = 0.017), respectively. CONCLUSION FL Allografts may serve as an alternative to autogenous CTG in multiple gingival recession coverage procedures based on the tunnel technique.
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Affiliation(s)
- Wojciech Bednarz
- Specialistic Outpatient Medical Clinic MEDIDENT, Gorlice, Poland
| | - Jacek Żurek
- Specialist Medical Practice, Tarnowskie Góry, Poland
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Veličkov AV, Kovačević P, Veličkov AI. Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection. SRP ARK CELOK LEK 2016; 144:288-292. [PMID: 29648746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Enlarged inguinal lymph nodes very often present a site of metastatic disease. Inguinal lymph node block dissection is a demanding procedure, which usually requires at least one of reconstructive modalities. Among different reconstruction options we selected the tensor fascia lata (TFL) musculocutaneous flap. OBJECTIVE The paper aims at presenting a series of inguinal block dissections, followed by immediate reconstruction, using the TFL flap, and evaluation of tumor type, flap dimension, complication rate and the duration of hospital stay. METHODS We present a consecutive case series of 25 conducted block dissections. The defects were reconstructed using TFL flap, because of the extent and site of the tissue defects, reliability of the flap, and potentially primarily infected exulcerated tumors. RESULTS The reconstruction was successful in all cases, the incidence of surgical complications was 16%, no further complications, such as lymphedema or gait disturbances, were noted. Primary skin tumors were predominant (13 cases), followed by genitalia tumors (four cases). The male sex was more frequently affected (14 vs. 11 cases). CONCLUSION Having in mind that TFL presents as a flap of adjustable size, length, shape, and volume, with negligible donor site morbidity, and after comparing of our results to those of other authors, we advise broader use of TFL flap. As a reliable flap, not too difficult to harvest, with a low complication rate, it must be taken into consideration regarding the benefits for the patient, and, on the other hand, the surgery cost and duration.
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Forster AO, Jones J, Davis J, Weber B, Hawkshaw M, Sataloff RT. Efficacy of allograft fascia lata in tympanic membrane repair. EAR, NOSE & THROAT JOURNAL 2016; 95:158-164. [PMID: 27140015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
We conducted a retrospective study to determine the efficacy of allograft fascia lata in both primary and revision tympanic membrane surgery (myringoplasty). Our patient population included 64 patients-31 men and 33 women, aged 19 to 98 years (mean: 49.5)-who had undergone tympanic membrane surgery with allograft fascia lata. Patients were grouped according to whether they had undergone primary surgery (n = 47) or revision surgery (n = 17). Data were compiled at preoperative and immediate postoperative visits, as well as at 3, 6, 9, and 12 months postoperatively. Residual perforations were defined as those present for less than 6 weeks postoperatively, and recurrent perforations were defined as those that occurred more than 6 weeks postoperatively. A residual perforation was found in only 1 patient (1.6%), a primary surgery patient. Recurrent perforations were found in 8 of the 64 patients (12.5%), including 5 in the primary group (10.6%) and 3 in the revision group (17.6%). We conclude that allograft fascia lata is a comparable alternative to other graft materials for performing myringoplasty.
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Affiliation(s)
- Ashley O'Connell Forster
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Milton S. Hershey Medical Center, Hershey, PA, USA
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Abstract
Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.
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Affiliation(s)
- Uwais B Zaid
- Department of Urology, UCSF School of Medicine, 400 Parnassus Ave, UC Clinics, San Francisco, CA, 94143, USA,
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Abstract
Since the start of the era of exclusive use of valve replacement in 1960, the only valve that has received continuous use [since 1962] has been the aortic homograft. Results with this valve indicate about a 60- to 70-percent 10-year survival rate. The next most continuously used designs have been the Smeloff-Cutter and the 1200-1260 series Starr-Edwards ball valves. Both of these valves have survival rates after 8 years of about 70%, and are, therefore, comparable to the homografts. More recently started series of homografts valves, tissue valves and prosthetic valves of various types appear to confer a better chance of 10-year survival than older valves in older series. Not all the improvements in survival rates can be ascribed to changes in valve design. Better selection of patients, improved intraoperative myocardial protection and better postoperative care all contribute to what appears to be progressive improvement in surgical results.
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Abstract
Neuroendoscopic endonasal approach has gained popularity in managing traumatic, spontaneous, and especially iatrogenic cerebrospinal fluid (CSF) rhinorrhea. The authors examined 8 patients presenting with CSF rhinorrhea between December 2012 and June 2014: 5 patients had iatrogenic leak, 2 patients had traumatic leak, and 1 patient had a spontaneous onset of CSF rhinorrhea. Sites of the CSF leaks were detected through computed tomographic cisternography and magnetic resonance imaging in the patients with traumatic and spontaneous leaks. All patients received neuroendoscopic endonasal surgery for the CSF leak. The largest defect was 22 mm in maximum diameter. Endoscopic supraciliary "keyhole" approach was performed in 1 patient after confirmation of a frontal sinus leak using the endoscopic endonasal approach. The success rate was 100% in the first attempt. Follow-up period ranged from 3 to 24 months, and no recurrence was reported. Identifying the leak site and choosing the appropriate surgical technique remain the most important factor in surgical success.
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Affiliation(s)
- Wen-Jian Zheng
- From the *Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen; and †Shantou University Medical College, Shantou, China
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Kemaloğlu CA, Tekin Y. A comparison of diced cartilage grafts wrapped in perichondrium versus fascia. Aesthetic Plast Surg 2014; 38:1164-8. [PMID: 25303880 DOI: 10.1007/s00266-014-0403-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/22/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Cartilage grafts are the most commonly used grafts for structural and aesthetic purposes. This study aimed to compare the viability of diced cartilage grafts wrapped in fascia with diced cartilage grafts wrapped in perichondrium. Approximately 2 × 2 cm cartilage grafts were harvested from the ears of seven New Zealand rabbits, diced to approximately 1-mm cubes, and then wrapped in perichondrium harvested from the ears or muscle fascia harvested from the right rear leg of the same rabbits. The wrapped grafts were then weighed and implanted into two paravertebral subcutaneous cavities created on the shaved backs of the donor rabbits. After 3 months, the rabbits were sacrificed and the grafts were removed, weighed and examined histopathologically. We found no statistically significant difference in the weights of the two graft types before and after embedding. The mean chondrocyte viability was 87.14 % in the perichondrium-wrapped cartilage grafts and 41.43 % in the fascia-wrapped grafts, which was determined to be statistically significant. Overall, our findings show that cartilage grafts wrapped in perichondrium led to higher chondrocyte viability and graft survival rates as compared with grafts wrapped in fascia. This method may be used as an alternative in clinical practice to provide patients requiring cartilage grafts with positive long-term effects, lower morbidity and lower costs associated with the procedure. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Cemal Alper Kemaloğlu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Erciyes University, Erciyes Üniversitesi Tıp fakültesi Talas, Kayseri, Turkey,
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