Distal Injury Research Articles

The Rule of Fours-Clinical and Radiographic Parameters for Trans-articular Distal Interphalangeal Joint Kirschner Wire Insertion.

Distal phalangeal and interphalangeal joint injuries are common, and confer a significant burden to the individual, healthcare system and society. Operative intervention (when required) may involve retrograde trans-articular Kirschner wire (K-wire) fixation. Safe wire passage through the center of the distal interphalangeal joint (DIPJ) and associated phalanges is key in maintaining alignment and reducing complications. There is little evidence to guide optimal wire entry point and passage. The aim of this study was to determine soft tissue and radiographic landmarks to guide optimal trans-articular k-wire placement at the DIPJ. A retrospective cohort study was conducted at a single institute, with 100 uninjured lateral phalangeal radiographs with a clear sagittal projection assessed by 3 independent assessors. Each assessor drew a line of ideal insertion, traversing the isthmus of the middle and distal phalanges, and the midline of the DIPJ, with soft tissue and bony parameters identified. The mean distance from the dorsal aspect of the nail plate to the line of ideal insertion was 3.86 mm, with a disparity between sexes noted. The distance from the dorsum of the soft tissue to the line of ideal insertion was expressed as a proportion of the total soft tissue diameter-the line of ideal insertion traversed approximately 40% of total width at the DIPJ and DIPJ soft tissue crease. The results suggest that a simple 'rule of fours' can be utilized to allow expedient and optimal passage. The entry point should be midline in the coronal plane, approximately 4 mm volar to the dorsal surface of the nail plate and aimed at a point 40% volar to the dorsal aspect of the soft tissue envelope at the level of the DIPJ crease. These guidelines are easily replicable and conveyable; additionally, they can guide insertion in the absence of fluoroscopy.

Isolated Distal Tibiofibular Syndesmotic Injury: A Case Series and Proposed Mechanism

Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present.

Which risk factors are involved in a distal biceps tendon injury? A systematic review.

Distal biceps tendon rupture is a rare injury predominately occurring in middle-aged men. This study aimed to collect relevant risk factors associated with distal biceps tendon rupture from the published literature. This systematic review aimed to collect and tabulate the risk factors for distal biceps tendon rupture. Studies published in English were searched concerning risk factors for distal biceps tendon ruptures until July 2022; cohort studies, case series and randomized controlled trials were subjected to analysis. Case studies, cadaveric studies and reviews in any form were excluded. The studies were quantitatively and qualitatively reviewed. One hundred twenty-one articles presenting risk factors for distal biceps tendon ruptures were identified, recruiting a total of 7,484-7,576 patients. The average age of the individuals was 46.8 years, with 96.7% being males and 94.7% having affinity for sports activities. In 56.7% of the cases, the dominant arm was involved, and in 54.6%, the right arm was affected. The use of tobacco was found in 20.8% of cases and of anabolic steroids in 2.5% of cases. On average, 55.8% of distal biceps tendon rupture patients had a physical occupation and the most common mechanism of the injury was related to heavy weight lifting observed in 53.2% of subjects. The most common and outstanding reported risk factors for distal biceps tendon ruptures were age, sex and sports activity, i.e., middle-aged males being still physically active and practicing sports. Steroid usage does not seem to increase significantly the risk of the distal biceps tendon rupture.

Training in the Use of Myoelectric Prostheses Through the Combined Application of Immersive Virtual Reality, Cross-education, and Mirror Therapy

ABSTRACT Introduction During the rehabilitation process (RHB) of the patient with traumatic upper-limb amputation, the use of immersive virtual reality (IVR) facilitates the incorporation of the prosthesis into the body schema. This reinforces and enhances sensorimotor and cognitive stimulation to improve motor learning and motor patterns, while normalizing global gestures. Objectives The aims of this study were to implement retraining of gestural acquisition and prosthetic control in patients with upper-limb injuries and amputations through IVR, and to then incorporate this in the normalization of functional patterns in activities of daily living (ADLs) with the work of “cross-education” as well as the therapy of observation of actions—mirror therapy to enhance the joint effect of the approach with IVR. Methods Standard sessions were established for transradial and transhumeral trauma patients with upper-limb amputation and traumatic injuries within the rehabilitation treatment. During the sessions, games and virtual environment were used. The software ran in desktop mode using a “Leap Motion” or for immersive versions of 3D glasses (Oculus Rift S). Results The application of IVR in combination with conventional treatment obtained significant benefits for functionality. These included learning correct motor execution as well as motivational and emotional state with distal traumatic injuries and upper-limb amputations with or without myoelectric prosthesis, obtaining 5.6 on average on the GROC (global rating of change) scale. Conclusions Immersive virtual reality shows benefit for the normalization of motor learning of functional patterns in DLA and on the emotional, motivational level of the patient. Clinical Relevance The integrated combination of cross-education, mirror therapy, and immersive virtual reality may represent greater acquisition of motor patterns in the prosthetic training of patients with upper-limb amputation.

Magnetic resonance classification proposal for medial gastrocnemius muscle injuries.

Calf muscle injuries are common among athletes and occupational populations, with highly variable recovery times that are challenging to be predicted at the initial clinical evaluation. Specifically, in distal gastrocnemius muscle injuries, an ultrasound-based severity classification has shown to be useful for estimating the recovery time. According to the location of lesions and the recognition of some US signs, four types of injuries of the distal gastrocnemius muscle were described. Since magnetic resonance imaging (MRI) has proven to be useful in diagnosing and prognosticating muscle injuries by assessing the extent of affected connective tissue, a specific MRI protocol involving T1-weighted and fluid-sensitive static and dynamic acquisitions has been developed aimed to characterize the four types of injuries. We here describe the characteristics of this new MRI protocol and the interpretation of images, which will be useful to improve the recognition of acute and delayed distal gastrocnemius muscle injuries. The proposed classification includes: myoaponeurotic muscle injury without aponeurotic discontinuities (type 1), myoaponeurotic muscle injury with aponeurotic discontinuities (type 2), isolated free aponeurosis discontinuity (type 3), and a mixed myoaponeurotic-aponeurotic injury pattern (type 4). A comprehensive understanding of the MRI features associated with each injury type, in conjunction with multidisciplinary team collaboration, is essential for optimizing the athlete's recovery and return to play.

Hemodynamic analysis on the flow characteristics around abdominal aortic hemorrhage site

The hemodynamic characteristics of blood flow around the site of abdominal aortic hemorrhage can serve as a valuable indicator for identifying the location of hemorrhage. In this research, we conducted numerical simulations to analyze the flow fields in the patient-specific abdominal aorta with and without hemorrhage. We quantitatively compared differences in flow field patterns, blood loss, and branch vessel perfusion between hemorrhagic and non-hemorrhagic cases. Our numerical results demonstrate that there is a distinct hemodynamic characteristic observed around the hemorrhage site, characterized by continuous abnormal high-velocity (>0.7 m/s) and high-Rortex (>200) zone. Additionally, we evaluated the amount of blood loss and time to moderate shock for different cases of abdominal aortic hemorrhage, while statistically analyzing variations in branch vessel perfusion along the abdominal aorta. These findings provide quantitative estimations for blood loss, branch perfusion, and potential indicators to assess rescue time window as well as evaluate the extent of distal tissue damage and organ injury.

Long-term Outcomes of Complete Tears of the Distal Biceps Tendon: An Analysis of Surgical Management at a Median Follow-up of 14.7 Years.

Surgical repair of full thickness biceps tears has demonstrated adequate outcomes in short and mid-term studies. However, data on the long-term outcomes of full thickness distal biceps injuries and their treatment are currently lacking. The purpose of this study was to report on patient demographics, injury characteristics, and long-term outcomes for patients with full-thickness distal biceps tears. It was hypothesized that complete distal biceps tears managed operatively would demonstrate robust clinical success at long-term follow-up. Case series; Level of evidence, 4. Patients with magnetic resonance imaging-confirmed, complete distal biceps tendon rupture sustained between 1996 and 2016 were identified. Patients were cross-referenced with a regional geographic database. A total of 66 patients (3 female, 63 male) with a median age of 50.8 years (IQR, 41.5-60.4) and a median clinical follow-up of 14.7 years (IQR, 9.6-17.9 years) were included. Patients who sustained a full-thickness distal biceps tendon tear were likely to be in their early 50s, male, right-hand dominant, current/former smokers, and laborers with a history of traumatic injury during an intentional movement. Most of these patients had pain and supination weakness but no loss of range of motion. All included tears were treated operatively. At final follow-up, patients maintained a majority of near-normal range of motion (median total arc of flexion/extension 140° and supination/pronation 80°), excellent elbow flexion strength (91% of patients had full strength), and adequate elbow supination strength (76% of patients had full strength). The overall complication rate was 24%, with 16 out of 66 patients experiencing some type of complication between infection, rerupture, heterotopic ossification, reoperation, and nerve complications. Overall return to work was 98%, and 85% of those who returned to work did so without restrictions. Complete tears of the distal biceps were most common in patients 50 years of age, male sex, right-hand dominant, and current/former smokers. The most common profession was laborer, and injuries were primarily traumatic in nature during intentional activity. Patients managed operatively demonstrated high rates of success at long-term follow-up with respect to elbow function and clinical outcomes.

Physeal Growth Arrest after Traumatic Injury of Distal Tibial Physis A Systematic Review and Meta-Analysis

Abstract Background Injury to the physis of the distal tibia in children can lead to subsequent growth arrest. This can result in physeal bars, leg-length discrepancies and angular deformities. Aim of the Work Is to review & meta-analysis the distal tibia physeal injury, treatment & how to decrease complications e.g premature physeal closure (PPC), angular deformity & leg length discrepancy. Patients and Methods We considered randomized controlled trials, prospective or retrospective cohort studies and case–control studies that directly compared ORIF to closed treatment of distal tibia physeal fractures in children and reported the rate of PPC. PPC was defined on radiographs by the presence of a bony bar in the distal tibia physis of the injured limb. Participants were young patients below 18 years old who have distal tibial physis fractures treated by closed reduction & internal fixation (CRIF), open reduction & internal fixation (ORIF). Results this systematic review we found that the degree of initial displacement was significant risk factor for growth arrest after physeal fracture of the distal tibia. Therefore, physicians should consider the possibility of growth arrest in patients with severely displaced physeal fractures of the distal tibia. The displaced S-H II distal tibia physeal fractures have a high risk of periosteal entrapment. ORIF is an effective choice of treatment to obtain an anatomical reduction for patients with > 3 mm of initial displacement. However, PPC is a common complication following ORIF. The presence of associated fibula fracture plays an important role in the fracture outcome. Conclusion the degree of initial displacement was significant risk factor for growth arrest after physeal fracture of the distal tibia. Therefore, physicians should consider the possibility of growth arrest in patients with severely displaced physeal fractures of the distal tibia. The displaced S-H II distal tibia physeal fractures have a high risk of periosteal entrapment. ORIF is an effective choice of treatment to obtain an anatomical reduction for patients with > 3 mm of initial displacement. However, PPC is a common complication following ORIF. The presence of associated fibula fracture plays an important role in the fracture outcome.

Bilateral triceps rupture: a review of the literature and case series

Introduction Distal triceps tendon injuries are the least common of tendon injuries, comprising 1% all cases. This injury is more common in active men, between 30-50 years old. Risk factors include anabolic steroid use, local steroid injections and hyperparathyroidism. The principal mechanism of injury is an eccentric load applied to a contracting triceps. This injury is often misdiagnosed and thus far, bilateral injury has not been reported. Methods Retrospective description of two patients diagnosed with bilateral distal triceps injury with different presentations, treated surgically at a surgical center in the USA. Electronic records were reviewed for patient demographics, rehabilitation and clinical outcomes. Discussion The triceps tendon may be weakened by stem cell or corticoid injections or may cause tendinosis. Early diagnosis and surgical repair with a Krackow-type suture configuration in the triceps and parallel bone tunneling is a safe technique with a secure repair. Graded rehabilitation can offer patients good outcomes for range of motion and strength. Clinicians can explain that patients can expect to return to sport and activity. Conclusion Triceps tendon rupture is a rare, significant injury that requires a secure surgical repair with bone tunnelling. Our experience careful post-operative rehabilitation with gradual motion and strengthening is the key for successful recovery.

Clinical application of the free superficial palmar branch of radial artery flap for soft-tissue reconstruction of distal digital injury

PurposeThe purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury.Method13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6–12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap.ResultsAll the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases.ConclusionThe SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries.

How has acute syndesmotic injury management evolved over the last decade? Results from a national survey

The management of acute distal tibiofibular syndesmotic injuries has evolved over time and therefore, the aim of this study was to evaluate the use of different methods and the changes regarding management of distal tibiofibular syndesmotic injury among Dutch trauma- and orthopedic surgeons.A digital survey based on a previous survey conducted in 2012 was sent to (orthopedic) trauma surgeons from all different hospitals in the Netherlands.Sixty out of the 68 invited hospitals completed at least one survey (88.2 %). For Weber B or low Weber C fractures, there was a preference for the use of a single syndesmotic screw (SS)(73.6 %), while two screws were mainly used in Maisonneuve fractures (89.3 %). Furthermore, there was a clear preference for 3.5-mm screws, engaging three cortices, 2 to 4-cm above the tibiotalar joint. There is a significant decrease in routine removal of SSs (23.2 % compared to 87.0 % in 2012, p < 0.01). The percentage of hospitals in this survey that used the suture button (SB) was relatively low: 8.3 % for low fibular fractures and 5.0 % in high fibular fractures.In conclusion, the most striking difference compared to 2012 is the large decline in routine removal of the SS, which is in line with current literature. The SS is mainly implanted engaging three cortices, placed 2-4 cm above the tibiotalar joint and 3.5 mm in size and for the treatment of Maisonneuve fractures, two screws are preferred over a single SS. Level of evidenceLevel III

Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report

Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.

The 100 most cited articles in hand surgery from 2012–2022: a bibliometric analysis

Introduction: There has been an increase in the volume of scientific literature over the last decade in the field of hand surgery. The purpose of this bibliometric analysis was to ascertain the articles that have significantly contributed to advancements in hand surgery. Methods: The Web of Science database was used to produce a list of the 100 most cited articles from February 2012 to February 2022. The full text of all articles was carefully examined for further descriptive analysis not limited to subject matter, journal of publication, authorship, institution, country and year of publication. Results: The 100 most cited articles were cited on average 75 times. The most cited article was cited 179 times. Subject matter was not limited to pain management, distal radius fractures and tendon injuries. Source journals were spread across 36 journals, but six prominent journals published 60 per cent of articles. Conclusion: While the measurement of scientific merit is not solely based on bibliometric analysis, this study provides a good representation of substantial work in the last decade.

Circulating B Cell-Derived Small RNA Delivered by Extracellular Vesicles: A Dialogue Mechanism for Long-Range Targeted Renal Mitochondrial Injury in Obesity.

The intricate processes that govern the interactions between peripatetic immune cells and distal renal injury in obesity are not fully understood. Employing transcriptomic analysis of circulating extracellular vesicles (EVs), a marked amplification of small RNA (miR-3960) is discerned within CD3-CD19+ B cells. This RNA is found to be preferentially augmented in kidney tissues, contrasting with its subdued expression in other organs. By synthesizing dual-luciferase reporter assay with co-immunoprecipitation analysis, it is pinpointed that miR-3960 specifically targets the nuclear gene TRMT5, a pivotal actor in the methylation of mitochondrial tRNA. This liaison instigates aberrations in the post-transcriptional modifications of mitochondrial tRNA, engendering deficiencies within the electron respiratory chain, primarily attributable to the diminution of the mitochondrial bioenergetic compound (NDUFA7) complex I. Such perturbations lead to a compromised mitochondrial respiratory capacity in renal tubular cells, thereby exacerbating tubular injury. In contrast, EV blockade or miR-3960 depletion markedly alleviates renal tubular injury in obesity. This investigation unveils a hitherto unexplored pathway by which obesity-induced circulating immune cells remotely manipulate mitochondrial metabolism in target organs. The strategic targeting of obese EVs or infiltrative immune cells and their specifically secreted RNAs emerges as a promising therapeutic avenue to forestall obesity-related renal afflictions.

Ankle mechanics during jump landings across different foot positions in professional ballet dancers

ABSTRACT This study aimed to investigate the effect foot position on ankle joint mechanics and vertical ground reaction forces (vGRF) across jump landings in professional ballet dancers. Twenty-seven professional ballet dancers (men: 14; women: 13) attended one data collection session, completing five maximal countermovement jumps in parallel, first, second, fourth, and fifth positions. Three-dimensional ankle mechanics, landing vGRF variables, and jump height were recorded via a seven-camera motion capture system and one force platform. A repeated measures multivariate analysis of variance was used to assess the main effects foot position across all target variables. A linear discriminate analysis was conducted to investigate target variables across foot positions. Frontal and transverse plane ankle mechanics had the largest impact when discriminating between foot positions. Ankle power in the transverse plane during jump landing in fourth was double that of all other positions. Our findings suggest that ankle range of motion should be restored before returning to jumps in fourth and fifth positions following distal lower extremity injury. The multiplanar energy transfer observed indicates a need for specific exercises to develop multiplanar force and rate of force development of local structures around the ankle.

Activation of alveolar epithelial ER stress by β-coronavirus infection disrupts surfactant homeostasis in mice: implications for COVID-19 respiratory failure.

COVID-19 syndrome is characterized by acute lung injury, hypoxemic respiratory failure, and high mortality. Alveolar type 2 (AT2) cells are essential for gas exchange, repair, and regeneration of distal lung epithelium. We have shown that the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and other members of the β-coronavirus genus induce an endoplasmic reticulum (ER) stress response in vitro; however, the consequences for host AT2 cell function in vivo are less understood. To study this, two murine models of coronavirus infection were used-mouse hepatitis virus-1 (MHV-1) in A/J mice and a mouse-adapted SARS-CoV-2 strain. MHV-1-infected mice exhibited dose-dependent weight loss with histological evidence of distal lung injury accompanied by elevated bronchoalveolar lavage fluid (BALF) cell counts and total protein. AT2 cells showed evidence of both viral infection and increased BIP/GRP78 expression, consistent with activation of the unfolded protein response (UPR). The AT2 UPR included increased inositol-requiring enzyme 1α (IRE1α) signaling and a biphasic response in PKR-like ER kinase (PERK) signaling accompanied by marked reductions in AT2 and BALF surfactant protein (SP-B and SP-C) content, increases in surfactant surface tension, and emergence of a reprogrammed epithelial cell population (Krt8+ and Cldn4+). The loss of a homeostatic AT2 cell state was attenuated by treatment with the IRE1α inhibitor OPK-711. As a proof-of-concept, C57BL6 mice infected with mouse-adapted SARS-CoV-2 demonstrated similar lung injury and evidence of disrupted surfactant homeostasis. We conclude that lung injury from β-coronavirus infection results from an aberrant host response, activating multiple AT2 UPR stress pathways, altering surfactant metabolism/function, and changing AT2 cell state, offering a mechanistic link between SARS-CoV-2 infection, AT2 cell biology, and acute respiratory failure.NEW & NOTEWORTHY COVID-19 syndrome is characterized by hypoxemic respiratory failure and high mortality. In this report, we use two murine models to show that β-coronavirus infection produces acute lung injury, which results from an aberrant host response, activating multiple epithelial endoplasmic reticular stress pathways, disrupting pulmonary surfactant metabolism and function, and forcing emergence of an aberrant epithelial transition state. Our results offer a mechanistic link between SARS-CoV-2 infection, AT2 cell biology, and respiratory failure.

Total lower eyelid reconstructions with septal chondromucosal graft and pedicled flap on the superficial temporal artery

BackgroundSubtotal and total lower eyelid tissue loss after tumour excision is a complex issue for reconstructive surgeons. The anterior and posterior flaps must be restored to avoid compromising the functional and aesthetic prognosis of the eye. This study used a septal chondromucosal graft for the posterior lamella and a fasciocutaneous flap pedicled on the temporal artery for the anterior lamella. MethodWe conducted a 10-year monocentric retrospective study, including 18 patients who were treated using a septal chondromucosal graft with a temporal artery pedicle flap following tumour excision. We collected demographic and medico-surgical data related to flap survival, absence of ectropion, lagophthalmos and other post-operative complications. The aesthetic outcome was judged using a grading scale during the last follow-up consultation. ResultsAll grafts and flaps survived, whereas 2 patients required early repeat surgery (1 for ectropion and 1 for graft site haematoma). None of the patients developed lagophthalmos. Two patients had distal flap injuries that healed with local care. All patients were satisfied with the aesthetic outcome at the last follow-up visit. ConclusionCombining a septal chondromucosal graft with a fasciocutaneous flap pedicled to the temporal artery for total lower eyelid reconstruction is a reliable method with satisfactory functional and cosmetic outcomes.

Distal Abdominal Oblique Avulsion Injuries in Two Collegiate Hockey Players: A Case Report.

While injuries to the abdominal oblique muscles near their origin at the lower ribs are commonly seen in sports that require explosive trunk rotational movements such as baseball and tennis, there are few reports in the literature of avulsion injuries to these muscles from their distal attachments at the iliac crest. We present the case of two collegiate male hockey players who suffered such injuries as a result of a direct impact mechanism while rotated at the waist. These injuries should be suspected when patients have significant pain in the lower abdominal region worsened by flexion and rotation of the trunk and can be accurately characterized by musculoskeletal ultrasound or MRI. With a conservative rehabilitation program focused on core, hip adductor, and hip flexor strengthening, our athletes were able to return to game participation within 6 wk of the initial injury.

Exploring the success of fasciocutaneous flap techniques in treating distal leg injuries, a Sub-Saharan African experience from Sudan

BackgroundSoft tissue and bone injuries in the lower extremities associated with high-energy trauma remain a formidable challenge to treat. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage remain under discussion. MethodThis prospective, cohort, multi-center study was conducted in Khartoum, Sudan, from April 2021–September 2021. The study included 70 patients. Data was collected using a questionnaire filled with patients after getting informed consent. ResultsMales were 53(75.7 %) and females were 17(24.3 %). Male to female ratio was 3.1: 1. The mean age of the patients was 27.2 ± 3.4 years. The indications for the use of fascia-cutaneous flap in the management of traumatic soft tissue injuries of distal legs were distal substance loss areas of the leg 55(78.6 %), bone exposure 60(85.7 %), open fracture 29(41.4 %), and tendon exposure 31(44.3 %). The type of fasciocutaneous flap used for the patients in this study was perineal artery flap in 20(28.6 %), sural flap in 19(27.1 %), anterior tibial artery perforator flap in 18(25.7 %), and posterior tibial perforator flap in 13(18.6 %) of the patients in 42(60 %) of the patients, no complications were reported. The reported complications were infection 16(5.7 %), distal flap necrosis 8(11.4 %) and total loss 4(5.7 %). ConclusionDespite advances in microsurgery and free flap use, a fascia-cutaneous flap is still a valid option for distal leg soft tissue reconstruction in settings where this service is unavailable. fasciocutaneous flaps are an excellent option for distal leg defects to cover soft-tissue defects, exposed bones, and tendons.

Innovative approaches in equine wound management: Addressing challenges and their remedies

Horses are highly susceptible to musculoskeletal wounds due to the demands of their work, whether in transportation or as athletes. These wounds significantly impact the overall performance of horses, emphasizing the importance of effective wound management for optimal functionality. Among equine wounds, distal limb injuries are prevalent, accounting for over 60% of all cases. However, managing wounds in these extremities poses considerable challenges, as poor healing often leads to the formation of exuberant granulation tissue. In equine practice, biofilms are frequently observed in wounds with delayed healing, and there is an alarming rise in the incidence of multi-drug-resistant microbial strains. Consequently, there is an urgent need to implement advanced strategies in wound care management to address these clinical scenarios effectively. Maintaining the soundness of the musculoskeletal system is crucial for horses, particularly those destined for athletic careers. Thus, ongoing trials in equine clinical practice aim to explore innovative approaches for achieving effective wound healing. This article highlights the importance of innovative strategies in equine wound management and emphasizes the need to address challenges such as exuberant granulation tissue formation, biofilm presence, and multi-drug-resistant microbes. By implementing these innovative approaches, equine clinicians can enhance wound healing outcomes and ensure the optimal health and performance of horses.