Fascia Lata Research Articles

Electromyographic and behavioral analysis of horses submitted to medial patellar desmotomy.

The passive stay apparatus works by blocking flexion of the knee and tarsus joints in the horse, preventing muscle fatigue. During ambulation, if this mechanism fails to release, the animal will present upward fixation of the patella, which in severe cases, can only be treated by medial patellar desmotomy (MPD). The objective of this study was to investigate the possible electromyographic and behavioral changes, after the impairment of the passive stay apparatus, in horses who have undergone MPD surgery. Five horses presenting dorsal fixation of the patella underwent electromyographic measurements at preoperatively and immediately postoperatively, 24h, seven, 14 and 21 days after surgery. The samples were collected on a computerized surface electromyograph designed in accordance with the standards of international society of electrophysiology and kinesiology (ISEK). To capture the signals, electrodes positioned on the tensor fasciae lata, vastus lateralis, biceps femoris and semitendinosus muscles were used, bilaterally. These muscles were chosen due to their participation in the passive stay apparatus. The electromyographic signals were collected and processed using a software calibrated to collect data with a sampling frequency of 1000Hz per channel. The collections took place over 60min periods, and the results were obtained from the root means square (RMS) analysis. It was noted that the preoperative average of rest in tripedal support was 62%. On the other hand, change in weight bearing member and rest in three limbs in the postoperative period did not occur. This inability to maintain tripedal support in the postoperative period prevents the horse from resting while standing. Furthermore, there was a gradual increase in the need for post-surgical muscle recruitment, resulting in long periods of decubitus due to muscle fatigue, which is less than ideal for such large animals. Therefore, it was concluded that the animals submitted to medial patellar desmotomy, in this study, presented an inability to maintain tripedal support, in addition to a greater need for recruitment of muscle fibers, evidenced by the gradual increase in the electromyographic tracing and total RMS value of the muscles evaluated.

A novel lower eyelid reconstruction using a skin-tarsoligamentous sling to prevent postoperative drooping deformity: Quantitative analyses using drooping index and angular difference in canthal tilt

Lower eyelid reconstruction using skin flaps sometimes results in undesirable deformities due to postoperative flap drooping. We aimed to examine the effectiveness of a novel procedure for reconstructing the skin-tarsoligamentous sling of the lower eyelid. We included 37 patients who underwent anterior lamellar reconstruction with a cheek rotation flap for full-thickness lower eyelid defect. They were divided into two groups: Group A included 19 patients who underwent tarsoligamentous sling reconstruction with a fascia lata strip and buccal mucosa grafting, while Group B comprised 18 patients who underwent skin-tarsoligamentous sling reconstruction using an additional combination of a periosteal flap and de-epithelialized triangle flap at the lateral canthal region, representing our novel approach. To evaluate the severity of postoperative deformities, we used the drooping index, the ratio of drooping compared to the healthy side, along with the angular difference in canthal tilt, obtained between the reconstructed and healthy sides, using photographs taken ≥6 months post-reconstruction. Group B demonstrated superior outcomes, with mean drooping indices of 1.13 compared to 1.33 in Group A (P = 0.031) and mean angular differences in canthal tilt of -0.73° compared to -2.45° in Group A (P = 0.021). Patient satisfaction was significantly higher in Group B than in Group A (P = 0.042). Furthermore, patients with a drooping index of < 1.2 and an angular difference in canthal tilt ≥-1.0° exhibited higher satisfaction scores. Our novel approach to lower eyelid reconstruction using a skin-tarsoligamentous sling yielded improved aesthetic outcomes, fewer complications, and higher patient satisfaction.

Assessment of the advantages and limitations of an innovative silk fibroin scaffold for the reconstruction of the anterior cruciate ligament with preclinical in vitro and in vivo evaluations

The gold standard treatment in anterior cruciate ligament (ACL) reconstruction involves autologous tissue transplantation, but this can have complications. Artificial grafts are an alternative, but the best option is debated. This study aimed to assess the biocompatibility and integration of a silk fibroin textile prosthesis (SF-TP) with peri-implant bone tissue and the native ACL. Twenty-six sheep underwent ACL reconstruction with SF-TP or autologous femoral fascia lata (FFL). Sheep were divided into two groups (3 and 6 months) and retrieved joints processed for histological, morphometrical and mechanical analysis. In vitro, SF-TP showed no cytotoxicity and good cell interaction up to 14 days. Histology revealed fibro-vascular tissue around SF-TP, with a progressive attempt of ligamentous-like tissue formation at 6 months. However, SF-TP group had higher joint damage scores. Micro-CT showed tunnel enlargement in SF-TP group, while FFL group had a decrease. SF-TP reconstructions had lower stiffness and strength (44 % and 64 % decrease) than those of autologous FFL reconstruction and often failed by pull-out from the bone tunnel due to tunnel enlargement. These results indicate poor osteointegration and graft motion with SF-TP, leading to joint damage/bone resorption and reduced mechanical competence. These results do not support the use of SF-TP for ACL reconstruction.

Use of Fascia Lata as Matrix for Subpectoral Breast Reconstruction.

Matrices are used with increased frequency to assist with tissue expander or implant-based breast reconstruction. These devices usually have a high cost, especially when they are human-derived. We present the use of fascia lata for implant and expander-based subpectoral reconstruction. According to our review of the literature, this is the first report of the use of a patient's own fascia lata instead of a matrix.

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears Yields Good Clinical Outcomes for Patients With and Without Diabetes Mellitus

PurposeTo compare the clinical outcomes after superior capsule reconstruction (SCR) for irreparable rotator cuff tears (RCTs) in patients with and without diabetes mellitus (DM). MethodPatients who underwent SCR using fascia lata autograft for irreparable RCTs between 2012 and 2020 with a minimum 2-year follow-up were divided into non-DM and DM groups. Propensity score matching was used to select controls matched for patients’ characteristics. Only patients with HbA1c <8% were eligible. The Visual Analog Scale (VAS) for shoulder pain, American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association scores, and acromiohumeral distance were evaluated preoperatively and at 2 years postoperatively. Shoulder active range of motion (ROM) was evaluated preoperatively, at 6 months, 1 year, and 2 years postoperatively. Graft integrity and postoperative complications required additional surgery were evaluated. The Wilcoxon signed-rank test and Mann-Whitney U test were used to compare continuous variables. Pearson’s chi-squared test and Fisher’s exact test were used for categorical variables. The interaction between the postoperative period and ROM were analyzed by Friedman test and Wilcoxon rank sum test with Holm-Sidak post-hoc test. ResultsWe studied 154 patients (non-DM, 130; DM, 24) who underwent SCR. After matching, 21 patients were selected in each group. All clinical outcomes significantly improved at 2 years (all P<0.05) in both groups. We found no significant differences in clinical outcomes and rates of patients who achieved minimal clinically important differences of VAS and ASES scores between the groups (P=0.10-1.0). The rates of graft tear (both 9.5%) and complications (non-DM, 4.8%; DM, 0%) were not significantly different (both P=1.0). ConclusionSCR using fascia lata autograft for irreparable RCTs yields good clinical outcomes, including ROM, in patients with and without DM. No significant differences in postoperative outcomes were observed between the two groups. Level of EvidenceRetrospective cohort study, Level III.

"Muscle foreshortening after free gracilis transfer for smile: Where, when, why?"

Gracilis free muscle transfer (GFMT) remains the standard for smile restoration in patients with long-standing facial palsy. Resting oral commissure lateralization (ROCL) following GFMT is aesthetically unappealing and can cause functional problems including dysarthria and oral incompetence. The risk factors for ROCL following GFMT are poorly understood. Of all patients who underwent GFMT for smile restoration from 2003 - 2021, patients with subsequent ROCL were identified from a facial nerve database using pre-determined search criteria. Medical records were reviewed to identify potential risk factors for muscle foreshortening. Of 412 patients who underwent successful GFMT since 2003, we identified 41 (10%) patients who subsequently developed ROCL. ROCL rates varied significantly based on gracilis innervation source, with ipsilateral CN VII innervation and dual-innervation (cross-facial nerve graft (CFNG) plus ipsilateral nerve-to-masseter (NTM)) demonstrating the highest foreshortening rates (27.3% and 15.4%, respectively), compared to the lowest rates of foreshortening when gracilis was innervated by CNFG alone (3.2%), p=0.005. Patients with a history of radiation to the surgical field were significantly more likely to develop ROCL (22%) compared to those without a history of radiation (8.6%), p<0.001. Furthermore, the rate of ROCL was significantly higher among patients who underwent concurrent stabilization of the nasolabial fold using a wide band of fascia lata (20.8%) compared to those who did not (6.6%), p<0.001. Herein we report potential risk factors for ROCL following GFMT for smile restoration, including innervation source, radiation history, and concurrent fascia lata static suspension.

Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base

BackgroundLateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF. MethodsMedical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment. ResultsTen patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7). ConclusionUltrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years. Level of evidenceLevel IV

PRESERVATION OF THE LATERAL CIRCUMFLEX ARTERY IN DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY: EFFECT ON MUSCLE STATUS AND CLINICAL OUTCOMES

The direct anterior approach (DAA) is a popular minimally invasive approach for total hip arthroplasty (THA). It usually involves ligation of the lateral femoral circumflex artery's ascending branch (a-LFCA), which contributes to the perfusion of the tensor fasciae latae (TFL) muscle. Periarticular muscle status and clinical outcome were assessed after DAA-THA after a-LFCA preservation versus ligation.We evaluated surgical records of 161 patients undergoing DAA-THA with tentative preservation of the a-LFCA by the senior author between May and November 2021. Among 92 eligible patients, 33 (35 hips) featured successful preservation, of which 20 (22 hips, 13 female) participated in the study. From 59 patients with ligated a-LFCA, 26 (27 hips, 15 female) were enrolled, constituting the control group. MRI and clinical examinations were performed at 17–26 months to analyze volume and fatty infiltration of the TFL, gluteus medius and gluteus minimus muscles relative to the contralateral non-THA hip (15 preserved, 18 ligated). Clinical and radiographic data was retrospectively extracted from patient files. Patient-reported outcomes (PROMs) were added from the THA registry.There was a relative difference in TFL muscle volume of -6.27 cm3 (−9.89%, p=0.018) after a-LFCA preservation versus -8.6 cm3 (=11.62%, p=0.002) after ligation, without group differences (p&gt;0.340). a-LFCA preservation showed lower relative TFL fatty infiltration (p=0.10). Gluteal muscle status was similar between sides and groups. Coxa valga morphology was more frequent in a-LFCA preservation (83%) than ligation (17%). Clinical outcomes showed high patient satisfaction in both groups, without difference in PROMs, but less anterolateral soft-tissue swelling after a-LFCA preservation (p&lt;0.001).Despite excellent clinical results in both groups, preservation of the a-LFCA was associated with less TFL fatty infiltration and soft tissue swelling. Provided there is no compromise of intraoperative access we recommend a-LFCA preservation for DAA-THA.

Tensor fascia lata graft with fat graft used as a wrist watch sling for ectropion release in a complex facial scar

Tensor fascia lata graft with fat graft used as a wrist watch sling for ectropion release in a complex facial scar

HLA Awareness in tissue decellularization: A paradigm shift for enhanced biocompatibility, studied on the model of the human fascia lata graft

Last twenties, tissue engineering has rapidly advanced to address the shortage of organ donors. Decellularization techniques have been developed to mitigate immune rejection and alloresponse in transplantation. However, a clear definition of effective decellularization remains elusive. This study compares various decellularization protocols using the human fascia lata model. Morphological, structural and cytotoxicity/viability analyses indicated that all the five tested protocols were equivalent and met Crapo's criteria for successful decellularization. Interestingly, only the in vivo immunization test on rats revealed differences. Only one protocol exhibited Human Leucocyte Antigen (HLA) content below 1% residual threshold, the only criterion preventing rat immunization with an absence of rat anti-human IgG switch after one month (N=4 donors for each of the 7 groups, added by negative and positive controls, n=28). By respecting a refined set of criteria, i.e. lack of visible nuclear material, <50ng DNA/mg dry weight of extracellular matrix, and <1% residual HLA content, the potential for adverse host reactions can be drastically reduced. In conclusion, this study emphasizes the importance of considering not only nuclear components but also major histocompatibility complex in decellularization protocols and proposes new guidelines to promote safer clinical development and use of bioengineered scaffolds.

Resection of 4th-5th Metacarpal Synostosis and Fascial Interposition for Creation of a Functional Grip /Pinch in the Apert Hand.

The 4th-5th metacarpal synostosis, present in over 80% of Apert hands, flattens the metacarpal arch, restricts metacarpal descent, may prevent opposition of border rays, and combined with symphalangism, negates any functional flexion. Ironically, the fifth ray including the digit is the most intact finger within the hand. Restoration of both position and mobility with arthroplasty changes the cardinal plane of flexion and enables both pinch and grip in these compromised hands. This report summarizes the evolution of our technique over five decades. In a cohort of 184 Apert patients (368 hands) the presence, anatomy, and level of the metacarpal synostosis with a classification was determined. The present technique consists of incision along ulnar border of hand, wide excision of the skeletal coalition, release of dorsal structures, soft tissue interposition (with cadaveric fascia lata graft) with the fifth metacarpal flexed and supinated. During the past two decades the fascia was also wrapped around the fifth metacarpal in a subperiosteal plane. No fixation is needed. The arthroplasty was commonly combined with a thumb lengthening procedure, such as opening wedge osteotomy plus autogenous bone graft at 2-6 years or distraction lengthening and bone graft at 11-13 years old. Silicone blocks, silicone sheeting, and autogenous tendon were also used as interpositions early in our experience were not included. Data was generated over a 46 period and consisted of clinical and operative records, serial molds, serial X-rays, and OT records. Follow-up ranged from 3 to 44 years. 80% of the hands (N=147 patients) had bilateral 4-5th metacarpal synostoses, the extent of which correlated with the Apert hand classification3. In 72 patients (144 hands) the synostosis was resected and cadaveric fascia interposed. The 7 hands that had silicone blocks, silicone sheets, or tendon interposition were not included in the final results. Synostosis refusion occurred in 38 hands, all of which were performed early in the series and under the age of 6 years. Despite refusion, the position of the 5th digit was improved and the flat transverse arch tin a more curved or cupped posture. Eight of refused synostoses were re-released, usually in conjunction with thumb distraction lengthening. Distance between the opposing border rays was always improved and a new grip and pinch mechanism created. Aggressive ostectomy of synostosis and fascial interposition places the ulnar side of the hand in a much more functional position. In conjunction with thumb lengthening, opposition between the thumb and fifth finger becomes a clinical reality in Apert children who are born with diminutive thumbs and minimal interphalangeal joint motion.

Unusual branch of the saphenous nerve to the sartorius muscle in a female cadaver.

The saphenous nerve is a predominantly sensory nerve. It is the longest nerve of the body which supplies the skin of the medial side of the leg and foot as far as the ball of the great toe. We present here an unusual motor branch of the saphenous nerve to the sartorius muscle. Institutional guidelines for use of human cadaver were followed. Routine dissection of the lower limbs for undergraduate medical teaching was performed in a 67 years old female cadaver employing standard methods. Relevant gross features of the variations were photographed. H&E staining of relevant structure was done and photomicrographed. The unusual motor branch to Sartorius was observed in the right thigh. The branch was given off in the lower third of the thigh after the saphenous nerve exited the adductor canal. The branch was distinctly seen entering the substance of the sartorius. The structure was confirmed to be a peripheral nerve by histological examination. The saphenous nerve then descended between the sartorius and gracilis tendons, pierced the fascia lata and became cutaneous. The motor branch to the sartorius muscle is a very rare branch whose knowledge is important for clinicians as it can get damaged during arthroscopy and other knee surgery or during adductor canal block.

Thin Skin in Rhinoplasty: Considerations for Camouflaging Dorsal Nasal Irregularities.

Thin skin presents a challenge for achieving optimal aesthetic outcomes and minimizing complications. The review analyzes various materials and techniques employed to achieve this goal.A comprehensive electronic search was conducted across various medical databases, retrieved 965 studies, from which 15 studies were eligible for inclusion in this review with a total number of 679 patients with thin nasal skin.Techniques that promote graft integration, minimize resorption, and provide a smooth dorsal contour are crucial for thin-skinned patients. Diced cartilage with PRP, fascia lata grafts, and laser-assisted rhinoplasty appear to be particularly effective based on the available evidence. Platelet-rich fibrin (PRF) appears to play a role in some techniques by enhancing healing and tissue regeneration. Natural materials, like fascia lata and ligamentous grafts, offer potential benefits but require further exploration. Fat grafting techniques show promise but necessitate more research. This review provides a comprehensive overview of various techniques for addressing dorsal irregularities in rhinoplasty for patients with thin skin. Surgeons can utilize this information to select the most appropriate approach for achieving optimal aesthetic outcomes while minimizing complications.

Fascia Lata Allograft Medial Patellofemoral Ligament Reconstruction—Restore the Nature as Close as Possible

Various surgical techniques for medial patellofemoral ligament (MPFL) reconstruction have been described, commonly using hamstring auto- or allografts. Despite their widespread use, these techniques have limitations due to the tubular structure of the hamstring tendons, which does not match the flat, sail-like anatomy of the MPFL. Furthermore, over- or undertensioning of the graft due to tunnel misplacement remains a significant risk, even if anatomic and radiologic landmarks are used. To address these issues, a fascia lata allograft MPFL reconstruction with assessment of angular anisometry is presented. This technique allows for reconstruction of the MPFL as close as possible to its nature with a flat and wide patellar attachment and a gradual transition of maximal tension across the graft fibers, depending on the knee flexion angle. Precise intraoperative control of predefined graft angular anisometry allows for achievement of the desired amount of tension at specific flexion angles. This mitigates the risk of under- or overtensioning and subsequently ensures proper medial-lateral mobility of the patella.

Reliability of Goniometric Techniques for Measuring Hip Flexor Length Using the Modified Thomas Test.

The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Intra- and inter-rater reliability study. Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. 3.

Ability of Nicotinamide Riboside to Prevent Muscle Fatigue of Barrows Subjected to a Performance Test.

The objective of this study was to determine the daily dietary nicotinamide riboside (NR) dose required to maximize the delay of subjective muscle fatigue onset. Barrows (N = 100) were assigned to one of five treatments: a conventional swine finishing diet containing 0 (CON), 15 (15NR), 30 (30NR), 45 (45NR) mg·kg body weight-1·d-1 NR, or CON supplemented with 45 mg·kg body weight-1·d-1 NR by drench or cookie dough (DRE). All treatments were administered for the final 11 days of feeding. On supplementation d 10, barrows individually experienced a performance test at 1.09 m/s until they were subjectively exhausted. Wireless electromyography (EMG) sensors were affixed to the biceps femoris (BF), tensor fascia latae (TFL), and semitendinosus (ST) to measure real-time muscle activity. There were no treatment effects for barrow speed (p = 0.57), a tendency for a treatment effect (p = 0.07) for distance, and a treatment effect (p = 0.04) on time to exhaustion. Barrows of the 15NR and DRE treatments had greater (p = 0.05) distances to exhaustion than CON barrows but did not differ from other NR barrows (p > 0.11). Barrows in the 45NR treatment did not differ (p = 0.11) in distance from 30NR barrows but tended to have a greater (p = 0.07) distance compared to CON barrows. All other treatment comparisons did not differ (p > 0.27). Barrows in the DRE treatment moved for longer (p < 0.01) than CON barrows, but all other treatments did not differ from each other (p > 0.15). There was no treatment × period interaction for all muscles' root mean square (RMS) values (p > 0.16), but there were Period effects for all muscles (p < 0.01) and a Treatment effect (p = 0.04) in the TFL. For all muscles, period 4 had greater RMS values than all other periods (p < 0.01), who did not differ from each other (p > 0.29). In the TFL, CON barrows had greater RMS values during the performance test compared to all NR treatments (p < 0.02), who did not differ from each other (p > 0.18). Overall, NR demonstrates potential in being a useful tool in fatigue prevention, but efficient administration of the compound needs further investigation.

Ultrasound visualization of augmentation rhinoplasty using diced cartilage framework: A pictorial study

Diced cartilage (DC) plays an integral role in rhinoplasty, and its application is well established in nasal dorsal augmentation rhinoplasty as a diced cartilage framework (DCF). Fifteen patients requiring nasal dorsal augmentation were included. Two different types of DCF were applied: DC wrapped in fascia lata or Lyomesh® and DC embedded in platelet-rich fibrin (PRF). Postoperative ultrasound follow-ups were performed at intervals of one month, three months, and one year after surgery using a high-frequency linear ultrasound transducer. The aim was to depict the viability of the DCF in vivo. DCF was successfully depicted using ultrasound imaging in all 15 patients. Ultrasound rendered DC as hypoechoic and inhomogeneous areas. Perifocal hypoechoic edema was detected, which significantly decreased by the one-year follow-up. During the one-year postoperative period, very little DC had decreased in diameter and the framework was fully intact, with no signs of migration. On high-frequency ultrasound, DC wrapped in fascia lata or Lyomesh® appeared as a hypoechoic and inhomogeneous area clearly limited by a thin hyperechoic envelope material, whereas DC embedded in PRF presented as a hypoechogenic area that spread laterally along the bone and nasal cartilage on both sides. Using color Doppler imaging, neovascularization of the DCF was identified in 7 of 15 patients at the postoperative examination. High-resolution ultrasound is an accurate, non-invasive imaging method appropriate for visualizing DCF in augmentation rhinoplasty. Additionally, it is possible to detect nascent neovascularization within grafts by using color Doppler imaging.

The free vastus lateralis-And conjoined vastus lateralis anterolateral thigh/tensor fascia lata flap for oncological chest wall reconstruction.

A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options. Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared. A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9). The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.

Diagnosis and Management of Paradoxical Cerebrospinal Rhinnorhea in Mondini's Dysplasia.

To highlight a case of unilateral Mondini's dysplasia and it's potential to manifest as paradoxical cerebrospinal fluid (CSF) rhinorrhoea and recurrent meningitis in an adult. A single case report with presentation and management of a patient with left sided Mondini's Dysplasia who presented with watery nasal discharge in the background of recurrent meningitis. We review the differential diagnoses and the importance of a multi-disciplinary approach to management. Post-auricular approach was taken and the leak was identified at the footplate of Stapes and sealed with fascia lata. The middle ear was obliterated and blind sac closure was done. The patient made a good recovery. The online version contains supplementary material available at 10.1007/s12070-024-04903-5.

Osteosynthesis and Reconstruction in Neglected Neck of Femur Fracture: A single-center Study and literature review.

Purpose : Our study evaluates the effectiveness of our innovative treatment for neglected femoral neck fractures. Methods : This retrospective study included 23 patients from January 2016 to March 2023, treated with our new innovative technique. Data has been extracted from the respective department, and informed consent has been obtained prior to any intervention. Radiographs, including AP and lateral radiographs and range of motion at the hip joint, were evaluated in follow-ups at different intervals. Post-operative complications and total hip arthroplasty conversions were also noted. The SPSS software version 26 was used to analyze data for this study. Results : With a mean follow-up of 4.5 ± 1 years, the participants’ ages ranged from 14 to 60 years old, with a mean age of 29.74 ± 11.47 years. The database record indicates that 20 subjects had the radiological and clinical union observed. The non-union was reported in 3 (14.2%) patients; however, only one was symptomatic. Almost 41.7% of the patients reported feeling pain occasionally after exertion. At the operated hip, all patients had excellent range of motion (ROM), primarily in the areas of hip flexion, abduction, adduction, and external rotation. Following reconstruction, the average hip Haris score was 83.46 ± 10.40 at one year. As a post-operative complication, 4 individuals (16.7%) had an infection. Conclusion : Our unique technique has dramatically improved neglected femur neck fractures, even in young patients. It involves ORIF using three cancellous screws, non-vascularized fibular and iliac crest cancellous grafts for reconstruction, and vascularized Tensor fascia lata pedicle graft osteosynthesis.