Lateral Incision Research Articles

The Impact of Lateral Relaxing Incision on Middle Ear Function in Cleft Palate Repair.

Children with cleft palate are susceptible to otitis media with effusion. This study aimed to investigate the effect of lateral relaxing incision (RI) on middle ear function in cleft palate patients who underwent palatoplasty using double-opposing Z-plasty (DOZ). This is a retrospective study of patients who underwent bilateral ventilation tube insertion concurrently with DOZ, wherein RI was selectively performed on the right side of the palate (Rt-RI group) or not (No-RI group). The frequency of VTI, duration of the first ventilation tube retention, and hearing outcomes at the last follow-up were reviewed. Outcomes were compared using the χ 2 test and t test. A total of 126 treated ears from 63 non-syndromic children (18 male, 45 female) with cleft palate were reviewed. The mean age at surgery was 15.8±6.17 months. There were no significant differences in the frequency of ventilation tube insertion between the right and left ears within the Rt-RI group or between the Rt-RI and no-RI groups in the right ear. Subgroup analysis for ventilation tube retention time, auditory brainstem response thresholds, and air-conduction pure tone averages showed no significant differences. In the DOZ, the use of RI had no significant effects on middle ear outcomes during 3 years of follow-up. Relaxing incision seems to be safe without concern for middle ear function in children with cleft palate.

Medial and lateral dual plating of native distal femur fractures: a systematic literature review.

Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature. Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score. The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality. Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.

Hybrid Percutaneous Management of Acute Midsubstance Achilles Tendon Ruptures

Background: Operative management techniques of Achilles tendon ruptures can be categorized into open repair, mini-open repair, or percutaneous repair. Indications: Surgical repair of acute ruptures of the Achilles tendon is indicated in athletic populations, with percutaneous repair being an effective technique with more favorable outcomes. Technique: With the patient prone, the Achilles rupture is identified and the Percutaneous Achilles Repair System (PARS) jig is inserted under the proximal paratenon. A series of Keith needles and flat braided SutureTape sutures are passed transversely across the proximal stump of the tendon. The sutures are then shuttled through the distal stump using a SutureLasso through medial and lateral percutaneous incisions on the distal medial and distal lateral borders of Achilles, respectively. Sutures are passed, tensioned, and secured to the posterior tuberosity of the calcaneus with two SwiveLock anchors. Results: Percutaneous repair, compared with open repair, results in lower wound complication rates, improved cosmetic appearance and fewer adhesions. Following surgery, patients follow a 5-stage rehabilitation protocol with return to sport when patients demonstrate dynamic neuromuscular control during multiplane activities without pain or swelling. Outcome studies have compared percutaneous repairs to open repairs, with percutaneous repairs demonstrating a quicker return to work or baseline activities (2.8 months versus 5.6 months) and a shorter return to play for athletes (average 18 weeks). Also, a greater number of PARS patients were able to return to baseline activities within 5 months (98%), compared with open repair patients (82%; P = .0001). In a prospective randomized controlled trial of 33 patients, Lim et al reported no postoperative wound infections in the percutaneous group and a 21% infection rate in the open repair group ( P = .01). Finally, in a recent systematic review of only percutaneous repairs, reported rates of sural nerve injury and rerupture were only 3.3% and 2.1%, respectively. Discussion/Conclusion: Compared to open repair, percutaneous Achilles repair allows for decreased risk of soft-tissue complications with comparable functional outcomes and earlier return to activity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

“STUDY OF FUNCTIONAL OUTCOME OF SURGICAL EXCISION OF THE POSTERIOR CALCANEAL TUBEROSITY THROUGH A MEDIAL LONGITUDINAL INCISION WITH DEBRIDEMENT, REATTACHMENT OF THE ACHILLES TENDON USING BONE ANCHORS IN HAGLUND'S DEFORMITY”

The aim of this study of functional outcome of surgical excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors in haglung deformity. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difcult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund's deformity. This study is to evaluate whether adequate resection of Haglund deformity by a lateral approach and reattachment of the Achilles tendon using bone anchor, provides good to excellent results. During the period from 2021 to 2022, 30 patients with had undergone resection of Haglund deformity using lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale. The AOFAS ankle hind foot scale was employed to evaluate the patient's outcome. The AOFAS ankle- hind foot score evaluates pain (40 points), function (50 points) and alignment (10 points).The mean AOFAS score at the follow up was 90/100, with the majority of patients reporting alleviation of pain at one year follow up. The medial approach to calcaneal ostectomy can be an effective treatment for those suffering from refractory Haglund deformity. However, the patient must be made aware of the duration of recovery being long. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. Surgical management consisted of excision of the posterior calcaneal tuberosity through a lateral longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described

Outcomes of double-incision posterior knee release for severe knee flexion contracture.

Many surgical solutions for knee flexiondeformity in the pediatric population alter the anatomical bony alignment in the distal femur. Posterior knee capsule release has been presented as an alternative surgical procedurethat maintains the anatomical shape of relevant bones while solving the issue of knee flexion contracture. The aim of this study is to assess the results of a double-incision posteriorknee capsulotomy release performed on pediatric patients with neuromuscular or congenital severe knee flexion deformity. Thirty cases (24 patients, mean age 7.4 years) of severe knee flexion contractures were retrospectively analyzed in a cohort of varying underlying conditions (including spina bifida, muscular dystrophy, cerebral palsy, sclerodermia, and congenital patellar dislocations). Posterior knee release was performed through medial and lateral short incisions with subsequent serial casting. Range and pace of correction as well as the complication rate were recorded. Follow-up information (>1 year) included functionality (FMS scale) and pain (Kujala/Knee Injury Osteoarthritis Score [KOOS]) scales. Significant correction in the knee position was achieved in all analyzed knees (from mean 40.2° to 0.7°; P < 0.01). Twenty-nine out of 30 cases achieved correction by 7 days postoperatively (average number of casts: 1.93 ± 1.05). Overall complication rate in the analyzed cohort reached 6.7% (2/30 cases; double metaphyseal fracture and arthrofibrosis). At follow-up (22.3 months on average), functional ambulation and pain parameters improved drastically, with no further complications observed. Double-incision posterior knee release is an effective method of knee contracture release, which does not affect the axial alignment of the distal femoral bone. Thus, posterior knee release should be considered as potential alternatives to osteotomies and eight-plate corrections, which are currently the basic methods of knee contracture treatment.

Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Experience with 270 Flaps.

The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the aesthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V. This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected. The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used the LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). The LTV was present in 94%, and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups. The LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps. Therapeutic, III.

Skin sensory alteration and kneeling ability following cruciate retaining total knee arthroplasty are not affected by the incision position: A randomised controlled trial of simultaneous bilateral surgery

PurposeThe purpose of this randomised controlled trial was to assess the impact of skin incision location on the patients’ ability to kneel.MethodsA total of 29 patients undergoing bilateral total knee arthroplasty (58 knees) were randomised to receive a lateral or midline incision, with the contralateral limb receiving the alternative option. Cruciate retaining implants were used in all cases by three experienced arthroplasty surgeons. The primary outcome measures assessed functional ability to kneel using an innovative five-point kneeling scale, preferred knee to kneel on and the area of cutaneous sensory loss around the incision at 6 weeks, 6 months and 12 months. Secondary outcome measures were the OKS, KOOS JR, FJS and EQ5D patient reported outcome measures (PROMS), length of surgical scar, overall knee preference and range of motion (ROM).ResultsThere were no significant differences between the two groups for any primary or secondary outcome measures. Flexion range however, had a significant positive correlation with kneeling score (r = 0.335, p = 0.010). The kneeling score increased at each time point after surgery and was significantly greater at 12 months than preoperatively (2.7 v 3.5, p = 0.015). The area of sensory loss lateral to the incision was significantly less at 6 and 12 months than at 6 weeks (43.6cm2 and 40.1cm2 v 84.1cm2, p < 0.0001).ConclusionThe ability to kneel following cruciate retaining total knee arthroplasty is not affected by the incision position but by time and flexion range. TKA improves the ability to kneel by 12 months post-surgery. Sensory loss lateral to the incision reduces with time.Level of evidenceTherapeutic Level 2.

Arthroscopic Superior Capsular Reconstruction

Background: Limited options exist for young patients with massive, irreparable rotator cuff tears. While several treatment options exist, superior capsular reconstruction (SCR) was developed to restore glenohumeral joint stability by preventing superior humeral head migration during glenohumeral motion. Indications: Arthroscopic SCR is indicated in young patients with a massive, irreparable rotator cuff tear. Patients require a functioning deltoid muscle with minimal to no glenohumeral joint arthritis. In addition, patients should have Hamada grade 2 or less and should have an intact or repairable subscapularis tendon. Technique Description: The patient is positioned in the beach chair position. Standard anterior, posterior, and mid-lateral portals are established. An accessory posterior-superior lateral portal is used for visualization. Three 3.0 mm knotless anchors are placed in the glenoid through lateral percutaneous incisions. Two 4.75 mm anchors are placed adjacent to the humeral articular cartilage for medial row fixation. The graft dimensions are measured using the distance between the anchors. The graft is prepared using a gown card as a template with 5 mm added to the medial, posterior, and anterior graft dimensions, and 10 mm added to the lateral dimension. Sutures are passed through the graft in an inverted horizontal mattress for the glenoid anchors to diminish friction and allow appropriate suture passage through the knotless mechanism of the anchor. The graft is then shuttled into the joint through a lateral PassPort button cannula. Two lateral row anchors are used to secure the lateral graft on the humerus. Native rotator cuff tissue is repaired to the graft using sutures from the medial row anchors as well as free SutureTape. Results: Outcomes following SCR have demonstrated improvements in clinical outcomes and shoulder range of motion. Similar outcomes have been identified between the use of allograft and autograft. Patients generally are able to return to light recreational activities and work. Discussion/Conclusion: Arthroscopic SCR yields favorable results in the setting of a massive, irreparable rotator cuff tear. Meticulous surgical technique is needed to avoid intraoperative surgical complications. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Minimally invasive Vs open medial displacement calcaneal osteotomy. A cadaveric study

Category: Hindfoot; Hindfoot Introduction/ Purpose: Medial displacement calcaneal osteotomy (MDCO) is routinely used to correct hindfoot valgus in flexible pes planovalgus deformities. Classically MDCO was described through a lateral heel oblique incision with soft tissue dissection and the use of sagittal saw. Recently, minimally invasive surgical (MIS) techniques have gained popularity among foot and ankle surgeons, with the aim to reduce wound complications and postoperative pain and swelling. MIS calcaneal osteotomy was reported to be safe and effective as compared to open techniques. The aim of this cadaveric study was to compare the degree of deformity correction (coronal calcaneal displacement) using MIS vs open MDCO. Methods: Eight matched pairs foot and ankle cadaveric specimen were used. All specimens were checked radiographically for any previous foot and ankle operations or deformities. For each pair, one foot (right or left) was randomly assigned to either open or MIS MDCO. After the completion of osteotomy, the calcaneal tuberosity was maximally displaced medially and fixed with 2 mm wire. The displacement was measured manually using a flexible metric ruler. All osteotomies and manual measurement was done by the same Orthopaedic surgeon. Displacement was measured on standardized axial calcaneal radiographs by three blinded foot and ankle Orthopaedic surgeons independently using an image processing software with standard scaling for magnification. The displacement was measured laterally on the anterior body fragment and medially on the posterior tuberosity fragment Figures 1. Data was compared using the Wilcoxon-Mann-Whitney U test with the P value of &lt; 0.05 considered significant. Results: Five right and three left ankles underwent MIS osteotomy. On manual measurement the mean medial displacement was 7.87 mm and 8.66 mm for MIS and open technique respectively P=0.21). On radiographs, on medial measurements the average displacement of MIS osteotomy was 5.83 mm compared to 6.36 mm for the open group with a P value of 0.34. On lateral measurements the average displacement of MIS osteotomy was 5.94 mm compared to 6.17 mm for the open group with a P value of 0.67. Conclusion: This cadaveric study reported comparable coronal displacement using MIS vs open techniques for medical displacement calcaneal osteotomy. MIS calcaneal osteotomy offers a reliable alternative to open techniques with the potential advantages of lower wound related complications.

Peroneus Brevis Muscle Flap for a 20-year-old Neuroischemic Diabetic Ulcer Induced by Traumatic Injury: A Case Report Detailing the Efficacy of Advanced Combined Treatment Modalities for Chronic Wound Closure

Introduction. Peroneus brevis flaps provide a viable option to achieve soft tissue coverage in hard-to-heal lower extremity wounds, specifically those to the lateral ankle and hindfoot. Case Report. The authors present a unique case of a patient with a 20-year-old wound dehiscence complicated by osteomyelitis. The wound was a complication from a lateral extensile incision utilized during prior calcaneal open reduction and internal fixation. Due to many factors, including multiple comorbidities, the patient could not obtain complete healing despite IV antibiotics, vascular optimization, local wound care, surgical debridement, and grafting. Wound closure was ultimately achieved with a PB muscle flap. Adjunctive therapies also utilized included multilevel ring external fixation, negative pressure wound therapy, and hyperbaric oxygen therapy. On follow-up 32 months after the procedure, the patient continued to be wound free and satisfied with the results. Conclusions. This case report demonstrates the utility of PB muscle flaps for hard-to-heal lower extremity wounds in patients with comorbidities.

Congenital lingual cyst: an unusually large presentation without obstruction

Congenital lingual cysts are rare tumours that present in variable sizes and locations within the tongue. We report the case of an infant whom we received at two weeks for a mass protruding from the oral cavity. On physical examination, the neonate had a good general condition. There was no respiratory or feeding difficulty. There was a large mucosa-covered, pink, soft tissue oral mass, occupying and expanding the oral fissure. The mass extended about 5 cm anterior to the fissure, and the lingual dorsum was identifiable intra-orally at its superior left surface. Head and neck computerized tomography scan showed an intra-lingual cystic mass, with mass effect on surrounding structures and no bone erosion. The diagnosis of a congenital cyst of the tongue was made. Surgical excision was planned at six months, with very close monitoring for feeding or breathing abnormalities. The procedure consisted of a lateral right mucosal incision along the edge of the tongue, followed by meticulous blunt dissection and separation of the cyst from the surrounding tissues. The cyst was excised completely. It had an approximate volume of 180 ml. The mucosa was closed by interrupted stitches. The procedure was well tolerated and post-operative outcome was good. The patient was addressed to the odontostomatologist for management and eventual correction of occlusal abnormalities. Diligent assessment and management of the airway shared by the surgeon and anaesthetist was capital.

Oblique Dome Division Technique/ Preservation Rhinoplasty

Open rhinoplasty techniques as well endonasal techniques that involve lower lateral cartilage delivery and marginal incisions lead to many unpleasant effects such as alar notching, alar retraction, alar collapse, dropped/pinched tip, Pollybeak, asymmetry, alar collapse, deviation, and dimpling. Both the original Joseph endonasal technique and the later Goldman endonasal tip technique has also resulted in the above issues, while these problems are well documented in the open rhinoplasty approach. To reduce these sequalae, the author has developed a new combination technique. It is based on the Goldman's tip and the I-beam of intermediate crura while avoiding lateral crus marginal incision and delivery (which are the culprits associated with a poor outcome). This results in an intact alar rim reducing healing problems along the alar rim. Furthermore, lateral crus preservation together with a strong tripod of conjoined lateral to medial crura supported by a columellar strut and tip grafts lead to significantly enhanced tip support thus substantially reducing negative sequalae such as asymmetry, alar collapse, dropped tip, pinching, notching and alar retraction while at the same time making the outcome more predictable. The author has been applying this technique since 1999 (Last 23 years). The technique and follow-up will be fully discussed.

Subarachnoid‐peritoneal shunt to treat a diffuse thoracolumbar arachnoid diverticulum in a dog

AbstractA 2‐year‐old, male German shepherd dog presented with a chronic history of hindlimb gait abnormalities, urinary and faecal incontinence. Magnetic resonance imaging of the area revealed a diffuse subarachnoid diverticulum (from T6 to L2), and a novel subarachnoid‐peritoneal shunting technique was considered. Surgery involved a T11–T13 dorso‐lateral hemilaminectomy and placement of a lumbar catheter into the diverticulum via durectomy. The catheter was then inserted into the peritoneal cavity via a left lateral incision to the abdomen. The dog recovered well from the surgical procedure and showed a resolution of its clinical signs at the follow‐up appointment (2 weeks after surgery). The patient represented 7 months later for recurrence of urinary and faecal incontinence and mild pelvic limb ataxia. Repeated diagnostic imaging revealed kinking of the lumbar catheter. Revision surgery was performed and the patient showed a resolution of the pelvic limb ataxia the following day. Patient lost to long‐term follow‐up.

A midline retroperitoneal approach for complex abdominal aortic repair: Case description and operative technique.

In the current endovascular era, open repair of complex aortic aneurysms is becoming a rare, but indispensable, part of vascular surgeons' skill set in specific scenarios. For young, low-risk patients and patients with connective tissue disorders, early target vessel bifurcation, a horseshoe kidney, or pedunculated intraluminal aortic thrombus, fenestrated-branched stent graft technology will not be applicable without significant risks. Thus, an open surgical approach has been recommended for these patients. Most vascular surgeons will be familiar with a transperitoneal approach or a retroperitoneal approach with a lateral incision. For patients with a horseshoe kidney, an inflammatory aneurysm, or a history of multiple intraperitoneal procedures, a retroperitoneal approach should be preferred. In the present report, we have described in detail the optimization of a retroperitoneal approach through a midline incision that provides excellent exposure to the paravisceral aorta, improves exposure to the right renal artery and right iliac artery bifurcation (which is limited using the left flank retroperitoneal approach), and avoids division of the lateral abdominal wall muscles, which has often been associated with iatrogenic muscle denervation and postoperative bulging for four patients who had required complex aortic reconstruction.

Clinical study of sinus tarsal approach combined with Herbert screw and minimally invasive calcaneal locking plate in the treatment of SandersⅡ and Ⅲ calcaneal fractures

To investigate the clinical effect of the tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate compared with traditional lateral L-shaped incision approach combined with plate internal fixation in the treatment of SandersⅡ and Ⅲ calcaneal fractures. Total of 110 patients with SandersⅡ and Ⅲ calcaneal fractures admitted from March 2018 to March 2020 were selected. There were 66 males and 44 females, ranging in age from 20 to 72 years old, with an average of (48.82±8.03) years old. There were 48 SandersⅡ patients and 62 Sanders Ⅲ patients, including 41 left calcaneal fractures and 69 right calcaneal fractures. According to the surgical approach, the patients were divided into the tarsal sinus approach group and the L-shaped incision approach group, 55 cases in each group. The L-shaped incision approach group was treated with traditional lateral L-shaped incision approach combined with internal fixation plate, while the sinus tarsal approach group was treated with tarsal sinus approach combined with Herbert screw and minimally invasive calcaneal locking plate. The operative time, intraoperative blood loss, length of hospital stay and time of fracture healing were recorded to evaluate the surgical effect. The B?hler angle, Gissane angle, calcaneal length and width of the patients before and after surgery were examined by X-ray and the surgical reduction was highly evaluated. Foot function recovery was evaluated by American Orthopedic Foot and Ankle Society (AOFAS) Maryland Scale, and postoperative complications were recorded. All patients were followed up to 12 months after surgery, the operation time and hospitalization time of patients in the sinus tarsal approach group were shorter than those in the L-shaped incision approach group (P<0.05), and the amount of intraoperative blood loss was lower than that in the L-shaped incision approach group(P<0.05). One year after surgery, B?hler angle, Gissane angle, calcaneus length and height were increased(P<0.05), calcaneus width was decreased (P<0.05). One year after the operation, the Maryland scores of the two groups were increased(P<0.05). During the follow-up period, the incidence of postoperative complications (incision infection, joint pain, soft tissue injury) in the sinus tarsalapproach group was lower than that in the L-shaped incision approach group(P<0.05). The traditional lateral L-shaped incision approach and the tarsal sinus approach are both good for the treatment of SandersⅡand Ⅲ calcaneal fractures, but the latter can shorten the surgical treatment time and reduce the incidence of complications.

Treatment of acetabular fracture involving quadrilateral body by external rectus abdominis incision combined with calcaneal profiled plate internal fixation

To investigate the therapeutic effect of lateral rectus abdominis incision combined with winged calcaneal plate on pelvic and acetabular fractures involving quadrilateral body. From January 2017 to April 2021, 21 cases of pelvic and acetabular fractures involving quadrilateral bodies were retrospectively analyzed, including 12 males and 9 females. The age ranged from 21 to 73 years with an average of (43.23±6.45) years. All patients were treated by lateral incision of rectus abdominis combined with open reduction and internal fixation with aerofoil plate, including 12 cases of pelvis with anterior and posterior column fractures, 7 cases of acetabular fractures with quadrilateral involvement, and 2 cases of acetabular fractures with central dislocation. All 21 patients were followed up for 12 to 36 months with an average of (18.60±6.45) months. All fractures healed. According to Matta's image reduction evaluation after operation, 11 cases of pelvic anterior and posterior column fractures were all anatomic reduction, 1 case was satisfactory reduction, 7 cases of acetabular fractures involving quadrilateral were anatomic reduction, 1 case with central dislocation was anatomic reduction, and 1 case was satisfactory reduction. The modified Merle D'Aubigne Postel hip joint score was 13 to 17 points. Lateral incision approach of rectus abdominis combined with wing-shaped steel plate can obtain good radiological and clinical results in the treatment of complex pelvic and acetabular fractures involving quadrilateral bodies, and has advantages in the treatment of complex pelvic fractures and acetabular quadrilateral fractures.

What are the influencing factors on the outcome in lateral incisional hernia repair? A registry-based multivariable analysis

IntroductionIncisional hernias following lateral abdominal wall incisions with an incidence of 1–4% are less common than following medial incisions at 14–19%. The proportion of lateral incisional hernias in the total collective of all incisional hernias is around 17%. Compared to midline defects, lateral incisional hernias are more difficult to repair because of the more complex anatomy and localization. A recent systematic review identified only 11 publications with a total of 345 patients reporting on lateral incisional hernia repair. Therefore, further studies are urgently needed.MethodsMultivariable analysis of the data available for 6,306 patients with primary elective lateral incisional hernia repair was performed to assess the confirmatory pre-defined potential influence factors and their association with the perioperative and one-year follow-up outcomes.ResultsIn primary elective lateral incisional hernia repair, open onlay, open IPOM and suture procedures were found to have an unfavorable effect on the recurrence rate. This was also true for larger defect sizes and higher BMI. A particularly unfavorable relationship was identified between larger defect sizes and perioperative complications. Laparoscopic-IPOM presented a higher risk of intraoperative, and open sublay of postoperative, complications. The chronic pain rates were especially unfavorably influenced by the postoperative complications, preoperative pain and female gender.ConclusionOpen-onlay, open IPOM and suture procedures, larger defect sizes, female gender, higher BMI, preoperative pain and postoperative complications are associated with unfavorable outcomes following primary elective lateral incisional hernia repair.

Calcaneus Fracture Fixation: Assessing the Adequacy of the Sinus Tarsi Surgical Fixation Technique

Category: Trauma; Hindfoot Introduction/Purpose: Intra-articular calcaneus fractures are devastating injuries, and life-changing for patients that develop post-traumatic arthritis, a common outcome. Debate exists as to whether non-operative symptomatic management, or operative treatment, best manages these injuries, partially due to the difficulty of achieving anatomic subtalar joint reduction. Traditionally, a large, lateral extensile incision has been used, plagued with soft tissue complications quoted at rates upwards of 22%. A less invasive incision, the limited sinus tarsi approach (ST-a), has become more common, proposed to lower complication rates without compromising radiographic nor clinical outcomes. The primary purpose of this study was to objectively assess the adequacy of joint reduction along with the associated soft tissue complications using the ST-a and compare it to the standards of the lateral extensile incision. Methods: All calcaneus fractures fixated through the ST-a at our institution were reviewed between March 2017 and Jan 2020. Inclusion criteria included the presence of preoperative and post-operative X-rays and CT scans. Primary outcomes were radiographic measures, including Bohler's angle on X-ray, and the maximum summative step deformity at the posterior facet of the subtalar joint in all three planes on CT scan. Secondary clinical outcomes included soft tissue complications (infection, delayed wound healing) and the need for reoperation. Results: Thirty patients were included with an average age of 48.9 +- 13.9 (n=24 males, n=6 females) and Sanders classification of 2.8. Pre-operatively, the mean Bohler's angle and summative posterior facet step deformity were 5.8 +- 16.6° and 17.2 +- 9.3mm, respectively. These radiographic outcomes were significantly improved postoperatively to 27.2 +- 7.7° and 5.3 +- 2.9mm. Soft tissue complication rates were half that of the comparative extensile approach. Conclusion: Using the ST-a, radiographic joint reduction was acceptable compared to literature standards. There was subsequently a lower incidence of soft tissue complications than previously quoted for the lateral extensile approach. Although technically more demanding, the ST-a is a valuable method for the treatment of intra-articular calcaneal fractures and should be considered when planning operative management of intra-articular calcaneus fractures.

Dynamic bedrock channel width during knickpoint retreat enhances undercutting of coupled hillslopes

AbstractMountain landscapes respond to transient tectonic and climate forcing through a bottom‐up response of enhanced bedrock river incision that undermines adjoining hillslopes, thus propagating the signal from the valley bottom to the valley ridges. As a result, understanding the mechanisms that set the pace and pattern of bedrock river incision is a critical first step for predicting the wider mechanisms of landscape evolution. Typically, the focus has been on the impact of channel bed lowering by the upstream migration of knickpoints on the angle, length and relief of adjoining hillslopes, with limited attention on the role of dynamic channel width. Here, we present a suite of physical model experiments that show the direct impact of knickpoint retreat on the reach‐scale channel width, across a range of flow discharges (8.3 to 50 cm3 s−1) and two sediment discharges (0 and 0.00666 g cm−3). During knickpoint retreat, the channel width narrows to as little as 10% of the equilibrium channel width, while the bed shear stress is &gt;100% higher immediately upstream of a knickpoint compared to equilibrium conditions. We show that only a fraction of the channel narrowing can be explained by existing hydraulic theory. Following the passage of a knickpoint, the channel width returns to equilibrium through lateral erosion and widening. For the tested knickpoint height, we demonstrate that the lateral adjustment process can be more significant for hillslope stability than the bed elevation change, highlighting the importance of considering both vertical and lateral incision in landscape evolution models. It is therefore important to understand the key processes that drive the migration of knickpoints, as the localized channel geometry response has ongoing implications for the stability of adjoining hillslopes and the supply of sediment to the channel network and export from landscapes onto neighbouring depositional plains.

Total Autologous Fascia Lata Sacrocolpopexy for Treatment of Pelvic Organ Prolapse: Experience in Thirty-Four Patients

ObjectiveTo develop a technique for open/robotic sacrocolpopexy using autologous fascia lata autograft. We report our experience in our first 34 patients. MethodsThe operation utilizes a 4-5-cm x 15-18-cm piece of fascia lata harvested through a 3-4-inch lateral upper thigh incision. The graft is configured into a traditional Y-shaped configuration using CV-2 Goretex sutures and is used to perform sacrocolpopexy. Patients were followed by history and physical, POP-Q scores, and symptoms related to thigh harvest including visual analog pain (VAP) scores. Treatment failure was defined as symptomatic pelvic organ prolapse (POP) involving apical descent. ResultsAutologous fascia lata sacrocolpopexy was performed on 34 patients with a mean age of 62. Mean follow-up was 13 months (range 2-42). Thirteen cases were open sacrocolpopexies, and 21 were robotic. Concurrent procedures included hysterectomy (9), vaginal mesh excision (7), bowel resection and rectopexy (5), and autologous sling (5). POP symptoms resolved in all 34 patients, and there were no treatment failures. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.4 (range 0-3). Three patients developed non-bothersome thigh bulges. One patient developed a harvest site seroma. Twelve patients reported mild, non-bothersome harvest site paresthesias. No thromboembolic events occurred. ConclusionAutologous fascia lata sacrocolpopexy is an efficacious treatment for patients who desire non-mesh POP repair. Most harvest site issues are minor and typically resolve with expectant management alone. Continued follow-up of this series is ongoing to determine long-term success of this operation.