Reproducible Technique Research Articles

“Tension band wiring first” —an easy, fast and reproducible technique to reduce patellar fractures, a retrospective comparative study with traditional reduction technique

ObjectiveTo evaluate intraoperative and early postoperative clinical outcomes using the “tension band wiring first technique” to reduce C type patellar fractures.MethodsSixty-four patients with C type fractures were enrolled in this study. Thirty-four patients underwent open reduction and internal fixation (ORIF) surgeries using the traditional reduction technique by pointed clamps (TRT group). The other thirty patients received the patellar fracture reduction using the “Tension band wiring first technique” (TBWFT group). All patellar fractures were treated with a cable tension band and a cerclage cable. The duration of intraoperative procedure and X-ray exposure times were recorded. All patients were followed up at 1, 3, 6, and 12 months. Bone union time was recorded. The articular surface steps of the patellas were measured. After surgery, range of motion (ROM) of the knee, and complications were evaluated, and patellar function was evaluated using the Lysholm knee scores and Böstman scores.ResultsWhen compared to TRT group, the “Tension band wiring first technique” significantly reduced the intraoperative time and X-ray exposure times and tended to reduce the articular surface steps, though without statistical significance. In the two groups, there was no significant difference in bone union time, ROM, complications and patellar function.ConclusionThe utilization of “Tension band wiring first technique” proved to be a straightforward, expeditious, and reproducible technique for reducing patellar fracture in comparison to the conventional reduction technique utilizing pointed clamps. Further studies are required to ensure the generalizability of these findings to additional patient populations at other institutions.

Deltopectoral approach without subscapularis detachment for reverse shoulder arthroplasty. Technique and results of a safe and reproducible subscapularis-sparing approach

AimsThe importance of the subscapularis for reverse total shoulder arthroplasty (rTSA) has been demonstrated, especially for internal rotation and stability. In a deltopectoral approach, a detachment of the subscapularis is performed (tenotomy, tuberosity peeling or osteotomy) but the tendon is not always repairable at the end. When it is repaired, healing is obtained in only 40% to 76% of the cases, with potential consequences for the outcomes. The Anterior Muscle-Sparing (AMS) approach is a deltopectoral approach with preservation of the subscapularis, providing a solution to these problems. We present the surgical technique and results. MethodsIn a retrospective study, we included our first 45 cases of rTSA performed with the AMS approach for a degenerative affection of the shoulder (massive rotator cuff tear, cuff tear arthropathy, primary glenohumeral arthritis, rheumatoid arthritis), excluding traumatic and revision cases. The subscapularis was intact in all the cases. The mean age at inclusion was 74.1 years. No patients were lost at the minimum 24-month follow-up. All the patients underwent a clinical evaluation preoperatively and at the last follow-up, including Constant score, simple shoulder value (SSV), pain scale, and range of motion. An X-ray evaluation was conducted postoperatively and at the last follow-up to assess implant positioning and evolution. ResultsThere was no intraoperative complication, and the mean operative time was 62 minutes. We observed a significant improvement in Constant score (from 36 to 70, p <.001), SSV (from 33 to 81, p <.001), pain (from 6.3 to 0.7, p <.001), strength (from 0.5 to 3.5, p <.001), and most of the active mobilities. Regarding internal rotation, 95% of the patients reached level L3 or higher. Glenoid positioning was considered optimal in more than 90% of the cases (inferior tilt and low position) without any occurrence of superior tilt or high position. The osteophytes could be totally removed in 8 out of 9 cases (88.9%). Six postoperative complications (13.3%) were reported: 1 infection (2.2%), 2 cases of traumatic glenoid loosening (4.4%), 2 acromion fractures (4.4%), and 1 hematoma (2.2%). There was no instability. Eighty percent of the patients could return home, with a mean hospital stay of 1.8 days. ConclusionThe AMS approach is a safe and reproducible technique. The preservation of the subscapularis has potential benefits regarding internal rotation and stability. In the absence of tendon suture, rehabilitation can be started immediately without motion restriction, allowing for a fast recovery and return to autonomy.

Visual Patterns of Diaphragmatic Motion in Acute Respiratory Failure: A Prospective Pilot Study.

Right diaphragmatic excursion is a reliable and reproducible technique used in intensive care to assess diaphragmatic function. The aim of this study was to investigate the relationship between the appearance of diaphragmatic motion and the etiological diagnosis of patients admitted to the emergency department with acute respiratory failure (ARF). A prospective, observational, and multicenter pilot study was conducted. All adult patients admitted in the emergency department with ARF were included. The different visual patterns of diaphragmatic motion were analyzed according to the three main etiologies of ARF encountered in emergency departments. A total of 39 adult patients were included. We observed a different visual pattern in patients with pneumonia. A sum of plateau times of less than 0.2 s predicted that the main diagnosis was pneumonia, with sensitivity = 89% 95%CI [52%; 100%], specificity = 87% 95%CI [69%; 96%]. Our study seems to show that the shape of diaphragmatic motion in patients with ARF secondary to pneumonia is different from that in patients with exacerbation of chronic obstructive pulmonary disease or acute heart failure. ClinicalTrials.gov: NCT04591509.

Mastering Snow Analysis: Enhancing Sampling Techniques and Introducing ACF Extraction Method with Applications in Svalbard

Semi-volatile organic contaminants (SVOCs) are known for their tendency to evaporate from source regions and undergo atmospheric transport to distant areas. Cold condensation intensifies dry deposition, particle deposition, and scavenging by snow and rain, allowing SVOCs to move from the atmosphere into terrestrial and aquatic ecosystems in alpine and polar regions. However, no standardized methods exist for the sampling, laboratory processing, and instrumental analysis of persistent organic pollutants (POPs) in snow. The lack of reference methods makes these steps highly variable and prone to errors. This study critically reviews the existing literature to highlight the key challenges in the sampling phase, aiming to develop a reliable, consistent, and easily reproducible technique. The goal is to simplify this crucial step of the analysis, allowing data to be shared more effectively through standardized methods, minimizing errors. Additionally, an innovative method for laboratory processing is introduced, which uses activated carbon fibers (ACFs) as adsorbents, streamlining the analysis process. The extraction method is applied to analyze polychlorobiphenyls (PCBs) and chlorinated pesticides (α-HCH, γ-HCH, p,p′-DDE, o,p′-DDT, HCB, and PeCB). The entire procedure, from sampling to instrumental analysis, is subsequently tested on snow samples collected on the Svalbard Islands. To validate the efficiency of the new extraction system, quality control measures based on the EPA methods 1668B and 1699 for aqueous methods are employed. This study presents a new, reliable method that covers both sampling and lab analysis, tailored for detecting POPs in snow.

Efficient Protocol for Isolating Human Fibroblast from Primary Skin Cell Cultures; Application to Keloid, Hypertrophic Scar and Normal Skin Biopsies

Abstract This protocol introduces a streamlined and efficient method for isolating human fibroblast from skin primary cell culture with a specific focus on its application to keloid, hypertrophic scar, and normal skin biopsies. Additionally, the absence of suitable animal models for keloid and hypertrophic scar has led preclinical research to rely on in vitro studies using primary cell cultures. This approach addresses the challenges of existing protocols in terms of time, cost, equipment, and technical expertise required. The method involves derivation, culture, and characterization analysis including cell proliferation, migration, and fibroblastic marker (Vimentin, CD90, CD73, and CD105) expression. Our study yielded high amounts of fibroblast from tested skin explants while maintaining their in vivo-like characteristics and behaviour. Immunostaining assay confirmed that the cultivated fibroblast was positively expressed Vimentin. Flowcytometry results showed high expression of CD90 and CD73 while relatively showing lower expression of CD105. Fibroblast derived from keloid tissue showed the highest rate of proliferation and migration ability compared to the other samples. These findings suggest an efficient and reproducible technique to cultivate high qualified fibroblast from human skin in normal or pathological condition, particularly for keloid and hypertrophic scar. The application of this protocol provides a foundation for further studies to investigate the progression and potential intervention of aberrant fibrotic dermatological disorder, in vitro.

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction.

This study aims to develop a practical algorithm for utilizing smartphone-based thermal imaging (SBTI) in the perioperative setting and to establish a standardized evaluation method for objectively assessing SBTI images for cutaneous perfusion of pedicled flaps in the face, head, and neck. This prospective conducted study, integrated SBTI into the assessment of 16 patients undergoing reconstructive surgery for face and neck defects. Thermal images were captured at four timepoints: after marking (T1), after flap elevation (T2), upon completion of surgery (T3), and 24h postoperatively (T4). The flap areas were divided into three flap zones and graded based on temperature differences (ΔT), with a grading system where grade 1 indicated perfect perfusion and grades 2 to 5 indicated increasing perfusion impairment. 6 male and 10 female patients aged 64-93 years (mean 78.5 years) undergoing reconstructive pedicled skin flap surgery for facial and neck defects (1 × 1cm to 11 × 8cm) due to diagnoses of malignant cutaneous lesions were investigated. Intraoperative assessments indicated good perfusion across flaps. One postoperative dehiscence occurred in an 83-year-old male with a cervical advancement flap, correlated with a significant temperature difference (ΔT > 4°C) intraoperatively. Statistical analysis revealed a strong positive correlation (p = 0.0003) between clinical assessment grades and ΔT values between specific flap zones at T3. SBTI is an easy-to-apply, low-cost, real-time and reproducible technique for indirect perfusion assessment in pedicled skin flaps of the head and neck region. Further studies are needed implementing this methodology in large and free flaps.

Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study

IntroductionThe treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results. Primary objectiveTo evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique. Secondary objectivesTo evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months. MethodProspective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed. Results122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous.There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group. ConclusionsUM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.

Non-invasive physiological assessment of coronary artery obstruction on coronary computed tomography angiography.

Computed tomography-derived fractional flow reserve (CT-FFR) enhances the specificity of coronary computed tomography angiography (CCTA) to that of the most specific non-invasive imaging techniques, while maintaining high sensitivity in stable coronary artery disease (CAD). As gatekeeper for invasive coronary angiography (ICA), use of CT-FFR results in asignificant reduction of negative ICA procedures and associated costs and complications, without increasing cardiovascular events. It is expected that CT-FFR algorithms will continue to improve, regarding accuracy and generalisability, and that introduction of new features will allow further treatment guidance and reduced invasive diagnostic testing. Advancements in CCTA quality and artificial intelligence (AI) are starting to unfold the incremental diagnostic and prognostic capabilities of CCTA's attenuation-based images in CAD, with future perspectives promising additional CCTA parameters which will enable non-invasive assessment of myocardial ischaemia as well as CAD activity and future cardiovascular risk. This review discusses practical application, interpretation and impact of CT-FFR on patient care, and how this ties into the CCTA 'one stop shop' for coronary assessment and patient prognosis. In this light, selective adoption of the most promising, objective and reproducible techniques and algorithms will yield maximal diagnostic value of CCTA without overcomplicating patient management and guideline recommendations.

Technical note: Measuring bicondylar length in computed tomography data.

With the increased use of 3D-generated images in biological research, there is a critical need to adapt classical anatomical measurements, traditionally conducted with calipers, to a virtual environment. We present detailed protocols for measuring bicondylar length, a critical dimension of the femur, using three different imaging software programs-3D Slicer™, Amira™, and Simpleware™. These protocols provide researchers and practitioners in radiology, orthopedics, biomechanics, and biological anthropology with accurate and reproducible measurement techniques. The objective is to standardize and support virtual osteology in biomechanical research, stature estimation, and related medical and anthropological studies. Adhering to standardized protocols, we adapted femoral bicondylar length measurements for computed tomography images from a New Mexican collection (n = 10). The method was designed for applicability and reproducibility across three software platforms. By comparing measurements from the same sample across different observers and different platforms, this study validates the accuracy and consistency of the adapted protocol, demonstrating its utility for research and clinical assessments. We present a step-by-step guide for each program, detailing bone alignment and measurement. We illustrate each step and provide video tutorials via links for an enhanced understanding of the process. Bicondylar length can be measured effectively in each software program following the provided instructions. However, ease of measurement varied among the programs, with some offering a more straightforward process. This variability underscores the importance of choosing appropriate software for the user's needs and proficiency. It also suggests areas for improvement and standardization in software design and instructional clarity.

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament by Removing the Semitendinosus and Gracilis: A Simple, Reproducible Technique

Persistent rotatory laxity is a factor in failure after anterior cruciate ligament (ACL) reconstruction, and numerous studies have highlighted the benefits of ACL reconstruction combined with anterolateral ligament (ALL) reconstruction, in particular to reduce the risk of iterative rupture and provide additional rotatory stability. Various techniques for combined ACL-ALL reconstruction exist, none of which has been proven to be superior. We propose a surgical technique for combined ACL-ALL reconstruction using the hamstrings, pedicled semitendinosus, and gracilis, with a single femoral tunnel.

Advancing ethanol content determination in hydrogels: non-destructive and operational methods for health and criminal inspections.

The significance of accurate determination of ethanol content in hydrogel formulations was accentuated during COVID-19 pandemic coinciding with the heightened demand for sanitizing agents. The present article proposes three robust methodologies for this purpose: Fourier Transform Infrared Spectroscopy (FTIR), Raman spectroscopy, and Densitometry with matrix effect correction by Near-Infrared Spectroscopy (NIR). All three methods demonstrated outstanding linearity (R2 ≥ 0.99) and minimal errors (< 1.7%), offering simplicity and operational efficiency. FTIR and Raman, being non-destructive and requiring minimal preparation, enable practical on-site analysis capabilities, underscoring the potential of the spectroscopic methods to expedite health investigations and inspections, empowering on-site ethanol determination, and relieving the burden on official laboratories. Additionally, the densitometry with NIR-based approach showcased superior accuracy and precision compared to spectroscopic methods, meeting validation criteria while offering operational advantages over the costly official distillation-based method. Therefore, it stands as a reliable and reproducible technique for comprehensive health and criminal compliance assessments, making it a compelling alternative for both industry and official laboratories.

Posterior Stabilization and Reverse Hill-Sachs Remplissage Using Linked Knotless Anchors

Posterior glenohumeral dislocation can result in impaction fractures to the anteromedial humeral head, known as a reverse Hill-Sachs lesion. They may also cause damage to the posterior capsuloligamentous structures. This can lead to ongoing posterior instability and altered biomechanics resulting in early degenerative changes. Ongoing symptoms may result in challenges to a patient’s day-to-day and sporting activities. Early intervention to stabilize the shoulder may help avoid these. We present a reproducible technique for posterior stabilization using linked knotless anchors to perform a remplissage of the subscapularis into the reverse Hill-Sachs lesion defect that avoids the need for exposure of the subcoracoid bursa.

Quantitative assessment of renal steatosis in patients with type 2 diabetes mellitus using the iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence imaging: repeatability and clinical implications.

Fatty kidney disease is linked to renal function damage, but there is no noninvasive tool for monitoring renal fat accumulation. This study aimed to explore the repeatability of the iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification (IDEAL-IQ) sequence imaging in quantifying renal fat deposition and to assess the differences observed in patients with type 2 diabetes mellitus (T2DM). A total of 26 healthy participants underwent two IDEAL-IQ scans without repositioning, and the repeatability of the imaging technique was assessed with Bland-Altman analysis. Additionally, 96 patients with T2DM underwent a single IDEAL-IQ scan for the examination of renal fat deposition. The patients with T2DM were classified into three groups based on their estimated glomerular filtration rate (eGFR). One-way analysis of variance was used to analyze the differences of renal fat depositions between the groups. Receiver operating characteristic curve analysis was used to assess the diagnostic performance of IDEAL-IQ. Bland-Altman analyses showed narrower limits of agreement and a significant correlation (r=0.81; P<0.05) between the two IDEAL-IQ scans. Statistically significant differences between the healthy volunteers and patients with T2DM, diabetic kidney disease (DKD) I-II, and or DKD III-IV were found in renal parenchymal proton-density fat fraction (PDFF) values (P<0.001). Renal parenchymal PDFF was negatively correlated with eGFR (r=-0.437; P<0.001) and positive correlated with serum creatinine level (µmol/L) (r=0.421; P<0.001). The area under the curve of IDEAL-IQ in discriminating between the healthy volunteers and patients with T2DM was 0.857. For discriminating T2DM from DKD I-II and DKD III-IV, the IDEAL-IQ had an area under the curve of 0.689 and 0.823, respectively. IDEAL-IQ is a promising and reproducible technique for the assessment of renal fat deposition and identification of risk of DKD in patients with T2DM. Moreover, IDEAL-IQ imaging is expected to improve the sensitivity and specificity of early renal function damage and staging assessment of patients with T2DM.

Non-vascularized coracoid process autograft for glenoid reconstruction in revision shoulder arthroplasty.

To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Fifteen patients (9 males, 6 females; mean age 66.9years, range 38-85) were included. At a mean follow-up of 20.9months (range 12-56months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10-80°). The mean VAS for pain was 1.1 (range 0-8), mean SSV 67.3% (range 40-90%), mean ASES score 85.5 (range 65-98.3), mean Absolute Constant score 58.6 (range 21-83), and mean Ponderate Constant score 77.5% (range 28.8-110.7%). No neurological injuries were reported. Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate.

Simultaneous Estimation of Monoterpenes (Eugenol, Eucalyptol And R-Limonene) by HPTLC Densitometric Method and Its Validation .

Plant-derived monoterpenes have various pharmacological applications, but the problem lies with their detection and estimation. Hence, it is crucial to develop a robust technique to overcome this problem. This work was aimed at developing a swift, accurate and reproducible technique for the simultaneous detection of three monoterpenes, namely, eugenol, eucalyptol (1,8-cineole), and R-limonene, using the high-performance thin-layer chromatography technique, as per ICH guidelines. The best results were obtained in the eluent mixture prepared by using hexane: toluene: ethyl acetate (6:3:1, v/v/v), and silica gelcoated aluminum TLC plates 60F254 as a stationary phase that produced very sharp and well-resolved symmetrical peaks for eugenol, eucalyptol, and R-limonene at Rf values of 0.47 ± 0.03, 0.56 ± 0.03, and 0.71 ± 0.03, respectively. The linear range for eugenol, eucalyptol, and R-limonene was 1 to 15 ng/spot (r2 = 0.9906), 100 to 600 ng/spot (r2 = 0.99625), 50 to 300 ng/ spot (r2 = 0.9873), respectively. Furthermore, the LoD and LoQ values for eugenol were obtained at 0.0129 and 0.0391 ng/spot, followed by eucalyptol (0.82 and 2.48 ng/spot) and R-limonene (0.594 and 1.8 ng/spot), respectively. To the best knowledge, we are the first to report a quick and reproducible HPTLC technique for the simultaneous determination of eugenol, eucalyptol (1,8-cineole), and R-limonene. This method can further be used for the quantification of these secondary metabolites in plant extracts, enriched fractions, and pharmaceutical formulations.

Simultaneous Estimation of Monoterpenes (Eugenol, Eucalyptol and R-Limonene) by HPTLC Densitometric Method and Its Validation.

Plant-derived monoterpenes have various pharmacological applications, but the problem lies with their detection and estimation. Hence, it is crucial to develop a robust technique to overcome this problem. This work was aimed at developing a swift, accurate and reproducible technique for the simultaneous detection of three monoterpenes, namely, eugenol, eucalyptol (1,8- cineole), and R-limonene, using the high-performance thin-layer chromatography technique, as per International Council of Harmonization (ICH) guidelines. The best results were obtained in the eluent mixture prepared by using hexane: toluene: ethyl acetate (6:3:1, v/v/v), and silica gel-coated aluminum thin layer chromatography (TLC) plates 60F254 as a stationary phase that produced very sharp and well-resolved symmetrical peaks for eugenol, eucalyptol, and R-limonene at Rf values of 0.47 ± 0.03, 0.56 ± 0.03, and 0.71 ± 0.03, respectively. The linear range for eugenol, eucalyptol, and R-limonene was 1 to 15 ng/ spot (r2 = 0.9906), 100 to 600 ng/spot (r2 = 0.99625), 50 to 300 ng/spot (r2 = 0.9873), respectively. Furthermore, the limit of detection (LoD) and limit of quantitation (LoQ) values for eugenol were obtained at 0.0129 and 0.0391 ng/spot, followed by eucalyptol (0.82 and 2.48 ng/spot) and R-limonene (0.594 and 1.8 ng/spot), respectively. To our knowledge, we are the first to report a quick and reproducible high-performance thin-layer chromatography (HPTLC) technique for the simultaneous determination of eugenol, eucalyptol (1,8-cineole), and R-limonene. This method can further be used for the quantification of these secondary metabolites in plant extracts, enriched fractions, and pharmaceutical formulations.

Additively Manufactured Ceramics for Compact Quantum Technologies

AbstractQuantum technologies are advancing from fundamental research in specialized laboratories to practical applications in the field, driving the demand for robust, scalable, and reproducible system integration techniques. Ceramic components can be pivotal thanks to high stiffness, low thermal expansion, and excellent dimensional stability under thermal stress. Lithography‐based additive manufacturing of technical ceramics is explored, especially for miniaturized physics packages and electro‐optical systems. This approach enables functional systems with precisely manufactured, intricate structures, and high mechanical stability while minimizing size and weight. It facilitates rapid prototyping, simplifies fabrication and leads to highly integrated, reliable devices. As an electrical insulator with low outgassing and high temperature stability, printed technical ceramics such as and AlN bridge a technology gap in quantum technology and offer advantages over other printable materials. This potential is demonstrated with CerAMRef, a micro‐integrated rubidium D2 line optical frequency reference on a printed micro‐optical bench and housing. The frequency instability of the reference is comparable to laboratory setups while the volume of the integrated spectroscopy setup is only . Potential for future applications is identified in compact atomic magnetometers, miniaturized optical atom traps, and vacuum system integration.

Risk of Nerve Injury Following Peroneus Longus Harvest is Very Low: A Prospective Cohort of 600 Patients.

Peroneus longus (PL) graft harvest has gained popularity in recent years for a variety of ligament surgeries. One of the common apprehensions regarding its more widespread usage has been the risk of injury to the common peroneal nerve or the sural nerve during graft harvest. The purpose of the current study is to assess the rate of injury to the peroneal and sural nerve following PL harvest using our technique in a large cohort of patients. A prospective cohort of 600 consecutive patients undergoing PLG harvest over a period from January 2022 to December 2022 at a single tertiary referral centre were included for analysis. Patients had baseline screening of nerve function prior to surgery and were regularly followed up at 3 weeks, 6 weeks, 3 months and 6 months post-harvest. Grouped variables for the sural and peroneal nerve were completed and analysis was carried out using Cochrane's Q test and McNemar's test. We found that only 0.01% of patients had any nerve complications at 6 months follow-up, and three times more patients had sural nerve complaints than peroneal nerve complaints at the end of the 6 months follow-up. Peroneus longus harvest is a safe and reproducible technique with low complication rate. The rate of nerve complications post-harvest is grossly overestimated in the literature secondary to low-powered and low evidence studies. We believe that using our safe surgical technique for PL harvest with respect to surface landmarks allows for PL harvest with a low nerve complication rate.

U-T Flap for Distal Symes Toe Amputation. A New Flap Adapted to Diabetic Ulcers of the Pulp of the Lesser Toes

The surgical management of diabetic ulcers of the tip of the toes complicated with osteomyelitis of the distal phalanx usually consists of the excision of the bone and soft tissue using a distal Symes toe amputation. This surgery is usually conducted through 2 coronal flaps. When the ulcer is away from the nail or extends further on the plantar side of the pulp, wound closure could be difficult to achieve resulting in wound dehiscence. In addition, the remaining toe is often too short when compared with the neighboring digits. The objective of this surgical technique is to propose a new flap design that could be simple and easy to learn, mainly when dealing with small-to-moderate–sized wounds. The U-T flap is designed to reduce wound complications and yield better esthetics. We found the U-T flap to be a reproducible technique with better outcomes in terms of surgical wound healing and final toe length, after excision of distal infected toes. Level of Evidence: Diagnostic level 5—expert opinion. See Instructions for Authors for a complete description of levels of evidence.

CORR Insights®: Is Subcapital Realignment for Slipped Capital Femoral Epiphysis a Reproducible Technique? Midterm Results.

CORR Insights®: Is Subcapital Realignment for Slipped Capital Femoral Epiphysis a Reproducible Technique? Midterm Results.