Short Transverse Incision Research Articles

A Muscle-Preserving Short Transverse Incision for Unicompartmental Knee Arthroplasty: A Technical Note.

We describe the use of a short transverse incision technique with muscle retention for unicompartmental knee arthroplasty (UKA). The incision is made transversely just above the joint line, followed by a detachment of subcutaneous soft tissue from the underlying capsule and fascia to create a mobile window. The fascia is incised along the medial border of the vastus medialis and the capsule of the suprapatellar pouch is incised laterally, preserving vastus medialis muscle. All procedures are performed within the mobile window while controlling the knee flexion angle. Following implantation, the capsule and fascia are anatomically repaired. This approach was used in 30 consecutive patients who underwent Oxford UKA, including one bi-unicompartmental knee arthroplasty without complications. Importantly, no patients had any disturbances of the infrapatellar branch of the saphenous nerve disturbancessuch as numbness, hyperesthesia, hypoesthesia, or neuroma pain. The transverse approach is thought to be a safe and feasible method for UKA.

Effectiveness of modified transsection and longitudinal suture in epicanthoplasty

To introduce a modified transsection and longitudinal suture in epicanthoplasty and summarize its effectiveness. The clinical data of 119 patients underwent epicanthoplasty with modified transsection and longitudinal suture and with a follow-up time over 6 months between February 2014 and December 2016 were retrospectively analyzed. There were 8 males and 111 females with an average age of 22.7 years (range, 18-38 years). The epicanthus was as eyebrow type in 12 cases, as eyelid type in 57 cases, as tarsalis type in 39 cases, and as backward type in 11 cases. The narrow degree of epicanthus included mild (the lacrimal caruncle covered size was less than 1/3) in 42 cases, moderate (the lacrimal caruncle covered size was between 1/3 and 2/3) in 58 cases, and severe (the lacrimal caruncle covered size was over 2/3) in 19 cases. One hundred and thirteen patients were treated by blepharoplasty at the same time. The new canthus was located on the basis of the inner canthus physiological aesthetics. Through a short transverse incision, dislocated orbicularis oculi muscle near medial canthal ligament and the fiber between the medial canthal ligament and skin were completely released; then the medial canthal ligament was shortened precisely and the incision was tension-free sutured followed the Langer's line near eyes. All the incisions healed by first intention. All patients were followed up 6 months to 2 years (mean, 8.6 months). The bilateral hypertrophic scar on both bilateral medial canthal incisions happened in 3 patients at 3-6 months after operation; and the scarring gradually subsided at 10 months after the diprospan injections and the siliconegel and carbon dioxide laser treatment. Good effectiveness were obtained in the other patients, whose inner intercanthal distance significantly narrowed, both of the horizontal lid fissure length increased, the lacrimal caruncle fully exposed, and no obvious scar could be seen. The modified transsection and longitudinal suture in epicanthoplasty has the advantages of simple design, easy operation, minimally invasive, inconspicuous scar, and obvious, stable, and lasting postoperative effectiveness.

Z-lengthening of the Achilles tendon with transverse skin incision.

BackgroundThe risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required.MethodsThe treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision.ResultsThe functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients.ConclusionsThe new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages.

The Semi-Open Approach to the Gracilis Muscle Flap: Aesthetic Refinements in Gracilis Muscle Harvest

The gracilis muscle flap is certainly among the most versatile sources of vascularized tissue available for microsurgical reconstruction. However, the aesthetic appearance of the resultant scar has frequently been a source of dissatisfaction. Various minimal invasive techniques have been proposed, all of which aim to reduce scar formation. Drawbacks of endoscopic techniques, however, include a steep learning curve as well the need for special technical equipment. A semi-open approach without endoscopic assistance is presented, characterized by a short transverse incision in the groin area without a counterincision distally. This technique was performed in six patients (mean age, 48.8 years). Mean incision length was 8.8 cm, and average muscle harvesting time was 49 minutes. We suggest the semi-open approach to the gracilis muscle flap because it does not require special instruments and training and is characterized by easy performance and a short incision in the inconspicuous groin area with resultant better cosmesis.

Mini-Open Blind Procedure Versus Limited Open Technique for Carpal Tunnel Release: A 30-Month Follow-Up Study

To evaluate prospectively the safety and effectiveness of a mini-open blind technique for carpal tunnel release (group A) when compared with a limited open technique (group B). From November 1999 to May 2001 (mean follow-up period, 30 mo) we performed 222 carpal tunnel release procedures on 185 consecutive patients. All patients were affected by mild to moderate median nerve compression. Patients in group A (82 patients, 99 procedures) had a short transverse incision at the wrist (length, 2 cm). We used a manual surgical instrument that helps in blindly dividing the flexor retinaculum because it has an integrated light source. The light makes it possible to locate precisely the tool blade by transillumination. Patients in group B (103 patients, 123 procedures) had a limited longitudinal incision (length, 3-4 cm). The preoperative and postoperative patient statuses were evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire with a mean of 30 months' follow-up after surgery (range, 24-39 mo). Group A patients showed better results than group B patients in all of the sections of the Italian modified version of the Boston Carpal Tunnel questionnaire at a mean follow-up period of 19 months, whereas after a mean of 30 months of follow-up evaluation the differences between groups A and B tended to decrease. Disease recurred in 7 group B patients, whereas only 1 patient in group A experienced symptom recurrence at the latest office evaluation. The blind mini-invasive technique has been shown to be as safe as traditional techniques but the recovery period is significantly shortened. With the technique we described a low recurrence rate was observed. All patients in group A reported great reduction in preoperative pain and numbness.

A fresh approach in the treatment of pectus excavatum

A method of evaluation of possible functional disturbances due to pectus excavatum is presented. With spirometric investigations and the bycicle exercise test in supine and upright position it is possible to distinguish between functional impairment caused by the deformity and a poor physical condition, which allows to select cases for osteoplasty or for augmentation. In a series of 17 cases the indication was psychosocial in 16 patients and only in 1 case was it functional. For masking the funnel deformity in situ polymerized Silastic RTV 382 is used which allows implantation by a short transverse incision over the xyphoid and gives satisfying results without undue complications.

Technical considerations of selective arteriography.

Elective visualization of branches of the aorta can be obtained by injecting contrast substance through a catheter placed in or near the selected artery. We began our experimental work with available intracardiac catheters. Using dogs, we promptly convinced ourselves that success hinges upon fluoroscopic visualization of a catheter tip having the proper curve. Moulded radiopaque catheters met these requirements. Preparation of Catheter: Catheter design needs to be individualized. Disposable catheters (KIFA) may be bent, punched, and sealed to meet the anticipated needs (4). The proper bend is obtained by heating the catheter containing the stylet over a steam bath (176° F.) and cooling in running water while maintaining the arc. Slight heating of the adaptor end will cause it to curl, facilitating the development of the collar. The flanging tool will finish the seat for the Luer-Lok adaptor. Sterilization may be accomplished by immersion in germicidal solutions or fumigation at 140° F. for three hours in ethylene oxide. Before the introduction of the catheter it should be thoroughly irrigated with sterile saline as well as rinsed externally. Lubrication with sterile mineral oil may facilitate its passage. Introduction of Catheter: The essential features for open exposure were developed by one of us (J. D.) following the observation that large needle punctures of arteries produced complications. Ödman's (2) report of 58 per cent incidence of minor complications with the percutaneous femoral route reinforced our determination to continue this method. The artery is exposed under local anesthesia and the adventitia stripped. Umbilical tape is looped about the vessel above and below the site for introduction of the catheter to regulate bleeding. It is important to exclude collaterals. The distal artery is injected with 0.2 per cent heparin solution. A short transverse incision is then made in the artery, the proximal tape is loosened, and the catheter containing the stainless steel stylet is advanced gently to the approximate origin of the desired vessel. With removal of the stylet, the curve at the tip is largely restored. A 30-c.c. syringe containing normal saline with 0.2 per cent heparin is attached to the catheter. It is usually fairly easy to control the bent tip with external rotation and to visualize fluoroscopically entry into the selected vessel. During injection the tip should not be in the artery. When the catheter is removed, continuous suction is maintained to insure removal of any tiny clots. The artery is repaired with 6–0 arterial silk. Visualization of Vertebral and Carotid Arteries: The catheter may be introduced through the brachial artery and placed near the origin of the vertebral and common carotid so that visualization of these vessels is distinct. Fluoroscopic control of the catheter is highly recommended.

Transmission of Neurohumors in Animals by Other Means Than Blood and Lymph

It has been assumed that the contraction or expansion of dermal melanophores in fishes whereby these animals take on a light or a dark tint is dependent upon substances carried in the animal's blood and lymph (Parker). Such an assumption appears to be justified by the fact that if a small amount of dissolved adrenalin is injected into the muscles of a dark chub, Fundulus heteroclitus, this fish within a quarter of an hour or less will become very light-colored. That the normal changes in tint shown by such a fish are brought about by other means than by dissolved substances carried in blood and lymph seems very probable from the following observations. If a short transverse incision is made in the tail of a light-colored Fundulus, a dark stripe extending from the cut to the posterior edge of the tail will quickly appear. This stripe will gradually become lighter and lighter till in a few days it is no longer distinguishable from the rest of the tail. The transverse cut severs a number of radiating nerve fibers that pass out into the fish's tail and the dark stripe itself represents an area of denervation thus produced. That this stripe should be dark is due to the fact that the severance of the nerve fibers excites the discharge of an expanding neurohumor whereby the melanophores are made to enlarge and thus to darken the skin. On placing a light-colored fish, whose stripe has become equally light-colored, on an illuminated dark background, the body of the fish will become fully dark in a little less than 2 hours. The stripe, however, will remain light-colored for some time, changing slowly to dark only in the course of a day to a day and a half.