Single Longitudinal Incision Research Articles

Plate fixation with a single incisional approach in adjoining two metacarpal shaft fractures

Purpose: Multiple metacarpal shaft fractures are higher-energy injuries than single metacarpal shaft injuries and are considered relatively unstable because reduction is easily lost after splinting. However, few studies have been published on operative treatment because these fractures are rare. The aim of this study was to analyze the characteristics of this rare type of fracture and report the surgical outcomes. Methods: Medical records of patients with adjacent metacarpal shaft fractures who underwent surgery were retrospectively analyzed. In total, 20 cases were included in this study. A single longitudinal incision was made at the middle of the web space of affected metacarpal bones. Fractures were fixed using a plate and screws. The clinical results were evaluated by determining the metacarpophalangeal joint range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and hand grip strength at the final follow-up. Results: Among the patients included, there were fifteen male and five female patients. Their mean age was 41.2 years. The average range of motion of metacarpophalangeal joints was 78.1°. The average DASH score was 6.5. The average hand grip strength was 92.4% compared to the unaffected side. The mean time to union was 7.5 weeks. There were no cases of complications, such as soft tissue infections, joint stiffness, or extensor tendon injuries. Conclusion: Plate fixation through a single incisional approach performed for adjacent metacarpal shaft fractures showed satisfactory results. This could be a recommendable approach for two unstable adjoining metacarpal shaft fractures.

Fusiform Anastomosis Technique with a Single Longitudinal Incision in the Lacrimal Sac in External Dacryocystorhinostomy

In the present study, we aimed to evaluate the surgical outcomes of the fusiform anastomosis technique in external dacryocystorhinostomy (ex-DCR) that we designed in the form of a physiological tube, which sufficiently covered the bone ostium with the mucosa. This was a retrospective observational study that included 145 eyes of 131 patients who underwent ex-DCR due to nasolacrimal duct obstruction. The patients were divided into two groups. Group 1 included 73 eyes of 65 patients who underwent fusiform anastomosis, and group 2 included 72 eyes of 66 patients who underwent conventional anterior and posterior flap anastomosis. The open nasolacrimal passage with lacrimal irrigation and the absence of reflux were accepted as anatomical success, and the absence of epiphora symptoms was accepted as functional success. The groups were compared in terms of anatomical success, functional success, and granulation tissue formation. Anatomical success was observed in 73 eyes (100%) in group 1 and 66 eyes (91.6%) in group 2 (p = 0.01). Functional success was observed in 72 of 73 eyes (98.6%) in group 1 and 65 of 72 eyes (90.2%) in group 2 (p = 0.02). Nasal endoscopic examination performed in 32 eyes in group 1 and 28eyes in group 2 revealed that granulation tissue was observed in 7 of 28 eyes (25%) in group 2, while there were no eyes with granulation tissue in group 1 (p = 0.01). The fusiform anastomosis technique in ex-DCR provided excellent anatomical success and extremely good functional success.

One-year minimum follow-up results following distal biceps tendon repair using tension slide technique

Background Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. These tears are usually complete and the muscle is separated from the bone and retracted back, causing weakness in supination and mid-prone elbow flexion. We present our results of patients undergoing repairs of these tears using the tension slide technique through a single longitudinal anterior incision who were followed up for a minimum of 1 year. Patients and methods A total of 17 patients with acute distal biceps tendon rupture were treated surgically by two surgeons, at two independent centers, using the tension slide technique (Arthrex) between 2017 and 2019. Patients were evaluated retrospectively at a minimum of 1-year follow-up using the patient-reported outcomes Quick Disabilities of the Arm, Shoulder, and Hand (DASH), Oxford elbow score (OES) and EQ-5D-5L. Results The average age at the time of injury was 49 years. All patients were right-hand dominant. Eleven injuries were on the right and remaining on the left side. All patients were males, and there was no documented history of anabolic steroid use. The average time to surgery, following injury, was 6 weeks. The mean postoperative DASH score was 4.4, the average OES was 49.17, and mean European quality of life five dimension (EQ5D) Vas was 84. The elbow range of motion (ROM) was comparable to the healthy contralateral side. There were no reported major complications, although we did have two (11%) minor complications: one case with delayed wound healing and the second patient with a delayed infection, treated with oral antibiotics for 14 days. Conclusions The utilization of the tension slide technique for repair of acute distal tendon biceps rupture using Endobutton and interference screw is safe. The complications were minor, and the function was excellent as reflected with OES and DASH scores.

Minimally invasive approach in radio distal end fractures, three different types of incisions.

Two techniques are described to treat distal radius fractures: conventional (Henry approach) and minimally invasive plate osteosynthesis. The latter technique has been described by different authors such as Imatani et al. and Zenke et al.This was a descriptive retrospective study, analyzing 26 adult patients with unstable distal radius fracture, extra-articular type A or partially intra-articular type B according to AO. The approaches used were: (i) single longitudinal palmar incision; (ii) double T-incision (horizontal and vertical) and (iii) double position II.Ages were between 21 and 78 years. Most affected hand was the right. Most common fracture was 23B2 (AO classification). In total, 84.6% of the patients did not present complications. According to the functional evaluation of the wrist by the Mayo Clinic, 31% showed excellent results, 42% showed good results, 27% showed fair results.The techniques had satisfactory results for the osteosynthesis with more aesthetic and less invasive approach.

Intramedular transfer of the flexor digitorum brevis tendon for the correction of clawtoe/hammertoe deformity: A cross-sectional study

BackgroundA literature review did not reveal any studies concerning the intramedullary transfer of the flexor digitorum brevis tendons (FDB) technique with a single longitudinal incision through the proximal phalanx of the toes. The main goal of this investigation was to demonstrate whether the FDB tendons of the toes are long enough to enable intramedullary transfer to the dorsal area of the proximal phalanx. MethodsWe examined whether the technique would allow the surgeon to transfer the FDB tendons through the proximal phalanx of the toes. The technique transfers the FDB tendons through the proximal phalanx dorsal area of the toes using an intramedullary transfer of the FDB tendons. The intramedullary transfer of the FDB tendons was performed through a single dorsal incision. ResultsThe FDB tendons for the second, third, and fourth toes were performed in 100% of the feet. No ruptures in any toe in which the surgical technique was performed was noted, and no proximal phalanges of the second, third, and fourth toes were fractured. ConclusionsTransfer of FDB tendons via the intramedullary approach of the proximal phalanx of the second, third, and fourth toes is possible. The FDB tendons have sufficient length for transfer via an intramedullary transfer and were carried out in 100% of the second toes. For a successful transfer, it is essential to perform a thorough resection of the extensor digitorum longus aponeurosis since it has expansions intimately attached to the plantar base of the proximal phalanx of the toe.

The "FCR" Approach to the Knee for the Management of Posterior Tibial Plateau Fractures.

Three-column fixation of tibial plateau fractures is now an established philosophy. A direct posterior approach with the patient prone affords enhanced exposure of the posterior column and ease of access for fixation using a buttress plate and posterior-to-anterior screws. A "direct posterior" approach through a reverse L-shaped incision to back of the knee is popular, yet complications associated with raising a fascial flap can occur. We present a simple method of conceptualizing a direct posterior approach through a single longitudinal incision, by likening it to a commonly performed orthopedic approach, the flexor carpi radialis approach to the wrist.

Single medial approach for the treatment of Schatzker IV tibial plateau fractures

Objective Try to treat the Schatzker Ⅳ tibial plateau fractures with a single medial approach. Methods A single medial longitudinal incision was used to treat 16 cases of Schatzker type Ⅳ tibial plateau fractures admitted to hospital from January 2013 to January 2016 which diagnosed by computed tomography (CT). The range of peeling up to the anterior edge of the tibia, the back side skipping over the posterior bone crest to expose the Posterior surface, persisting the joint capsule and the medial collateral ligament, and the far end reached 3-5 cm beyond the fracture line. As the lower limbs in the situation of external rotation with hip and knee flexion, open the medial fracture, using a strutting forceps to brace the bone block, made out he collapsing cartilage and subchondral bone which belong to de back column, Using the detacher to lift the subchondral bone together with the cartilage surface, lift up to the lateral side until it can’t be raised again, fixed them with 2-3 Kirschner-pins of 1.5 mm-diameter. And then used a large C type Matta forceps to clamp the fracture line for recovering the width of tibial platform. A Tomofix plate was used to fix the fracture in the position of posterior bone crest. The intercondylar eminence fracture of the anterior cruciate ligament was fixed under direct vision, and the supporting plate was placed in the posterior medial wall to fix the posterior medial small fracture. The standard X-ray films of bilateral knee joint were taken and compared after the operation. The knee joint activity was measured at 1 year follow-up after 1 years. The healing of subchondral fracture and no secondary collapse were performed by plain scan, and the function of the knee joint was evaluated by Lysholm scoring system. Results 15 cases were followed up for more than 1 years. All the X-ray showed fracture healing at half a year. CT confirmed that the fracture healed completely at the time of reexamination. The condylar crest avulsion fracture healed well, there was no secondary cartilage surface collapse, no obvious osteoarthritis, the average knee joint activity was 118°, and the average of Lysholm score was 87. Conclusion Combined approach is an effective method for the treatment of complex tibial plateau fractures, but for Schatzker Ⅳ fractures, a good reduction can be achieved with a single medial approach combined with some proper tools. Key words: Tibial plateau fractures; Medial approach; Schatzker Ⅳ

The minimally invasive approach for distal radius fractures and malunions.

This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics. It is mainly indicated for extra-articular and simple intra-articular fractures of the distal radius. Relative contraindications are comminuted articular fractures in elderly osteoporotic patients. Functional and radiological results are comparable with those obtained with an extended flexor carpi radialis approach. My colleagues and I have used it for more than 2000 cases since 2012. This technique requires practise. Attempted conversion to a larger incision is possible in case of difficulty, but this is seldom necessary.

There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder.

The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder. Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34-61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. The mean follow-up duration was 30.4 (range, 13-72) months. The mean shoulder score significantly improved from 69.7 (range, 58-80) points before surgery to 97.8 (range, 89-100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3-dimensional computed tomography. Satisfactory clinical and radiological outcomes can be expected after reliable removal of calcific deposit through a single longitudinal incision and side-to-side repair with strong sutures, in association with an appropriate rehabilitation program.

Résultats de l’ostéosynthèse par plaque antérieure et abord mini-invasif (MIPO) des fractures de l’extrémité distale du radius : mise au point

Minimally invasive plate osteosynthesis (MIPO) has been used in recent years to treat fractures of the distal radius with volar locking plates. Its advantages are the preservation of the pronator quadratus and good esthetics. The MIPO technique was described originally with two incisions: one distal transverse or longitudinal incision and one proximal longitudinal incision. The trend is now to use a single longitudinal incision less than 20mm long. Functional and radiological outcomes are comparable to those of conventional techniques. The MIPO technique is indicated for extra-articular and intra-articular fractures. Arthroscopy may be used concurrently in the latter case. When the distal radius fracture is associated with a proximal shaft fracture, a double incision is needed to introduce a longer plate. The relative contraindications of the MIPO technique are comminuted intra-articular fractures in osteoporotic elderly patients. If reduction is problematic, a larger incision can easily be made.

Anatomical and clinical study of a novel anterial cubital approach for ulnar coronoid fractures

Objective To investigate the feasibility of a noval anterior cubital approach for the coronoid via flexor-pronator teres interval and assess the clinical result. Methods Five formalin-fixed adult cadaver elbows were used. Through a single universal anteromedial longitudinal skin incision, the coronoid tip was exposed via pronator and flexor carpiradialis interval, and coronoid anteromedial facet and base via palm longus and flexor carpi ulnaris interval. The distances from the entry point to the muscles or branching point of the nerves to the line passing through medial and lateral epicondyles, as well as the length were measured with regard to the motor nerve branches arising from median nerve to pronator teres, flexor carpiradialis, palm longus and flexor digiti superficialis, as well as the most proximal two motor branches to flexor carpi ulnaris arising from ulnar nerve. From September 2013 to August 2014, 4 male patients with ulnar coronoid fracture were treated operatively through the above anterior cubital approach in our hospital. They were all left side involved, with an average age of 32 years (range, 16-42 years). According to O'Driscoll classification, there were two cases of type Ib and two cases IIb respectively. They were all treated by open reduction and internal fixation through flexor-pronator teres interval. Results At cubital fossa, there were 2-3 branches to the pronator teres mostly, 1 branch to flexor carpiradialis and palm longus arising from median nerve. The branch to the flexor digiti superficialis usually was long and thick, and divided into 2-5 short twigs near muscle. The branch to palm longus had the same trunk with that to flexor digiti superficialis. The branch to flexor digiti superficialis was the most proximal among those passed through the interval of pronator teres and flexor carpiradialis, and its entry point to the muscle had an averaged distance of 37.22 mm to the line passing through medial and lateral humeral epicondyles. It was optimal to expose coronoid tip through the interval of pronator teres and flexor carpiradialis. It was safe to expose coronoid proximal to the branch to flexor digiti superficialis. While, it was better to expose the anteromedial facet and base of corocoid through the interval of palm longus and flexor carpiulnaris via median and ulnar nerve interface. All of the four patients were followed up for an average period of 9 months. They all achieved bone union from 6 weeks to 3months (mean, 9 weeks). All the patients obtained excellent result according to the modified An & Morrey elbow performance index with scores from 94 to 100. Conclusion The novel anteromedial cubital approach via flexor-pronator teres is optimal for exposure of coronoid. Key words: Ulna; Fractures, bone; Fracture fixation, internal

A Pilot Study Reporting Outcomes for Melanoma Patients of a Minimal Access Ilio-inguinal Dissection Technique Based on Two Incisions

A modified procedure for ilio-inguinal regional lymph node dissection (I-I RLND) involving 2 small skin incisions was evaluated with the aim of assessing surgical and oncological noninferiority compared with the traditional single, longitudinal incision I-I RLND. A total of 20 melanoma patients with positive groin lymph nodes who had traditional I-I RLND were compared with 20 patients who had a minimal access I-I RLND using 2 small surgical access incisions of 3-6 cm in length--one sited below and one above the inguinal ligament. Clinical, staging features, number of lymph nodes retrieved, length of hospital stay, time drains remained in situ, morbidity (wound infections, dehiscence, hematoma, seroma, and lymphedema), and disease free survival were compared. Patients in the groups were comparable with the exception that the minimal access I-I RLND group had a higher rate of AJCC stage N3 disease (60% vs 20%; P = .03) and more cases with extranodal spread (45% vs 15%; P = .041). After a median follow-up of 5 months (range 1-8) for the minimal access group and median 13 months (range 1-30) for the standard group there were no differences in disease-free survival (P = .13). Retrieved lymph node counts were similar (P = .34) including for the inguinal and pelvic components of the operations separately. No significant differences in wound complications or rates of early lymphedema were observed. At early follow-up, minimal access I-I RLND is feasible and noninferior to single longitudinal incision I-I RLND in regard to surgical morbidity and oncological outcome. Further evaluation is progressing.

MECHANICAL RESISTANCE OF THE PATELLAR LIGAMENT AFTER REMOVAL OF THE MIDDLE THIRD THROUGH EITHER ONE LONGITUDINAL INCISION OR TWO MINI-TRANSVERSE INCISIONS

Objective: To evaluate the resistance and regeneration of the patellar ligament after harvesting a graft for reconstruction of the anterior cruciate ligament, using the traditional technique of a single longitudinal skin incision or a technique of two transverse mini-incisions, in sheep. Methods: Ten sheep were used. In the right knee, we removed the graft using the traditional method, and in the left knee, using the two-incision method. The animals were observed for six months. The specimens (patellar ligament, tibia and patella) were adapted to the mechanical test machine for ligament resistance tests. Results: No difference was found between the two proposed techniques in relation to the regeneration and resistance of the patellar ligament. However, we observed that shortening of the patellar ligament occurred in both groups, and that suturing of the superficial fascia of the patellar ligament did not influence the regeneration of the patellar ligament, according to the histology. Conclusion: The technique using two incisions in the skin presents the same patterns of regeneration and resistance of the remaining patellar ligament as shown by the traditional technique of a single, longitudinal incision.

Single Port Access Adrenalectomy

To report the first single port access (SPA) adrenalectomy to minimize patient discomfort through a less invasive procedure. We performed the first SPA in a 63-year-old, otherwise healthy Caucasian female who had a 4.5-cm left adrenal mass that was incidentally discovered on computed tomography scan of the abdomen and pelvis. Through a 2-cm single longitudinal supraumbilical incision extended down to the abdominal fascia, three 5-mm ports were placed through separate facial entry points, to make a triangular port arrangement. The adrenal vein was identified and ligated using hemoclips. The remainder of the dissection was done using hemocoagulation. The adrenal gland was extracted via an EndoCatch bag device by removing one 5-mm port and upsizing to a 12-mm port. We report on the first SPA adrenalectomy. Although this technology is still in its infancy, the use of a single port for surgery provides a means to provide a potentially better patient outcome with a less invasive procedure.

Two transverse versus single longitudinal incisions for patella tendon harvest in anterior cruciate ligament reconstruction

The bone–patellar–bone autograft is the most commonly used graft in anterior cruciate ligament (ACL) reconstruction surgery. However, harvesting of the graft is associated with various local complications. Harvesting the graft via two transverse incisions rather than one longitudinal incision lowers the risk of injury to the infrapatellar branch of the saphenous nerve. Retrospective review of prospectively collected data. We compared the results of 38 consecutive patients who underwent arthroscopic ACL reconstruction between 12 and 20 months postoperatively. Group A (n = 16) consisted of patients in whom a single longitudinal incision had been used. Group B (n = 22) consisted of patients in whom harvest had been via two transverse incisions. The mean area of diminished sensation in Group A was 60.48 cm2, range 0–195, and in Group B was 32.19 cm2, range 0–132 (P = 0.028, t-test). The width and pigmentation of the scars were significantly less with the two transverse incisions technique. There was no significant difference between the two groups in any other tested parameter. The use of two transverse incisions was associated with a reduced area of altered sensation and objective evidence of a more cosmetically acceptable scar. We advocate the routine use of the two transverse incisions technique for graft harvest in ACL reconstructive surgery.

Management of floating knee

Dear Editor, We have read with great pleasure the article entitled “Ipsilateral fractures of tibia and femur or floating knee” [1]. We would like to congratulate the authors for evaluating the issue very well. They have definitely made a great contribution to the relevant literature on intramedullary (IM) nailing. IM nailing has become the gold standard to stabilise these fractures in immediate or delayed settings [2]. We would like to say that it is an era of “limb damage control orthopaedics,” which must be considered when dealing with polytrauma patients. During the 1990s it was advocated that the adverse outcome of fracture surgery, especially IM nailing, had systemic physiological effects known as “second-hit phenomena.” A major concern being to decrease second-hit phenomena, a more selective approach to fracture fixation was used; however, early fixation was still performed in most cases. This phenomenon, which particularly increases with reamed IM nailing in polytrauma patients, results in increased chances of pulmonary complications [3, 4]. We would like to draw the authors’ attention to the fact that they have not mentioned the approach for IM nailing. We suggest use of a single longitudinal incision over the knee for retrograde nailing of femur and antegrade nailing tibia in a single session with the advantage of decreasing the operative time and morbidity while obtaining equally good results [5].

Posttraumatische Ellenbogengelenksteife - offene Arthrolyse über dorsale Inzision („global approach“)

27 Patienten nach offener Ellenbogengelenkarthrolyse wurden im Mittel 21 Monate postoperativ (Minimum 12 Monate, Maximum 33 Monate) klinisch nachuntersucht. In allen Fällen erfolgte die Operation über eine dorsale Längsinzision mit Darstellung und primärer Schonung der Seitenbänder. Anteriore und posteriore Kapselektomien wurden bei 26 Patienten durchgeführt. Ein dynamischer gelenküberbrückender Bewegungsfixateur wurde bei 4 Patienten bei Instabilität verwendet. Das mittlere präoperative Flexionsausmaß von 109° wurde auf durchschnittlich 136° verbessert. Der Gesamtbewegungsumfang Flexion/Extension lag präoperativ bei 59° und wurde auf 112° verbessert, die Unterarmrotation lag präoperativ bei 118° und postoperativ bei 159°. Die Verbesserungen der Bewegungsausmaße waren statistisch signifikant (t < 0,005). Der präoperative Mayo Elbow Performance Score (MEPS) wurde von 60 auf 85 zum Zeitpunkt der Nachuntersuchung verbessert (p < 0,05). Alle Patienten hatten eine verbesserte Ellenbogengelenkbeweglichkeit und verminderte Schmerzen entsprechend des MEPS. An postoperativen Komplikationen traten heterotope Ossifikationen, milde symptomatische postero-laterale rotatorische Instabilität bei einem Patienten und ein Pin-Infekt auf. Keinerlei Komplikationen traten im Zusammenhang mit der dorsalen Hautinzision auf. Die dorsale Hautinzision erlaubt eine globale Darstellung der betroffenen Strukturen bei posttraumatischer Ellenbogengelenksteife. Die Arthrolyse über diesen Zugang ist erfolgversprechend und sicher. Die Armfunktion und Ellenbogengelenkbeweglichkeit können gut verbessert werden und eine Schmerzreduktion tritt ein. Die Patientenzufriedenheit dieses Eingriffes ist sehr hoch.

Patellar tendon graft harvesting using horizontal incisions for anterior cruciate ligament reconstruction.

Autograft endoscopic anterior cruciate ligament (ACL) reconstruction traditionally has been performed via standard arthroscopy portals and a single longitudinal anterior incision. This vertical incision is used for harvesting the central third of the patellar tendon with patellar and tibial bone blocks. From 1992 to 1995, more than 400 cases have been done with a new technique of graft procurement. This new method employs two transverse incisions that are more cosmetic and are less likely to become a source of pain or flexion limitation.

Simplified subxiphoid placement of implantable cardioverter defibrillators using a posterior rectus pocket

A simplified subxiphoid procedure using a single longitudinal epigastric incision and posterior rectus pocket for implantable cardioverter defibrillators was used in 100 patients. Through a single incision, ventricular patches are placed via a transverse pericardiotomy, and a pouch is created behind the rectus abdominis muscle in the left upper quadrant for placement of the implantable cardioverter defibrillator. Patients have minimal discomfort soon after operation, and the implantable cardioverter defibrillator generator is imperceptible to most.