Importance of the reconstruction of the extensor retinaculum after injury.

We reconstructed an extensive soft tissue defect of the dorsum of the left wrist after an injury using a free anterolateral thigh flap and a tendon graft, and intending to substitute the extensor retinaculum for the fascia in this flap. As a result, maximum function of the extension mechanism was restored to the reconstructed hand.

Distraction arthrolysis using an external fixator and flexor tenolysis for proximal interphalangeal joint extension contracture after severe crush injury.

PURPOSE: To introduce a technique for distraction arthrolysis with an external fixator followed by flexor tendon tenolysis for extension contracture of the proximal interphalangeal (PIP) joint after severe crush injury. We also assessed the results of this method in all patients treated. METHODS: Five fingers of 4 men with extension contracture of the PIP joint after severe injury underwent distraction arthrolysis using an external fixator, followed by flexor tenolysis. On the day of attaching the external fixator, moderate distraction was applied to the joint and the gap was widened to approximately 2 mm. From the following day onward, the PIP joint was gradually widened for 10 days until a gap of about 5 mm was attained. After sustaining this amount of distraction for 3 or 4 days, the fixator was removed. Passive range of motion was performed for about one week until swelling of the affected digit subsided. Then, flexor tenolysis was performed. Patients were follow-up for an average of 31 months after surgery. RESULTS: After tenolysis, the average improvement of active range of motion was 20 degrees, average gain of active flexion was 41 degrees, and average loss of active extension was 21 degrees. The average range of active motion was from 6 degrees to 38 degrees preoperatively, and from 27 degrees to 79 degrees postoperatively. The average median of active motion was 22 degrees preoperatively, and 52 degrees postoperatively. In all fingers, there was no significant difference in the total arc of active motion preoperatively and postoperatively, but there was a significant difference between preoperative and postoperative maximum active flexion. In all patients, painless motion was maintained and arthritic changes of the PIP joint did not worsen during the follow-up period. CONCLUSIONS: Distraction arthrolysis with an external fixator followed by flexor tenolysis was a useful treatment for our patients with extension contracture of the PIP joint and tendon adhesions after severe crush injury. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Prefabricated scalping forehead flap with skeletal support.

It is difficult to reconstruct a nose with adequate shape, color, and texture in patients who have full-thickness nasal defects with extensive loss of skeletal support. The scalping forehead flap is a reliable technique for nasal reconstruction. To our knowledge, however, there have been no reports about a prefabricated scalping forehead flap with a bone graft as skeletal support. In the case reported here, a prefabricated scalping forehead flap combined with an iliac bone graft as skeletal support was used to successfully reconstruct a full-thickness defect of the nose associated with partial frontal bone loss and complete loss of the nasal bones. Acceptable functional and aesthetic results were achieved. This method may be a good alternative for reconstruction of full-thickness nasal defects with extensive loss of skeletal support.