One double-loaded suture anchor is sufficient for all-inside arthroscopic anterior talofibular ligament repair.

PURPOSE: All-inside anterior talofibular ligament (ATFL) repair using anchors is frequently used to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. It remains unclear whether there are differences in the functional results between the use of one or two double-loaded anchors. METHODS: This retrospective cohort study included 59 CLAI patients who underwent an all-inside arthroscopic ATFL repair procedure from 2017 to 2019. Patients were divided into two groups according to the number of anchors used. In the one-anchor group (n = 32), the ATFL was repaired with one double-loaded suture anchor. In the two-anchors group (n = 27), the ATFL was repaired with two double-loaded suture anchors. At the last follow-up time point, the Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports in both groups were compared. RESULTS: All the patients were followed up for at least 24 months. Improvement in the functional results (VAS, AOFAS, KAFS, ATT, and AJPS) were recorded at the final follow-up time point. No significant differences were observed regarding VAS, AOFAS, KAFS, ATT, and AJPS between the two groups. CONCLUSION: In patients with CLAI undergoing all-inside arthroscopic ATFL repair, the use of either one or two double-loaded suture anchors produces comparable and predictably good functional outcomes. LEVEL OF EVIDENCE: Level III.

A new recipient artery for reconstruction of soft-tissue defects in the lower limb with a free anterolateral thigh flap: the reversed descending branch of the lateral femoral circumflex artery.

BACKGROUND: Complex and severe leg defects remain a persistent challenge in reconstructive surgery, especially when no feasible local or regional flaps are available. An operative solution is yet to be found. The descending branch of the lateral circumflex femoral artery of the injured leg was used as the recipient artery in a reverse-flow fashion in these difficult wounds. METHODS: From March of 2005 to May of 2010, 11 male and four female patients with soft-tissue defects in the lower leg were treated. Causes of injury were industrial machinery injuries in six patients and traffic accidents in nine patients. Mean patient age at surgery was 36.6 years. The mean soft-tissue defect size was 17.6 × 7.4 cm, and the mean anterolateral thigh flap was 19.3 × 8.7 cm. The mean length of flap pedicles was 11.8 cm, and the mean length of recipient pedicles was 15.7 cm. RESULTS: Fourteen flaps survived completely. Partial necrosis at the distal edge of the flap occurred in one case. No patient needed operative revision due to postoperative thrombosis of the vessels. At the mean follow-up period of 10.5 months, wound coverage was achieved in all patients. CONCLUSIONS: The reverse descending branch of the lateral circumflex femoral artery is a reliable recipient artery for the free anterolateral thigh flap taken from the opposite thigh. The technique can be used to reconstruct defects in the lower leg when use of local or regional flaps is not feasible and commonly used recipient arteries are not available. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Repair of the soft tissue defects at legs with free tissue flap anastomosed with descendant branch of lateral femoral circumflex artery].

OBJECTIVE: To investigate the therapeutic effect of free tissue flap anastomosed with reverse descendant branch of lateral femoral circumflex artery for severe soft tissue defect at leg. METHODS: The severe soft tissue defect at leg, without any vessels for anastomosis of free tissue flap, was reconstructed with free tissue flap, which was anastomosed with proximal end of descendant branch of lateral femoral circumflex artery and great saphenous vein. From Oct. 2004 to Dec. 2009, 36 cases were treated with 15 cases of latissimus dorsi musculocutaneous flaps, 12 cases of anterolateral femoral flaps, and 9 cases of thoracoumbilicus flaps. RESULTS: All the 36 free flaps survived completely. The patients were followed up for 6 months to 2.5 years with good cosmetic results. CONCLUSIONS: It is effective and practical to repair the severe soft tissue defects at legs with the reverse descendant branch of lateral femoral circumflex artery to carry the free flaps.

[The reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion].

OBJECTIVE: To discuss the application of reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion. METHODS: From Jan. 2005 to Mar. 2008, 28 cases with degloved fingertip avulsion were treated with reverse flaps based on two dorsal metacarpal artery. The defects were located distal to the distant interphalangeal joints and were 0.8-2.2 cm in length. 10 defects was in the index fingers, 13 in the middle fingers and 5 in the ring fingers. 24 fingers were treated in an emergency surgery. 4 fingers were treated due to skin necrosis. RESULTS: Epidermal necrosis happened at the distal end of flaps in 3 cases. All the other flaps survived completely. 25 cases were followed up for 4-27 months with satisfactory cosmetic and functional results. The 2-points discrimination distance was 6.0-9.0 mm (average, 7.6 mm). CONCLUSIONS: The reverse flap based on two dorsal metacarpal artery is easily performed and reliable for degloved fingertip avulsion with satisfactory results.

[Repair of defects at the end of fingers with island flaps pedicled with digital artery].

OBJECTIVE: To investigate the therapeutic effect of island flaps pedicled with digital artery for the defects at the end of fingers. METHODS: 63 cases with 72 soft tissue defects at the end of fingers were treated with the island flaps. The flap size ranged from 8 mm x 11 mm to 21 mm x 27 mm. RESULTS: All the flaps survived completely. The follow-up period ranged from 4 to 19 months. The functional and cosmetic results were satisfactory. The two-point discrimination was 7 to approximately 9 mm. The TAM functional examination showed excellent in 59 fingers, good in 11 fingers and common in 2 fingers. CONCLUSIONS: The technique with island flap is simple and reliable for the defects at the end of fingers.