Endoscopic harvest of the gracilis muscle flap.

Endoscopic technique is becoming increasing prevalent in plastic surgery and is being explored for use in tissue harvest for microneurovascular transplantation. To advance the art truly, endoscopic technique must provide similar success and complication rates, operative time, and ease of performance as the traditional "open" surgical harvest. We report the successful microvascular transplantation in 6 patients of gracilis muscles harvested with endoscopic guidance. Dissection of the primary pedicle was done through a small proximal incision, and subsequent dissection was accomplished with an endoscope through the primary incision and a small distal incision. This method provides excellent success of transfer and decreased morbidity compared with the open technique. Specifically, the resulting scar from the endoscopic technique is considerably smaller, with just a 5-cm proximal and a 1.5-cm distal scar. The technique is accomplished with standard endoscopic equipment and is learned rapidly. We believe the improved aesthetic outcome makes endoscopic gracilis harvest a preferred technique.

Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.

From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.

How to examine a foot and what to do with a bunion.

The foot is a remarkable structure that provides stable support for the body, lessens impact loading during gait, and allows for forward motion that is energy efficient. Because of the enormous loads concentrated at the joints in the foot and ankle with normal activities, frequent injuries occur and present to the primary care provider. Systemic conditions and improper footwear also contribute to the number of foot injuries that require medical attention. This article provides the clinician with the practical tools necessary for a complete examination of the foot and ankle. This article also includes a practical approach to examination and diagnosis of the bunion deformity.

Common injuries of the foot. Often more than 'just a sprain'.

While most foot injuries heal without treatment, failure to recognize and treat some can have disastrous consequences. The exact mechanism of injury must be determined for accurate diagnosis. Many injuries, such as plantar fasciitis, "pump bump," sesamoiditis, and stress fractures, are the result of cumulative, repetitive stress rather than of an acute event. Others, such as injuries to tendons, may be chronic or acute. The foot is susceptible to numerous types of acute trauma, including sprains, fractures, dislocations, crushing, freezing, thermal injury, puncture wounds, and penetration by foreign bodies. Special care is required to minimize the danger of serious complications when treating foot injuries in diabetic patients.