Simplified soft tissue coverage of the distal lower extremity: The reverse sural flap.

Soft tissue defects involving the distal lower extremity present challenging problems for orthopaedic surgeons to manage. Historically, wounds not amenable to primary closure have necessitated assistance from multidisciplinary teams using plastic surgeons to obtain adequate soft tissue coverage through rotational flap or free tissue transfer procedures. Techniques related to soft tissue rearrangement and local rotational flap coverage have advanced over the years with a growing knowledge of local anatomy and vasculature. The reverse sural flap may be performed to cover soft tissue defects within 10 cm of the foot or ankle region, negating the need for microvascular intervention. The simplistic nature of the reverse sural flap is appealing to orthopaedic surgeons as a means to provide timely patient care without additional support because it does not require microvasculature work or the need for intraoperative microscopes and has been popularized among orthopaedic trauma surgeons as a necessary tool to possess. Here, we discuss the reverse sural flap to include history, relevant anatomy, clinical indications, and a description of the technique for application.

Tibial Bone Transport With a Single Implant All-Internal Bone Transport Nail.

SUMMARY: A single implant all-internal magnet-driven bone transport nail (BTN-NuVasive Specialized Orthopaedics Inc) has recently been introduced as a treatment method for segmental tibial bone defects. This innovation provides promise in the management of segmental bone defects because it negates numerous complications associated with circular external fixation and the need for multiple implants when considering hybrid plate-assisted bone segment transport constructs. Given the novelty of the BTN, description of the surgical application and patient outcome measures are scarce in the current literature. To date, we have treated 4 patients with an average age of 27 years (range 19-44 years) using the BTN for segmental tibial defects ranging from 50 to 128 mm. We have accumulated data over an average follow-up of 18.07 months (range 12.96-25.13 months), demonstrating good patient tolerance of the device. Three patients successfully completed their treatment course with a calculated average bone healing index of 41.4 days/cm (range 31.41-54.82 days/cm). One patient was noted to experience an asymptomatic docking site nonunion requiring subsequent surgery for nonunion repair. Implant-associated complications included symptomatic implant, axial malalignment, docking site nonunion, and external remote control technical malfunction. Injury-related complications were encountered and noted to include: superficial infection, wound dehiscence, peroneal tendonitis, and joint rigidity. In this study, the authors present a case series using this implant to date and discuss our experiences with the BTN with reference to clinical indications, tibial bone preparation, BTN implantation, transport protocol, docking site procedure, and clinical/radiographic outcomes.

Variant Salter-Harris Type III Distal Ulna "T" Fracture in the Setting of Galeazzi Equivalent Wrist Injury: A Case Report.

CASE: An 11-year-old Caucasian boy presented to the emergency department with a displaced, closed, Galeazzi equivalent (GE) left wrist fracture sustained after a fall. Closed reduction was deemed unsatisfactory because of persistent displacement of the distal ulna epiphysis. An open reduction of the distal ulna and percutaneous fracture pinning was performed. At 1 year, the patient reported return to his preinjury baseline. No evidence of subsequent pathologic growth was detected on follow-up imaging. CONCLUSION: Open anatomic reduction of the distal ulna epiphysis and percutaneous fracture pinning may improve patient outcomes and limit progressive wrist deformity when treating GE wrist injuries.

Posttraumatic Soft Tissue Coverage of the Lower Leg for the Orthopedic Surgeon.

Soft tissue reconstructive techniques are powerful tools for the orthopedic surgeon caring for lower extremity trauma. This article seeks to inform orthopedic surgeons about useful techniques for skin closure, secondary wound closure techniques, and rotational flaps of the lower leg. Split thickness skin grafting, piecrusting, and the use of negative pressure wound therapy for skin closure, as well as rotational gastrocnemius, soleus, and reverse sural artery flaps are discussed with emphasis on techniques for the nonvascular and nonmicrovascular orthopedic surgeon.

A Computational and Experimental Study of Thieno[3,4-b]thiophene as a Proaromatic π-Bridge in Dye-Sensitized Solar Cells.

Four D-π-A dyes (D=donor, A=accpetor) based on a 3,4-thienothiophene π-bridge were synthesized for use in dye-sensitized solar cells (DSCs). The proaromatic building block 3,4-thienothiophene is incorporated to stabilize dye excited-state oxidation potentials. This lowering of the excited-state energy levels allows for deeper absorption into the NIR region with relatively low molecular weight dyes. The influence of proaromatic functionality is probed through a computational analysis of optimized bond lengths and nucleus independent chemical shifts (NICS) for both the ground- and excited- states. To avoid a necessary lowering of the TiO2 semiconductor conduction band (CB) to promote efficient dye-TiO2 electron injection, strong donor functionalities based on triaryl- and diarylamines are employed in the dye designs to raise both the ground- and excited-state oxidation potentials of the dyes. Solubility, aggregation, and TiO2 surface protection are addressed by examining an ethylhexyl alkyl chain in comparison to a simple ethyl chain on the 3,4-thienothiophene bridge. Power conversion efficiencies of up to 7.8 % are observed.