Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest.

BACKGROUND: The groin flap has been relied upon for more than 4 decades and is well suited for reconstruction of the mutilated hand. Classic groin flap harvest is subfascial and includes the superficial circumflex iliac artery (SCIA). SCIA perforator flaps have shown that one perforator is sufficient to supply a large flap without breaching fascia. Accordingly, we routinely preserve the fascia and rely wholly on the superficial branch of the SCIA, sparing the deep branch. We aim to investigate the safety of suprafascial flap elevation and encourage a paradigm shift in reconstruction with groin flap transfer. METHODS: Between 2008 and 2013, 77 hand injuries were treated with pedicled groin flap transfers. According to surgeons' preference, 49 flaps were elevated with conventional technique ("subfascial") and 28 were harvested with suprafascial approach ("fascia sparing"). Demographic data including flap size, operative time, and outcome were reviewed in both approaches and compared. RESULTS: Suprafascial flaps were taken as large as 32 × 12 cm2 and subfascial flaps large as 30 × 10 cm2 (p = 0.08). Operative time was 268.2 ± 104.7 minutes in the suprafascial group and 227.4 ± 89.0 in the subfascial group (p = 0.14). One suprafascial flap (3.6%) had partial necrosis compared to four subfascial flaps (8.2%) (p = 0.65). All patients were followed for a minimum of six months. All the wounds finally healed without further flap reconstruction, and all the patients were back to the normal life with activities. CONCLUSION: Suprafascial dissection is safe and does not adversely influence outcomes. Thinner flaps are expected to facilitate flap insetting and reduce revisionary debulking surgery. LEVEL OF EVIDENCE: III (Therapeutic).

The Influence of Paranasal Augmentation on the Measurement of the Nose for the Treatment of Midfacial Concavity.

BACKGROUND: A concave midface with its associated deep nasolabial folds is more aesthetically displeasing than a convex midface. Midfacial concavity may be addressed with autologous tissue and implants. OBJECTIVES: The aim of this study was to determine the effect of paranasal augmentation on photogrammetric parameters. METHODS: Between July 2013 and August 2016, 12 patients underwent paranasal augmentation to address midface concavity. Augmentation was performed with autologous rib cartilage, autologous mandibular bone, or preshaped porous polyethylene (PPE). All operations were performed through the upper gingivobuccal approach. Twelve patients who underwent malar reduction using the same approach acted as a control group to account for the influence of the approach on soft tissue change. Preoperative and postoperative measurements were made photogrammetrically. RESULTS: The average follow-up period was 12.8 months (range, 5-30 months) for both groups. The mean thickness of augmentation grafts was 5.18 mm (range, 3-7 mm). Alar width and alar base width increased 4.84% (P = 0.01) and 7.66% (P = 0.01), respectively. The nasolabial angle increased from 97.2°to 103.6° and the columellar inclination increased from 116.0° to 119.1° but neither were statistically significant. Photogrammetric parameters did not change significantly in the control group. Partial wound dehiscence occurred in one case. There was greater postoperative increase in alar width (P = 0.020), alar base width (P = 0.024), and nasolabial angle (P = 0.033) in the experimental group compared to the control group. CONCLUSIONS: Paranasal augmentation using PPE or autologous material generates measurable soft tissue changes designed to enhance paranasal aesthetics.

Silicone-Polytetrafluoroethylene Composite Implants for Asian Rhinoplasty.

BACKGROUND: Silicone and Gore-Tex implants are mainstays of Asian rhinoplasty. Silicone implants are inexpensive and wieldy, but may elicit a foreign-body reaction and are prone to migration. Gore-Tex implants are more biocompatible and capable of ingrowth but expensive. Silicone-polytetrafluoroethylene (PTFE) composites have a silicone core and PTFE liner. Composite implants have been marketed for several years, but are not yet established alternatives for rhinoplasty because of a lack of relevant reports. METHODS: From February 2012 to June 2015, 177 Asian patients underwent primary (n = 63) or secondary (n = 114) rhinoplasty using an I-shaped composite implant. One hundred fifty-nine women and 18 men were 19 to 72 years old (mean, 34 years) at the time of surgery. Composite implants were 1.5 to 5 mm thick and 3.8 to 4.5 cm long. Autologous cartilage from the septum, concha, or both was used for tip refinement in every case. Glabellar augmentation was performed in 19 (10.7%) cases. RESULTS: Follow-up was 6.0 months (range, 1-36 months). There were 19 (10.7%) complications including malposition/deviation (4.5%), erythema (2.3%), and infection (1.1%). Four patients were unsatisfied, citing inadequate dorsal height correction. There was an 8.8% revision rate; 7 of 12 revisions were for malposition/deviation. We did not observe implant step-offs or extrusion. There were no differences in outcomes after primary or secondary rhinoplasty, although there was a trend toward higher infection rate after primary rhinoplasty (P = 0.06). CONCLUSIONS: I-shaped silicone-PTFE composite implants are feasible for both primary and secondary augmentation rhinoplasty in Asians. Early outcomes data suggest an overall complication rate that is comparable to PTFE alone.

Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps.

BACKGROUND: Complications arising from anastomotic failure may occur after pharyngoesophageal reconstruction. In this report we present results of pharyngoesophageal reconstruction with free thigh flaps using a refined design and inset strategy in a series of patients. METHODS: From May 2011 to December 2012, pharyngoesophageal oncologic defects were reconstructed in 12 men using thigh flaps. Flaps were designed to exceed defect circumference to allow draping of the excess over injury-prone vessels (so-called delta-inset). Patients were 39- to 68-years-old (mean, 51.8-years-old) at the time of surgery. BMI ranged from 17 to 28 kg/m2 (average, 21.5 kg/m2 ). The sites of defects were the hypopharynx in 11 cases and the pharynx in 1 case. Ten anterolateral thigh (ALT) flaps and 2 anteromedial thigh (AMT) flaps were used. All patients underwent radiation therapy. RESULTS: The average flap size was 22 × 9 cm (range: 16-26 × 7-11 cm2 ). There were no partial or total flap losses, and no donor site complications. Follow-up was 19.3 months (range: 2.4-21.6 months) including 8 patients (75%) who succumbed to disease in the follow-up period. Oral intake was achieved in all patients. Recipient site complications occurred in 50% of cases and included fistula (2 cases), fistula and stricture (2 cases), stricture (1 case), and lymphocele (1 case). Four patients required revision for fistula. CONCLUSIONS: A refined thigh flap design and inset method in pharyngoesophageal reconstruction may circumvent complications arising from toxic drainage and vascular injury. However, there are insufficient data to make meaningful comparisons to alternative methods. © 2015 Wiley Periodicals, Inc. Microsurgery 37:112-118, 2017.

Proposed pathway and mechanism of vascularized lymph node flaps.

OBJECTIVE: To investigate the pump mechanism and pathway of lymph transit in vascularized lymph node flaps. BACKGROUND: Microsurgical treatment of lymphedema with vascularized lymph node transfer can improve signs and symptoms of disease, but the pathways and mechanisms of these flaps warrant further exploration. METHODS: (Animal model) 72 flaps were raised in 18 rats: 36 groin flaps contained lymph nodes (LN), 36 deep inferior epigastric artery perforator flaps did not (non-LN). Indocyanine green (ICG) was added into normal saline (NS), 1%, 3%, 5%, 7% and 10% albumin. Three rats were assigned to each group. LN and non-LN flaps were submerged in solution and surveyed for venous fluorescence. In the 7% albumin and NS groups, volumetric change of solution was measured. (Human model) A similar experiment was performed in humans using five submental LN flaps. RESULTS: (Animal model) Fluorescence was detected in the venous pedicle of LN flaps submerged in 5%, 7% and 10% albumin, and half of flaps submerged in 3% albumin. Fluorescence was not detected in LN node flaps submerged in ICG-containing NS or 1% albumin solution. Fluorescence was not detected in non-LN flaps. There was greater volume reduction with LN flaps than non-LN flaps (p<0.001). (Human model) Fluorescence was detected in the venous pedicle of all flaps immersed in lymph. CONCLUSIONS: ICG fluorescence was detected in the venous pedicle of rat and human LN flaps submerged in lymph or albumin when the concentration was greater than 3%. Based on these results, a pathway for lymphatic uptake is presented.

An Algorithm for Forefoot Reconstruction With the Innervated Free Medial Plantar Flap.

BACKGROUND: Because of shearing forces, the forefoot is more prone to trophic ulcers than the heel. Reconstruction of trophic ulcers and other forefoot defects is a vexing challenge. We favor the innervated free medial plantar flap to replace like-with-like and confer protective sensation. We investigate the feasibility of this flap with the largest series to date and the first to describe ipsilateral flap transfer. METHODS: Between 2009 and 2013, 7 patients with forefoot defects were treated with innervated free medial plantar flaps. The average age of 4 men and 3 women was 35.1 years (range, 8-50 years). Indications were secondary reconstruction after trauma and coverage of oncologic defects. The mean defect was 5 × 7 cm (range, 4-6 cm × 6-10 cm). Four patients were treated with contralateral flaps and 3 with ipsilateral flaps using interposition vein graft. RESULTS: The mean flap size was 8.1 ± 1.6 cm × 5.9 ± 1.2 cm. There was no perioperative complication, venous congestion, or arterial insufficiency. Patients were followed clinically for 38.5 months (range, 6 months to 10 years). One patient died from complications of metastatic disease 7 months after plantar flap reconstruction. Two patients underwent sensory testing and gait analysis. The appearance was satisfactory, ambulation returned to normal, and there was protective sensation in every case. In 2 cases, hyperkeratotic tissue was excised in revision procedures. CONCLUSIONS: The innervated free medial plantar flap is an attractive and feasible option for coverage of medium-to-large defects of the plantar forefoot in the hands of a skilled microsurgeon. It has a place in our algorithmic approach to forefoot reconstruction.

Donor Site Aesthetic Enhancement With Preoperative Botulinum Toxin in Forehead Flap Nasal Reconstruction.

BACKGROUND: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. METHODS: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). RESULTS: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type A was assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1%. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A-treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients × 4 observers), there were 73 instances (70.2%) where the experimental VAS score was higher than the control. CONCLUSIONS: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps.

Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making.

The distally based, venous supercharged anterolateral thigh flap.

The distally-based anterolateral thigh flap is an attractive option for proximal leg and knee coverage but venous congestion is common. Restoration of antegrade venous drainage via great saphenous vein supercharge to the proximal flap vein is proposed. The purpose of this study was to evaluate and compare outcomes of 18 large, distally-based anterolateral thigh flaps with and without venous augmentation on the basis of flap size, venous congestion, and clinical course. The average age of 12 men and 6 women was 35.9-year old (range, 16-50 years old). Wounds resulting from trauma, burn sequela, sarcoma, and infection were localized to the knee, proximal leg, knee stump and popliteal fossa. The mean defect was 17.6 × 9.4 cm(2) (range, 6 × 7 cm(2) to 22 × 20 cm(2) ). The mean flap size was 21.4 × 8.8 cm(2) (range, 12 × 6 to 27 × 12 cm(2)). There were 14 cases in the venous supercharged group and 4 cases in the group without supercharge. The mean size of flaps in the venous supercharged group was significantly larger than that in the group without supercharge (22.6 ± 3.8 × 9.1 ± 1.7 cm vs. 17.5 ± 4.4 × 7.8 ± 1.7 cm, P = 0.03). Venous congestion occurred in all four flaps without supercharge that lasted 3-7 days and partial flap loss occurred in two cases. There was no early venous congestion and partial flap loss in supercharged flaps but venous congestion secondary to anastomotic occlusion developed in two cases. Early exploration with vein grafting resolved venous congestion in one case. Late exploration in the other resulted in flap loss. Preventive venous supercharge is suggested for the large, distally-based anterolateral thigh flap.

The Pi Graft for Correction of Severe Saddle Nose Deformity.

Saddle nose deformity is challenging because there is both aesthetic and functional compromise, and high rates of recurrence have been reported. Autologous costal cartilage is the widely preferred medium for reconstruction, but there may be room for improvement in the configuration of the cartilage struts. The pi graft is stabilized at two points, proximally and distally, distinguishing it from the traditional L-strut. Indications include severe (Types III and IV) saddle nose deformity with collapse of the mid-vault, and recurrence after prior reconstruction. Costal cartilage is harvested and three struts are crafted to make the foundation layer: a dorsal strut, caudal strut, and mid-vault strut. An aesthetic layer is composed of a carefully crafted dorsal graft and tip graft. Three men and 11 women were treated from 2013 to 2015 using this method for severe saddle nose deformity. Aesthetic and functional outcomes were evaluated. Patients were followed up for 12 months (range, 8-14 months). There was no recurrence of deformity or warping of the aesthetic or foundation layers. All patients were guided to anticipate refinement of the tip at 3 months to ease the burden on the skin envelope in stage I, but only five patients (35.7%) opted for it, as the remaining patients were satisfied with their appearance. The pi graft is a composite reconstructive method that is designed to minimize warping and recurrence of the saddle nose deformity. This method was successful in this series, although objective comparisons with traditional methods were not made.

An Economical Approach to Ethnic Asian Rhinoplasty.

Septal cartilage is deficient in Asians seeking augmentation rhinoplasty. Economized utilization of resources is necessary for durable tip enhancement that complements a dorsal implant. We introduce a modified tongue-in-groove method designed to transmit forces across the dorsum, eliminating the need for robust caudal support and prioritizing nasal lengthening and tip projection. We aim to promote the roundness index parameter and demonstrate the feasibility of a novel method in the context of Asian rhinoplasty. Between 2012 and 2014, a total of 104 Taiwanese patients underwent rhinoplasty with dorsal augmentation and lengthening with a modified tongue-in-groove technique. The concept borrows from methods established by Byrd, Guyuron, and Toriumi but distinguished by exaggerated forward positioning of a septal extension graft. Paired extended spreader grafts obviate the need for a columellar strut. Soft-tissue changes were analyzed with photogrammetry. A new parameter, the roundness index, was measured. Tip projection, dorsal length, nasal height, alar and columellar length increased significantly after 5.5 months of follow-up. Nasal tip angle, roundness, columella-labial angle, and nostril axis inclination decreased. There were no statistically significant differences in the magnitude of change in patients followed for less than and greater than 6 months. The most common complication was new or persistent tip deviation in five cases (5%). This technique was designed for a nasal anatomy typified by deficient septal cartilage. Significant photogrammetric changes were maintained after 6 months. Economized tissue allocation, dorsal septal load sharing, and relative independence from caudal support are key features of this feasible method.

Preventing Elevated Radix Deformity in Asian Rhinoplasty with a Chimeric Dorsal-Glabellar Construct.

BACKGROUND: Asian facial aesthetic surgery should enhance, but not change, natural features. Augmentation rhinoplasty is a hallmark of Asian cosmetic surgery. In the authors' experience, I-shaped implants can elevate and efface the radix, leading to an unnatural appearance (elevated radix deformity). OBJECTIVES: The Chimeric technique was developed to control final radix position and preserve the nasal profile. We aim to demonstrate that the Chimeric technique promotes forward projection, not elevation, of the radix. METHODS: Between 2013 and 2015, 49 patients underwent rhinoplasty with I-shaped implants. Nineteen patients had Chimeric dorsal-glabellar implants, 30 did not. Standardized photographs were obtained at every visit. Novel and established photogrammetric parameters were used to describe radix position and position change. A retrospective chart review provided additional procedural details and outcomes data. RESULTS: Patients were followed for 10.8 months (range, 2-36 months). Nasal height increase (113% vs 107%) and bridge length increase (118% vs 105%) were significantly greater when the Chimeric technique was not performed (P < .0001). The nasofrontal angle increased 6° in both groups; there was no difference between groups. The vector of radix position change was 26.1° in the Chimeric group and 63.4° in the traditional group (P < .0001). CONCLUSIONS: The Chimeric technique preserves the nasal profile with a favorable (horizontal) radix transposition vector. There was not a significant difference in final radix position when Chimeric rhinoplasty was performed because that is controlled by implant thickness and position. The technique did not blunt the radix significantly. LEVEL OF EVIDENCE 4: Therapeutic.

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update.

BACKGROUND: Indocyanine green (ICG) is a widely available dye of clinical importance that has been used for more than 50 years. Near-infrared (NIR) ICG fluorescence imaging has found a niche in cancer care since 2005, and was reviewed in 2011. There is a need for a comprehensive update and we aim to provide this through a review of the most recent literature. METHODS: A systematic review of the literature using PubMed, EMBASE, and MEDLINE databases of articles published from 2000 to June 2015 evaluated topics pertinent to NIR fluorescence imaging with ICG in the diagnosis and surgical treatment of cancer. Articles previously referenced in a 2011 review and a 2015 meta-analysis were excluded, while articles that referenced future directions and economics were included in this current review. RESULTS: Since 2011, the literature has grown exponentially, with significant advances at the molecular level. Significant findings from 89 select articles and 10 reviews, most of which were published between 2011 and 2015, are summarized. Preclinical studies are currently underway investigating tumor-specific fluorescence and targeted therapeutic delivery. The potential for ICG exists at every level of cancer care, from diagnosis to surveillance. CONCLUSION: The indications, applications, and potential for ICG have grown exponentially in the past decade; an updated review of the literature is overdue and we present the most comprehensive review to date.

Two versus 3 lag screws for fixation of long oblique proximal phalanx fractures of the fingers: a cadaver study.

PURPOSE: To compare 2- versus 3-screw fixation for oblique fractures of the proximal phalanx in a cadaver model that simulates active finger motion. METHODS: We experimentally cut the proximal phalanges of the index, middle, and ring fingers of 9 cadaveric hands. Five fingers were assigned to a control group with no fixation, and 22 were fixed with either 2 or 3 lag screws. One digit was excluded because of iatrogenic fracture during preparation. The fingers were fitted with a differential variable reluctance transducer that measured maximum interfragment displacement while the fingers were subjected to 2,000 full flexion and extension cycles to simulate a 6-week active motion protocol. RESULTS: Analysis of variance revealed a significant difference between the control group and both the 2- and the 3-screw group. The 2- and 3-screw group average displacements were not significantly different. Both of these groups were equivalent with a power of 90%. CONCLUSIONS: Biomechanical stability during simulated active motion protocol did not differ in simulated proximal phalanx fractures treated with 2 lag screws or 3. CLINICAL RELEVANCE: Fracture fixation using 2 screws may be more cost and time effective and, therefore, more attractive to the surgeon, even when 3 screws can be placed. Furthermore, surgeons may consider using 2 screws rather than resorting to plate fixation when 3-screw fixation is not possible for these types of fractures.

Defining predictable patterns of craniomaxillofacial injury in the elderly: analysis of 1,047 patients.

PURPOSE: Currently, nearly 1 in 5 Americans is at least 60 years of age. Bone atrophy, decreased capacity for tissue repair, and chronic disease are known to influence fracture patterns and operative algorithms in this age group. This study presents craniofacial trauma injury patterns and treatment in an elderly population at a major urban trauma center. METHODS: Patient records were retrospectively reviewed from February 1998 through December 2010. Patients at least 60 years of age who met the inclusion criteria for craniofacial fractures identified by International Classification of Diseases, Ninth Revision code review and confirmed by author review of available computed tomograms were studied. Demographic information, fracture type, concomitant injuries, and management were recorded. RESULTS: Of 11,084 patients presenting with facial fracture, 1,047 were older than 60 years. The most common mechanism of injury was falls (50%), and most patients were men (59%). Commonly fractured areas included the nose (n = 452, 43%), maxilla (316, 30%), zygoma (312, 30%), orbital floor (280, 27%), and mandible (186, 18%), with 51 patients (5%) having a concomitant basilar skull fracture. Inpatient mortality and length of stay were significantly increased compared with the nongeriatric population (P < .01), although only 5% of all fractures were treated operatively. CONCLUSIONS: Fractures in the elderly tend to be minimally displaced midfacial fractures that do not warrant surgical intervention. Despite conservative management, the elderly are hospitalized longer than their younger counterparts, have increased critical care needs, and have higher mortality. These data support national medical preparedness in anticipating the craniofacial trauma needs of the aging US population and can be used to update treatment algorithms for these patients.

Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction.

Heminasal agenesis: a reconstructive challenge.

Heminasal agenesis is a rare congenital malformation often associated with deformities of the eyes and lacrimal system, midface, and proboscis lateralis. Reconstruction is especially challenging because of missing lining, cartilage, and skin. We present a case of heminasal agenesis in a 5-year-old girl with concomitant hypertelorism, coloboma of the eyelids, and maxillary hypoplasia. The patient underwent facial bipartition for hypertelorism correction and cantilever bone graft. A forehead flap was designed using an anaplastic model from the patient's twin sister. Cartilage harvested from the conchal bowl and rib provided alar and dorsal support. Reconstructive goals, timing, and options are discussed.

Congenital platelet disorder and type I von Willebrand disease presenting as prolonged bleeding after cleft lip and palate repair.

Cleft lip and palate can be associated with coagulopathy. Here, we report the first known case of congenital platelet disorder and von Willebrand disease presenting as prolonged bleeding after cleft lip and palate repair. After identifying the underlying pathology, platelet infusions and aminocaproic acid were given to decrease bleeding from a second surgical procedure. Whole exome sequencing identified a von Willebrand factor gene mutation, an adenine to guanine substitution at the c.475A location. A high index of suspicion should be had for coagulopathy in patients with syndromic cleft lip and palate.

Total hip arthroplasty for posttraumatic arthritis after acetabular fracture.

Total hip arthroplasty (THA) outcomes for posttraumatic arthritis after acetabular fracture have yielded inferior results compared to primary nontraumatic THA. Recently, improved results have been demonstrated using cementless acetabular reconstruction. Thirty-two patients underwent THA for posttraumatic arthritis after acetabular fracture; 24 were treated with open reduction internal fixation, and 8 were managed conservatively. Time from fracture to THA was 36 months (6-227 months). Average follow-up was 4.7 years (2.0-9.7 years). Harris Hip score increased from 28 (0-56) to 82 points (20-100). Six patients required revision. Five-year survival with revision, loosening, dislocation, or infection as an end point was 79%. Survival for aseptic acetabular loosening was 97%. Revision surgery correlated with nonanatomic restoration of the hip center and a history of infection (P < .05). Despite obvious challenges, advances in fracture management and cementless acetabular fixation in THA demonstrate improved results for posttraumatic arthritis following acetabular fracture.