An experimental study comparing active mobilization to passive flexion-active extension-active flexion after flexor tendon repair in zone 2.

PURPOSE: Both passive flexion-active extension and active rehabilitation have shown advantages and disadvantages in tendon healing. The purpose of this study was to measure the effect of a combination of these 2 rehabilitation protocols. METHODS: A tendon injury model was used in white Leghorn chickens. Thirty-two animals were randomly assigned into 4 groups. We compared an unrestricted active flexion rehabilitation (UA) group with 3 groups starting passive flexion, active extension, and active flexion (PAA) at 5, 9.5 and 14 days after repair. The tensile properties and range of motion of the 3 interphalangeal joints were evaluated for 3 postoperative weeks. RESULTS: In terms of tensile properties of the operated foot, PAA-14 was higher than any other group, and PAA-5 was the lowest. There was no significant difference between the PAA-9.5 and UA. For the range of motion, there were significant differences between all 4 groups: UA increased the most, PAA-14 increased the least, and PAA-5 increased more than PAA-9.5. For the rupture rate, UA and PAA-5 were higher than were PAA-9.5 and PAA-14. CONCLUSIONS: The results indicate that the PAA-9.5 and UA may give the best balance (tensile properties, range of motion, rupture rates) of these rehabilitation protocols. PPA-9.5 and UA had similar moderate tensile properties. When considering an increased range of motion, the UA method may be the most appropriate despite its higher rupture rate. When considering a lower rupture rate, PAA-9.5 may be the most suitable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Aesthetic correction of short nail deformity in congenital brachydactyly Type D by distraction lengthening.

Brachydactyly Type D is a congenital condition of the thumb in which there is a short and broad thumbnail. Although the thumb function is often unaffected, some patients seek surgery for cosmetic improvement. This study aimed to describe our method of distraction lengthening to correct nail deformity in brachydactyly Type D. A total of 163 thumbs in 95 patients underwent this surgery between 2018 and 2021.The mean thumbnail length improved from 9 mm to 15 mm, with a mean percentage increase of 62%. The ratio of nail length to width changed from 0.6 to 1.1, which was equal to normal. The mean increased fingernail length/width ratio was 0.5, with a percentage change of 78%. No obvious surgical scar was observed. The thumb function was not significantly affected. We conclude that aesthetic correction of short nail deformity in brachydactyly Type D can be achieved by distraction lengthening with high satisfaction and without functional impairment.Level of evidence: IV.

Polydopamine-based nanospheres as nanoplatforms to kill Staphylococcus aureus and to promote wound healing by photothermal therapy.

Bacterial infections have always been a threat when it comes to public health accounting for increased morbidity and mortality rates around the world. For the first time, Polydopamine is often used as an ocular surface drug delivery medium to treat some ocular surface diseases based on its good tissue affinity. Mesoporous polydopamine nanospheres (MPDA NPs) under photothermal therapy (PTT) are demonstrated as efficient therapeutic nanoplatforms for Staphylococcus aureus (S. aureus) infection and wound healing. MPDA NPs were found to exhibit excellent photothermal performance, significantly causing an increase in temperature within a short period of NIR-I exposure (808 nm, 1 W cm-2, 6 min). The MPDA NPs under the NIR irradiation remarkably eliminated S. aureus in vitro. Moreover, these synergistic effects turnouts to be phenomenal in vivo, effectively killing and healing S. aureus-infected abscesses in mice. These revealed the combined effect of the intrinsic antibacterial activity of MPDA NPs enhanced upon NIR-I exposure. Hence, MPDA NPs under NIR-I could prove excellent therapeutic nanoplatforms for bacteria-related infections and other biomedical applications.

An anatomical study on the characteristics of cutaneous branches-chain perforator flap with ulnar artery pedicle.

BACKGROUND: The objective of this study was to provide anatomical information for the repair of small tissue defects in the hands and forearms with ulnar artery pedicle cutaneous branches-chain perforator flaps. METHODS: Twelve ulnar artery pedicle cutaneous branches-chain perforator flaps taken from human cadavers were studied using three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and polyvinyl alcohol and bismuth oxide perfusion for molybdenum target x-ray arteriography. Statistical analysis was performed on cutaneous perforators with a diameter of 0.2 mm or greater. Cluster analysis was conducted to determine the overall distribution of perforators. RESULTS: There are two main clusters of perforators at a relative distance of 22.34 percent and 58.73 percent along the pisiform bone to the medial epicondyle. Two thick cutaneous perforators extend through the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap, which are located 4.57 ± 0.59 cm proximal to the pisiform bone and 7.73 ± 1.14 cm distal to the medial epicondyle, with diameters of 0.63 ± 0.09 and 0.75 ± 0.15 mm and pedicle lengths of 1.49 ± 0.34 and 1.46 ± 0.54 cm. At the two main clusters of perforator-intensive sites, vessel chains formed by adjacent perforators were parallel to the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap. CONCLUSION: This study demonstrated that the ulnar artery has two main clusters of perforators in the proximal one-third and distal one-fourth of the forearm, which can be used for ulnar artery pedicle cutaneous branches-chain perforator flaps to repair hand and forearm parenchymal defects.

Anatomical classification of the first dorsal metatarsal artery and its clinical application.

BACKGROUND: Vascularized tissue transfer pedicled with the first dorsal metatarsal artery is commonly used in the microsurgical reconstruction of tissue defect. However, there are great anatomical variations of the artery. In this study, the authors classified the artery based on its origin (from where it arises), branches, and course. The significance of this classification system related to harvesting a first dorsal metatarsal artery-based tissue transfer is also discussed. METHODS: Fresh tissue dissection (n = 48) and cast specimens (n = 30) were studied. Three-dimensional reconstruction (n = 5) was performed based on the computed tomography angiogram of the adult feet. Ultrasound color Doppler imaging was performed on 340 feet. The anatomy of first dorsal metatarsal artery was also studied in patients (n = 148) who had surgery on the first web space. RESULTS: The intramuscular type of the artery described by Gilbert was not found in any of the study specimens. The most common type was found in the space between the dorsal interosseous muscle and the first metatarsal. The authors thus propose a new classification system for the first dorsal metatarsal artery: the arises (origin), branch, and course (ABC) classification system. CONCLUSION: The arises (origin), branch, and course classification system can help a surgeon to better understand the anatomical variations of the first dorsal metatarsal artery and harvest vascularized tissues based on the artery.

Ligament structures in the tarsal sinus and canal.

BACKGROUND: The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction. METHODS: In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view. RESULTS: The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. CONCLUSION: The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal. CLINICAL RELEVANCE: The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.

The relevant anatomy of the approach for axial lumbar interbody fusion.

STUDY DESIGN: Prospective trial. OBJECTIVE: To perform a precise anatomical study of the presacral space and to examine the approach safety of AxiaLIF (axial lumbar interbody fusion) in an anatomical aspect. SUMMARY OF BACKGROUND DATA: AxiaLIF is a novel, minimally invasive surgery. Though there were a few clinical reports on its safety, AxiaLIF is less used in current practice because of the unfamiliarity of surgeons with the regional anatomy of presacral space. METHODS.: Sixteen adult cadaveric pelvic specimens were divided along the median sagittal plane. The presacral fascial structures, the rectosacral fascia, and the pelvic splanchnic nerves were dissected and measured. In the simulated operation, a blunt guide pin was inserted bilaterally to determine the relation of the guide pin's path with important anatomic structures. Mean distances with 95% confidence intervals (CIs) were calculated. RESULTS: The results showed that the fascial structures of the presacral space were divided into 5 layers, and the pelvic splanchnic nerves limited the dissection of the lower rectum, the mean length of which was 2.2 cm (1.9-2.5 cm). In the simulated operation, the mean minimum distance from the guide pin to the pelvic splanchnic nerves was 0.8 cm (0.4-1.2 cm), and the mean vertical distance to the S3-S4 junction was 1.5 cm (1.2-1.7 cm). CONCLUSION: Our study suggests that the approach for AxiaLIF is risky and requires further modification. We should choose the accurate surgical plane when performing the presacral approach.

[Three-dimensional reconstruction and anatomic variation of the portal vein based on 64-slice spiral CT data].

OBJECTIVE: To investigate the three-dimensional reconstruction methods of the portal vein using 64-slice spiral CT data and the anatomical variation of the portal vein. METHODS: Three-dimensional reconstruction of the portal vein was performed using Mimics software based on the 64-slice spiral CT data of 64 cases. Each model of the portal vein and its branches was evaluated according to the presentation rate, depiction quality and anatomic variation. RESULTS: The reconstructed model showed a depiction rates of 100% for the 4-grade branches of the portal vein. The stem of the portal vein and the left and right branches of the level III or above were all displayed, but in 2 cases the superior mesenteric vein and in 1 case the spleen vein was displayed only to the level IV. Of the 64 cases, 50 (78.1%) had normal portal vein and 14 (21.9%) showed anatomical variations. CONCLUSION: The 3D model vividly mimics the anatomic variations of the portal vein to provide valuable information for surgical plans.

[Establishment of a whole-body visualization model of breast cancer with high hepatic metastatic potential in nude mice through serial passage in vivo].

OBJECTIVE: To establish a whole-body visualization model of breast cancer with high hepatic metastatic potential in nude mice and observe the development and metastasis of breast cancer by real-time imaging. METHODS: pEGFP-N1 plasmid was transfected into human breast cancer cell line MDA-MB-231 to obtain pEGFP-MDA-MB-231 cells that emitted fluorescence. pEGFP-MDA-MB-231 cells were inoculated orthotopically in BALB/C nude mice and cultured in vivo through serial passage, thereby establishing the mouse model bearing tumors with high hepatic metastasis potential. The fluorescence emitted from the tumors was quantitatively detected and imaged with a fluorescence stereo microscope for real-time visualization of the tumor growth and metastasis. RESULTS: The transfected breast cancer cells stably and efficiently expressed EGFP. After inoculation of the transfected cells in nude mice, 20% of the first-generation cells showed hepatic metastasis, and the rate increased to 80% among the second-generation and up to 100% among the third-generation cells. The reliability of this visualization model was validated with conventional pathological methods. CONCLUSION: The whole-body visualization model bearing breast cancer with high hepatic metastasis potential provides a reliable means for studying the mechanisms of hepatic tumor metastasis, and can be instrumental in the exploration of novel means for breast cancer treatment.