Cross-leg flaps: A nonmicrosurgical alternative treatment method in complex lower extremity trauma reconstruction.

OBJECTIVES: This study aimed to present our experiences with cross-leg flap surgery, which demonstrates successful outcomes in lower limb soft tissue defects without the necessity of microsurgical intervention. PATIENTS AND METHODS: The retrospective study included 26 patients (18 males, 8 females; mean age: 35.6±12.2 years; range, 18 to 65 years) between January 2015 and September 2019. A fasciocutaneous cross-leg flap was applied to the recipient extremity, and the extremities were immobilized by a tubular external fixator. Flap divisions were performed on the 21st postoperative day. At least two years of clinical outcomes were presented. RESULTS: Twenty-five flaps survived and recovered completely without any complication at the donor site, flaps, or the recipient area. In one diabetic patient, partial flap loss was encountered, which granulated with secondary healing. All patients demonstrated stable wound coverage, with none demanding additional soft tissue surgeries. All patients resumed normal ambulation and physical activity without any residual joint stiffness. CONCLUSION: Cross-leg flap method is an effective and respectable option for extremity salvage as a good alternative to free flaps for the management of traumatic complex lower limb defects. This method is simple, provides abundant blood supply to the wound, and does not require microsurgical experience or a good working recipient artery.

Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study.

The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.

Synthesis of Adenine-based Fluorescent and Naked-eye Chemosensors: Specific DNA Probes for The Detection of Bacterial Pathogens.

A rapid and confident tool to identify and diagnose bacterial pathogens with more accuracy using DNA as fingerprints is necessary. Herein, we report a smart chemosensor having a terminal adenine sticking to the thymine of single-stranded DNA (ssDNA) through supramolecular interactions and, which leaves ssDNA when the same ssDNA matches with the targeting desired DNA. We have synthesized a naked-eye coloured chemosensor with carbazole. As a model genetic material, DNA of Clavibacter michiganensis subsp. michiganensis was hybridized to ssDNA and immobilized over nitrocellulose membrane. The prepared adenine-chemosensor, by passing through the nitrocellulose-ssDNA membrane caused the formation of ssDNA nitrocellulose-ssDNA-adenine-chemosensor. FTIR results of the immobilized ssDNAs showed that the matching of same ssDNA releases the adenine-chemosensor from the surface of nitrocellulose-ssDNA that results in formation of the double stranded DNA. The selectivity of chemosensor was also confirmed with different bacterial DNA (Bacillus subtilis) as control. These data highlights accurate and reliable results of a new diagnostic kit prototype promising for further studies, which is able to diagnose DNA quickly and precisely.

Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction?

INTRODUCTION: Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. MATERIALS AND METHODS: One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. RESULTS: There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4 months in group 1, 19.1 months in group 2, and 21.4 months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1 cm, 1 cm, and 1.2 cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. CONCLUSIONS: No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.

Biomechanical assessment of suture techniques used for tendon repair.

OBJECTIVE: The aim of this study was to assess different tendon suture techniques from the perspectives of both tensile strength and early active mobilization. METHODS: In this study, we implemented repairs on 40 flexor digitorum profundus (FDP) tendons, acquired from fresh frozen cadavers. The tendons were divided into 5 groups of 8 tendons each. We applied the 2-strand modified Kessler suture technique in the first group, the 4-strand Strickland suture technique in the second group, the 4-strand modified Kessler (without epitenon suture) suture technique in the third group, and the 4-strand modified Kessler (with epitenon sutures) suture technique in the fourth group. The remaining 8 intact tendons were set aside as the control group. The strength of the different tendon suture techniques were measured using the Instron(®) device. RESULTS: The average tolerance strength of the first group was determined as 39.89 ± 9.65 Newtons (N), the average tolerance strength of the second group was 39.64 ± 9.14 N, the average tolerance strength of the third group was 50.29 ± 11.24 N, the average tolerance strength of the fourth group was 54.47 ± 6.83 N, and the average tolerance strength of the control group was 119 ± 17.59 N. The tensile strength of the fourth group was significantly higher (p<0.05) than the first group, and the tensile strength of the third group was also significantly higher (p<0.05) than the first group. No significant difference was observed between the tensile strengths of the second and first groups (p>0.05). CONCLUSION: According to our findings, the tensile strength of 4-strand sutures, with or without epitenon sutures, are significantly higher than the tensile strength of 2-strand sutures. All suture techniques applied had sufficient tensile strength to promote early mobilization.

[Results of limited open rotator cuff repair with partial acromioplasty for rotator cuff tears with subacromial impingement syndrome]. / Subakromiyal sikisma sendromu ile birlikte rotator manset yirtiginin, kismi akromiyoplasti ile sinirli açik rotator manset tamiri sonuçlari.

OBJECTIVES: Short term results of partial acromioplasty and rotator cuff repair with a limited open surgical technique were evaluated in patients with rotator cuff tears. PATIENTS AND METHODS: Forty-eight patients (16 males, 32 females; mean age 52 years; range 29 to 70 years) with rotator cuff rupture were recruited to the study between January 2001 and December 2006. A limited open rotator cuff repair along with partial acromioplasty (via rasper) was applied in all cases. The Constant-Murley shoulder score was used before and after surgery. RESULTS: Mean duration of follow-up was 38 months (range 14 to 70 months). Pre- and postoperative Constant-Murley scores averaged 44 (range 36 to 51) and 88 (range 75 to 96) respectively. Anchoring sutures were displaced in one subject (2%) and tendon insufficiency recurred, another two cases (4%) had impingement from secondary granulation tissue that developed due to sutures in the tendon repair site. CONCLUSION: We believe that minimal acromioplasty via a limited open surgical approach is an applicable technique with good results in the treatment of rotator cuff tears with subacromial impingement syndrome.

[Glenohumeral instability and arthrosis]. / Glenohumeral instabilite ve artroz.

Although the development of arthrosis is rare following shoulder dislocations, it represents a significant problem if it develops after surgery for shoulder instability. The incidence of arthrosis may be decreased by correct diagnosis of the instability and appropriate surgical technique. However, should it occur, shoulder arthroplasty should be considered.