Staged treatment with arterial reconstruction and flap transplantation for ischemic mangled extremity: An observational study.

Patients with traumatic ischemic mangled extremities first undergo arterial reconstruction using autogenous vein grafts, followed by flap transplantation as a staged treatment for soft tissue reconstruction. This study aimed to report the outcomes of such a staged treatment. Thirteen patients underwent arterial reconstruction between February 2015 and April 2017 due to damage to the major blood vessels by the traumatic mangled extremities. Of them, 6 patients (5 males and 1 female with a mean age of 51 years, age range: 36-60 years) who underwent soft tissue reconstruction due to necrosis were retrospectively analyzed. The average Mangled Extremity Severity Score was 7.2 (range, 6-8). Injuries were found in the lower leg (4 cases), foot (1 case), and wrist and hand (1 case). Arterial reconstruction was performed using autologous venous grafts. The reconstructed arteries included the posterior tibial artery (3 cases), anterior tibial artery (1 case), dorsalis pedis artery (1 case), and radial artery (1 case). The blood circulation status of the reconstructed blood vessels was assessed using computed tomography angiography at an average of 5 weeks (range, 4-6 weeks) after arterial reconstruction. For some necrotic soft tissues, debridement and flap transplantation were performed an average of 7 weeks (range, 6-8 weeks) after arterial reconstruction. Soft tissue reconstruction was performed with an anterolateral thigh free flap in 4 cases, a local flap in 1 case, and a muscle flap in 1 case. In 5 out of 6 cases, blood circulation was maintained in the reconstructed blood vessels, resulting in the salvaging of the extremities. All the patients who underwent flap surgery survived. Notably, there were no special complications during a follow-up visit conducted at an average of 19 months post-reconstruction. To treat an ischemic mangled extremity, the limbs should first be salvaged with arterial reconstruction, followed by subsequent appropriate flap surgery when soft tissue necrosis occurs at the mangled site as a staged treatment.

Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report.

RATIONALE: Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS: A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES: Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS: Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES: Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS: DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.

Tibial nerve compression due to osteochondroma of the fibular head: A case report.

RATIONALE: Osteochondroma is one of the most common primary benign bone tumors. In most cases, this disease is asymptomatic. However, it may become symptomatic owing to nerve and vascular compression when it affects the knee joint. Isolated tibial nerve palsy caused by proximal fibular osteochondroma is rare. PATIENTS CONCERNS: A 60-year-old male, was treated for degenerative arthritis of the right knee, referred to the right great toe flexion limitation that occurred 3 weeks prior. DIAGNOSES: Magnetic resonance imaging revealed compression of the tibial nerve and surrounding muscles due to an osseous lesion in the fibular head. A nerve conduction test confirmed tibial neuropathy in the right lower leg. INTERVENTIONS: Exploratory surgery was performed to decompress the tibial nerve and remove the bony lesion histopathologically diagnosed as an osteochondroma. OUTCOMES: Fifty-five months postoperatively, toe flexion recovered to normal. No recurrence of osteochondroma was observed. LESSONS: As in our case, if a bony lesion is diagnosed on radiographs with neurological symptoms, early decompression surgery is necessary. Moreover, since it can be misdiagnosed as a simple bony spur, magnetic resonance imaging and tissue biopsy are also indicated.

Anomaly originated flexor digitorum superficialis muscle of the small finger: A case report.

RATIONALE: We present a clinical case of flexor digitorum superficialis (FDS) muscle belly of the small finger originating from the palm of a patient undergoing carpal tunnel surgery with a literature review. PATIENTS CONCERN: A 28-year-old right-handed woman visited our hospital with a chief complaint of a continuous tingling sensation and weakness in the right hand, which began after the volar side of her wrist was crushed by a machine during work 2 weeks prior. The patient complained of a continuous tingling sensation in the thumb, index, and middle fingers. The patient had a positive result on Tinel test of the median nerve of the wrist. As electromyography and nerve conduction velocities showed signs of severe injury in the right median nerve, exploration and carpal tunnel release were planned. DIAGNOSIS: Carpal tunnel release was performed under regional anesthesia using the classical open approach. The median nerve in the distal forearm and distal portion of the flexor retinaculum appeared to be narrowed and compressed. An anomalous muscle originating from the flexor retinaculum is also observed. INTERVENTION: The FDS muscle of the small finger was excised at the flexor retinaculum and musculotendinous junction and sutured to the flexor digitorum profundus tendon. OUTCOME: At the 37-month follow-up, the patient did not experience any tingling sensation or weakness. She showed excellent range of motion of the right small finger. The grip strength was 20 kg on both the right and left sides. Quick disabilities of the arm, shoulder, and hand score was 2.3. CONCLUSION: Asymptomatic small finger FDS muscle anomalies can occur, as demonstrated in this case study. Thus, physicians should familiarize themselves with small finger FDS muscle anomalies during interactions with patients to facilitate future treatments of patient complaints related to the hand, as well as wrist laceration or trauma requiring hand exploration.

Volar wrist ganglion associated with radial artery atherosclerosis: A case report.

RATIONALE: There have been no reports of volar wrist ganglions being associated with atherosclerosis of the radial artery. Good results were obtained with radial artery reconstruction through ganglion excision and autogenous vein grafting. Hence, we report a previously unreported case, along with a review of the literature. PATIENT CONCERNS: A 58-year-old female presented with the chief complaint of a mass on the volo-radial side of her right wrist. The patient complained of a tingling sensation in the thumb, index, and extensor zones that worsened when pressing the mass. DIAGNOSES: Sonography revealed a well-defined, anechoic cystic lesion adjacent to the radial artery. INTERVENTIONS: Exploration was performed using a zig-zag incision on the mass. The superficial radial nerve (SRN), which innervates the thumb, was distorted by the mass and the nerve dissected from the mass. However, the artery and ganglion cysts were not separated completely in a part where hardening of the artery wall progressed as a result of degenerative changes, showing multiple small, hard, and yellowish masses. We resected the radial artery (approximately 1.5 cm) along with the ganglion and sent it for histological examination. The radial artery was then reconstructed using an autogenous venous graft. OUTCOMES: At the 34-month follow-up, the patient was asymptomatic. Radial artery patency was normal without recurrence of the ganglion cyst. LESSONS: In patients with risk factors for radial artery atherosclerosis, a more careful diagnosis is required for the surgical treatment of the volar wrist ganglion. In addition, if the ganglion and radial artery are not completely dissected, excision of the radial artery and subsequent reconstruction of the radial artery using an autogenous vein may be a good surgical strategy.

Multiple flexor tendon ruptures due to osteochondroma of the hamate: A case report.

BACKGROUND: Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook. Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported. Here, we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review. CASE SUMMARY: A 48-year-old man who had been a rice-field farmer for 7-8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints. The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma. Exploratory surgery was performed, and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed, which was pathologically diagnosed as an osteochondroma. CONCLUSION: One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.

Arthroscopy-assisted bone grafting for the treatment of SNAC stage I without radial styloidectomy.

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC). We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 - 10) preoperatively to 1.3 ± 1.3 (range, 0 - 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01). Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.

Improved Feature-Based Gaze Estimation Using Self-Attention Module and Synthetic Eye Images.

Gaze is an excellent indicator and has utility in that it can express interest or intention and the condition of an object. Recent deep-learning methods are mainly appearance-based methods that estimate gaze based on a simple regression from entire face and eye images. However, sometimes, this method does not give satisfactory results for gaze estimations in low-resolution and noisy images obtained in unconstrained real-world settings (e.g., places with severe lighting changes). In this study, we propose a method that estimates gaze by detecting eye region landmarks through a single eye image; and this approach is shown to be competitive with recent appearance-based methods. Our approach acquires rich information by extracting more landmarks and including iris and eye edges, similar to the existing feature-based methods. To acquire strong features even at low resolutions, we used the HRNet backbone network to learn representations of images at various resolutions. Furthermore, we used the self-attention module CBAM to obtain a refined feature map with better spatial information, which enhanced the robustness to noisy inputs, thereby yielding a performance of a 3.18% landmark localization error, a 4% improvement over the existing error and A large number of landmarks were acquired and used as inputs for a lightweight neural network to estimate the gaze. We conducted a within-datasets evaluation on the MPIIGaze, which was obtained in a natural environment and achieved a state-of-the-art performance of 4.32 degrees, a 6% improvement over the existing performance.

Artificial intelligence-based classification of bone tumors in the proximal femur on plain radiographs: System development and validation.

PURPOSE: Early detection and classification of bone tumors in the proximal femur is crucial for their successful treatment. This study aimed to develop an artificial intelligence (AI) model to classify bone tumors in the proximal femur on plain radiographs. METHODS: Standard anteroposterior hip radiographs were obtained from a single tertiary referral center. A total of 538 femoral images were set for the AI model training, including 94 with malignant, 120 with benign, and 324 without tumors. The image data were pre-processed to be optimized for training of the deep learning model. The state-of-the-art convolutional neural network (CNN) algorithms were applied to pre-processed images to perform three-label classification (benign, malignant, or no tumor) on each femur. The performance of the CNN model was verified using fivefold cross-validation and was compared against that of four human doctors. RESULTS: The area under the receiver operating characteristic (AUROC) of the best performing CNN model for the three-label classification was 0.953 (95% confidence interval, 0.926-0.980). The diagnostic accuracy of the model (0.853) was significantly higher than that of the four doctors (0.794) (P = 0.001) and also that of each doctor individually (0.811, 0.796, 0.757, and 0.814, respectively) (P<0.05). The mean sensitivity, specificity, precision, and F1 score of the CNN models were 0.822, 0.912, 0.829, and 0.822, respectively, whereas the mean values of four doctors were 0.751, 0.889, 0.762, and 0.797, respectively. CONCLUSIONS: The AI-based model demonstrated high performance in classifying the presence of bone tumors in the proximal femur on plain radiographs. Our findings suggest that AI-based technology can potentially reduce the misdiagnosis of doctors who are not specialists in musculoskeletal oncology.

Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair.

PURPOSE: To report the arthroscopic and clinical findings of patients with extensor carpi ulnaris (ECU) tendinopathy treated with wrist arthroscopy and open surgical repair. METHODS: We retrospectively reviewed the medical records of seven patients with chronic ECU tendinopathy who were treated with diagnostic wrist arthroscopy and open surgical repair between 2010 and 2017. Seven cases diagnosed with ECU tendinopathy had undergone open procedure for the ECU tendinopathy, as well as wrist arthroscopy in the same session. Any pathology of the triangular fibrocartilage complex (TFCC) diagnosed by wrist arthroscopy were treated simultaneously with open procedure for the ECU tendinopathy. The functional outcome was evaluated by comparing the preoperative and final follow-up values of range of motion (ROM), grip strength, visual analog scale (VAS) for pain, modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) score. RESULTS: TFCC tears were identified in four patients of which repair was performed concomitantly. The average follow-up period was 39 months (range, 25-49 months). At the final follow-up, all the outcomes including average VAS score (6.4→1), the ROM (173→192°), quick DASH score (42.5→18.2), and modified Mayo wrist score (48.6→79.3) improved significantly. CONCLUSION: When treating patients with ECU tendinopathy, the possibility of TFCC combined injury should always be considered. If surgical treatment is planned, we suggest a wrist arthroscopy for more accurate diagnosis an intra-articular pathology, particularly for patients whose MRI findings suggest a degenerative tear or degeneration at the periphery of the TFCC. Additionally, if ECU and DRUJ stability is obtained by repair or reconstruction of the concurrent pathologies in the ECU subsheath, TFCC and other intra-articular structures, the results will be favorable.

Efficient Single-Shot Multi-Object Tracking for Vehicles in Traffic Scenarios.

Multi-object tracking is a significant field in computer vision since it provides essential information for video surveillance and analysis. Several different deep learning-based approaches have been developed to improve the performance of multi-object tracking by applying the most accurate and efficient combinations of object detection models and appearance embedding extraction models. However, two-stage methods show a low inference speed since the embedding extraction can only be performed at the end of the object detection. To alleviate this problem, single-shot methods, which simultaneously perform object detection and embedding extraction, have been developed and have drastically improved the inference speed. However, there is a trade-off between accuracy and efficiency. Therefore, this study proposes an enhanced single-shot multi-object tracking system that displays improved accuracy while maintaining a high inference speed. With a strong feature extraction and fusion, the object detection of our model achieves an AP score of 69.93% on the UA-DETRAC dataset and outperforms previous state-of-the-art methods, such as FairMOT and JDE. Based on the improved object detection performance, our multi-object tracking system achieves a MOTA score of 68.5% and a PR-MOTA score of 24.5% on the same dataset, also surpassing the previous state-of-the-art trackers.

Arthroscopic-assisted bone grafting and percutaneous K-wires fixation for the treatment of scaphoid nonunion in the skeletally immature patient: Three cases report.

RATIONALE: The treatment methods of pediatric scaphoid nonunion are still controversial. To our knowledge, arthroscopic-assisted treatments for pediatric scaphoid nonunion has not been reported in the English-language literature. Therefore, the purpose of this study is to report the use of arthroscopic-assisted bone grafting for scaphoid nonunion fracture in 3 patients and present a literature review. PATIENTS CONCERNS: Two 15-year-old patients developed carpal joint injuries over a year, prior to their hospital presentation, since they had not received adequate treatment. The third patient, 12 years of age, was diagnosed with scaphoid fracture after a traffic accident and underwent conservative treatment but presented to the hospital due to issues related with bone union. DIAGNOSIS: All 3 patients were diagnosed with scaphoid nonunion at our hospital, using plain wrist radiographs and computed tomography. INTERVENTIONS: All the patients underwent arthroscopic debridement; 2 patients received autogenous iliac cancellous bone graft, while the other patient received a bone substitute graft. The internal fixation of the scaphoid was performed with K-wires. OUTCOMES: Bone unions were achieved in all patients, and the final follow-up resulted in successful outcomes. LESSONS: Arthroscopic-assisted bone grafting and percutaneous K-wire fixation can be considered as a good method for the treatment of pediatric scaphoid nonunion fractures. Therefore, it is a primary treatment option for symptomatic scaphoid nonunion fracture and displaced fractures.

Neglected extensor apparatus injury in the proximal interphalangeal joint: A case report.

RATIONALE: The extensor tendon of the proximal interphalangeal (PIP) joint is highly complex, and failure to ensure suitable balance during treatment following an injury is likely to produce poor outcomes. We have achieved good outcomes with the primary repair of neglected extensor tendon rupture in the PIP joint, and thus report the case along with a review of the relevant literature. PATIENTS CONCERN: A 40-year-old right-handed female who works at a meat shop visited our clinic due to pain and active limitation of the range of motion (ROM) of the PIP joint of her left long finger. She had previously experienced a cut on the dorsal aspect of the third PIP joint while cutting meat about a year earlier but did not receive any specific treatment for the injury. DIAGNOSIS: The patient was diagnosed with complete rupture of the central slip and lateral band in the PIP joint after investigation. INTERVENTION: We successfully debrided the ruptured tendon and performed extensor tendon repair using the modified Kessler technique and epitendinous cross-over repair technique. OUTCOME: At the 12-month follow-up, the patient was completely asymptomatic and had optimal PIP joint ROM (0°-90°) in her left long finger. LESSONS: Although the treatment of an extensor injury of the PIP joint area is difficult, satisfactory outcomes can still be achieved, even in cases of injuries which are neglected for over a year, using a repair technique that can properly balance the length and tension between the central slip and lateral bands with the selection of appropriate postoperative treatment strategies.

Arthroscopic treatment of chronic wrist pain after distal radius fractures.

We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment.We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20-68 years), average time from injury to treatment 21 ±â€Š23.46 months (range, 3-96 months) and average follow up period 20.13 ±â€Š8.71 months (range, 12-39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score.Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ±â€Š1.58 (range, 3-8) to 1.33 ±â€Š1.29 (range, 0-3) (P = .001) and from 49.38 ±â€Š19.09 to 12.63 ±â€Š7.63 (P = .001), respectively.Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.

An Extended Method for Saccadic Eye Movement Measurements Using a Head-Mounted Display.

Saccadic eye movementis an important ability in our daily life and is especially important in driving and sports. Traditionally, the Developmental Eye Movement (DEM) test and the King-Devick (K-D) test have been used to measure saccadic eye movement, but these only involve measurements with "adjusted time". Therefore, a different approach is required to obtain the eye movement speed and reaction rate in detail, as some are rapid eye movements, while others are slow actions, and vice versa. This study proposed a extended method that can acquire the "rest time" and "transfer time", as well as the "adjusted time", by implementing a virtual reality-based DEM test, using a FOVE virtual reality (VR) head-mounted display, equipped with an eye-tracking module. This approach was tested in 30 subjects with normal vision and no ophthalmologic disease by using a 2-diopter (50-cm) distance. This allowed for measurement of the "adjusted time" and the "rest time" for focusing on each target number character, the "transfer time" for moving to the next target number character, and recording of the gaze-tracking log. The results of this experiment showed that it was possible to analyze more parameters of the saccadic eye movement with the proposed method than with the traditional methods.

Acute compartment syndrome of the forearm associated with transradial coronary intervention.

This study documents our experience with acute forearm compartment syndrome after percutaneous transradial coronary artery intervention and suggests several strategies to achieve good results. A retrospective review identified the medical records of four patients with acute forearm compartment syndrome after transradial intervention who were treated by urgent fasciotomy. The mean time from the onset of symptoms to operation was 5.7 hours. In three cases bleeding was from radial artery rupture at the puncture site, and one case was caused by brachial artery rupture at the level of the distal humerus and radial artery rupture at the level of proximal forearm. We obtained satisfactory results without any complications. If acute forearm compartment syndrome after transradial intervention is diagnosed, the site of bleeding should be identified preoperatively. Early surgical decompression produced satisfactory results even in elderly patients.Level of evidence: IV.

The clinical result of arterialized venous free flaps for the treatment of soft tissue defect of the fingers.

The purpose of this study is to report the clinical results of the arterialized venous free flaps in reconstructing soft tissue defects of the finger and to extend the indications for the use of the flaps based on clinical experiences of the authors.We retrospectively reviewed the records of 35 patients who underwent an arterialized venous free flaps for a finger reconstruction, between May 2007 and August 2015. The mean size of flap was 4.8 ±â€Š1.23 × 3.1 ±â€Š0.84 cm. The donor site was the ipsilateral volar aspect of the distal forearm in all cases. There were 17 (48.6%) cases of venous skin flaps, 9 (25.7%) cases of innervated venous flaps, 7 (20%) cases of tendocu taneous flaps, and 2 (5.7%) case of innervated tendocutaneous flap. The vascularity of recipient beds was good except 8 (22.9%) cases (partial devascularity in 3, more than 50% avascularity [bone cement] in 3, and chronic infected bed in 2).Of the 35 cases, 29 (82.9%) cases (including 3 cases who had more than 50% avascularity recipient bed) showed complete survival. 3 (8.6%) cases, which had partially devascularity of distal phalanx in recipient bed, showed partial necrosis (P = .015). The mean number of included veins was 2.4 ±â€Š0.5 for a flap.A forearm arterialized venous free flap is a useful procedure for single-stage reconstructing of a soft tissue or combined defect of a finger, we consider that this technique could be applied to fingers despite an avascular or insufficient vascular recipient bed if the periphery of recipient bed vascularity was good and if the recipient beds were free from infection.

Trigger finger secondary to a neglected flexor tendon rupture.

Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23-59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4-18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3-5) preoperatively to 0.3 (range, 0-1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.

Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient: A case report.

INTRODUCTION: Infected segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a more complex reconstructive challenge. Here, we present a functional reconstruction of infected Achilles tendinitis with combined soft tissue defects using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata in an elderly patient. CASE PRESENTATION: A 71-year-old male patient was transferred to our department due to soft tissue defect of the left lower leg and infected Achilles tendinitis. The patient underwent incision and drainage of both lower legs with necrotizing fasciitis in another hospital 2 months ago. Physical examination revealed a 12 × 5 cm wound with exposed Achilles tendon over the posteromedial aspect of lower one-third of the leg. His wound culture grew methicillin-resistant Staphylococcus aureus (MRSA). All infected necrotic Achilles tendon with proximal muscle tissue was excised. The patient underwent successful Achilles tendon reconstruction and soft tissue coverage procedure with a 14 × 7 cm ALT flap with the fascia lata. At the 12-month follow-up, the patient resumed full daily activities, was able to squat, showed a range of motion at the ankle in the 15° dorsiflexion and 45° plantar flexion, and the American Orthopaedic Foot and Ankle Society (AOFAS) score was 94. CONCLUSION: A free ALT composite flap with the vascularized fascia lata, was successfully used for the treatment of infected Achilles tendinitis with overlying soft tissue defect even in an elderly patient. Furthermore, it provided satisfactory functional and cosmetic outcomes. Hence, the use of free ALT composite flap is highly recommended in such patients.