Arthroscopy-assisted reduction and simultaneous robotic-assisted screw placement in the treatment of fractures of the posterior talar process.

PURPOSE: A fracture of the posterior talar process is easily missed because of its hidden position. Inappropriate treatment is likely to result in complications, such as nonunion of the fracture and traumatic arthritis. This study evaluated the outcomes of arthroscopy-assisted reduction combined with robotic-assisted screw placement in the treatment of fractures of the posterior talar process. METHODS: The clinical data for nine patients who underwent surgical treatment of a fracture of the posterior talar process at our institution between September 2017 and January 2021 were retrospectively reviewed. Arthroscopy-assisted reduction of the fracture was performed, and a cannulated screw was placed using three-dimensional orthopedic robotic-assisted navigation. RESULTS: The patients (seven men, two women) had a mean age of 36.33 ± 9.77 years and were followed up for 21 ± 5.43 months. The operation time was 106.67 ± 24.5 min with blood loss of 47.78 ± 9.05 ml. Primary healing was obtained in all cases, and no patient sustained a nerve or tendon injury, had fracture nonunion, or developed talar osteonecrosis. One patient developed subtalar arthritis, for which subtalar joint fusion was performed; pain was markedly less severe after cleaning. CONCLUSION: Arthroscopy-assisted reduction and robotic-assisted screw placement have the advantages of visualization of fracture reduction, minimal injury, and precise screw placement in the treatment of fractures of the posterior talar process.

Feasibility evaluation of the induced membrane technique with structural autologous strip bone graft management of phalangeal and metacarpal segmental defects using radiography.

PURPOSE: The purpose of this study was to explore the feasibility and evaluate the clinical outcomes of treatment for phalangeal and metacarpal segmental defects with the induced membrane technique and autologous structural bone grafting. METHODS: Sixteen patients who sustained phalangeal or metacarpal bone segmental defects were treated by the induced membrane technique and autologous structural bone grafting from June 2020 to June 2021 at our center. RESULTS: The average follow-up was 24 weeks (range, 12-40 weeks). Radiography demonstrated union of all bone grafts after an average of 8.6 weeks (range, 8-12 weeks). All incisions at donor and recipient sites demonstrated primary heal without infection complications. The mean visual analog scale score of the donor site was 1.8 (range, 0-5), with a good score in 13 cases and a fair score in 3. The mean total active motion of the fingers was 179.9°. CONCLUSIONS: The feasibility of the induced membrane technique and structural treatment with a cylindrical bone graft for segmental bone defects of the metacarpal or phalanx is demonstrated by follow-up radiography results. The bone graft provided much more stability and structural support in the bone defects, and the bone healing time and bone union rate were ideal.

Correction of motion artifact in CL based on MAFusNet.

Computed laminography (CL) is one of the best methods for nondestructive testing of plate-like objects. If the object and the detector move continually while the scanning is being done, the data acquisition efficiency of CL will be significantly increased. However, the projection images will contain motion artifact as a result. A multi-angle fusion network (MAFusNet) is presented in order to correct the motion artifact of CL projection images considering the properties of CL projection images. The multi-angle fusion module significantly increases the ability of MAFusNet to deblur by using data from nearby projection images, and the feature fusion module lessens information loss brought on by data flow between the encoders. In contrast to conventional deblurring networks, the MAFusNet network employs synthetic datasets for training and performed well on realistic data, proving the network's outstanding generalization. The multi-angle fusion-based network has a significant improvement in the correction effect of CL motion artifact through ablation study and comparison with existing classical deblurring networks, and the synthetic training dataset can also significantly lower the training cost, which can effectively improve the quality and efficiency of CL imaging in industrial nondestructive testing.

[Clinical observation of superficial branch of radial artery wrist crease flap for repairing ring tissue defect of fingers].

Objective: To explore the effectiveness and operation method of the superficial branch of radial artery wrist crease flap for repair of ring tissue defect of the fingers. Methods: Between June 2013 and March 2016, the superficial branch of radial artery wrist crease flap was used to repair ring finger tissue defect in 20 cases (21 fingers). There were 14 males and 6 females with an average age of 39.3 years (range, 12-61 years). The causes included machine injury in 9 cases, traffic accident injury in 6 cases, heat inury in 2 cases, and avulsed injury in 3 cases. The index finger was involved in 6 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 6 cases. Combined injuries included exposure of bone, tendon, vessel, and nerve. The mean time of injury to operation was 3 hours (range, 0.5-5.5 hours) in 17 patients undergoing emergency operation, and was 8.5 days (range, 7-10 days) in 3 patients undergoing selective operation. The superficial palmar branch of the radial artery from the flap was used for bridging proper digital artery. The donor site was directly sutured in 19 cases and was repaired by skin grafting in 1 case. Results: One case had blood blister at distal flap, which was cured after dressing change; the other flaps survived, and primary healing was obtained. Healing of incision at the donor site healed by first intention. The patients were followed up 6-24 months (mean, 12 months). The appearance, texture, and color of the flaps were satisfactory. The two-point discrimination ranged from 6 to 13 mm (mean, 9 mm) at 6 months after operation. According to the Chinese Medical Association Society of hand surgery of thumb and finger reconstruction function evaluation standard, the results were excellent in 13 cases, good in 4 cases, and fair in 3 cases; the excellent and good rate was 85%. Conclusion: The superficial branch of radial artery wrist crease flap is an ideal choice for the repair of ring tissue defect of the fingers.

Use of giant-sized flow-through venous flap for simultaneous reconstruction of dual or multiple major arteries in salvage therapy for complex upper limb traumatic injury.

BACKGROUND/OBJECTIVES: Salvage repair after complex upper limb traumatic injury is surgically challenging due to underlying major arterial impairment with complicating a large-sized soft tissue defect. The purpose of this study was to evaluate the effectiveness and safety of using a giant-sized (≥100 cm(2)) flow-through venous flap for reconstruction of dual or multiple forearm, metacarpal, or digital arteries after complex upper limb traumatic injury. METHODS: Seven patients were consecutively hospitalized for emergency salvage repair after complex upper limb traumatic injury between March 2012 and May 2014. The forearm and palmar artery defects were repaired using the calf great saphenous vein flap and the volar forearm venous flap, respectively. RESULTS: The flow-through venous flap ranged from 9.5 cm × 12.0 cm to 12.0 cm × 20.0 cm (mean, 158.4 cm(2)) in size. The flaps and affected limbs survived uneventfully in five patients, with one patient experiencing distal flap marginal necrosis and a second patient requiring amputation of the affected limb. Computed tomography angiography showed patent vessels in all patients. The mean total active motion of the repaired fingers was 199.5° versus 258.8° for the contralateral counterpart (77.1%). The sensory return was determined to be S2 in 2 patients, S3 in 3 patients and S3+ in 1 patient. The disability scores for the arm, shoulder, and hand ranged from 4.6-18.2 (mean, 11.3), and the mean Michigan hand outcomes questionnaire score was 7.8 ± 0.9. CONCLUSIONS: The flow-through venous flap is an effective and safe treatment alternative for salvage therapy of a ≥100-cm(2) complex upper limb traumatic injury with dual or multiple major arterial impairment. This technique allows simultaneous reconstruction of dual or multiple artery injuries and an extensive soft tissue defect. Serious surgical site infection remains a major safety concern and necessitates radical debridement in complicating cases.

[Clinical application of a large flow-through venous flap].

Objective: To investigate the clinical effects of a large flow-through venous flap. Methods: Between January 2012 and January 2015,this flap was used in 9 patients with upper limb injury to reconstruct artery defect and large skin and soft tissue defect. The donor sites were covered with free skin grafts. The skin and soft tissue defects size ranged from 7.0 cm × 10.0 cm to 9.5 cm × 18.0 cm (average 9.2 cm× 12.0 cm). Results: The flaps size ranged from 9.0 cm × 12.0 cm-11.5 cm × 20.0 cm (average 10.3 cm × 13.5 cm).Except 2 cases of small area necrosis occurred in the distal end of the flap, which healed after dressing change; the other 7 flaps survived completely. The donor wounds healed primarily. Postoperative patients were followed up for 12-26 months (mean 14.5 months). Flap appearance, texture and thickness were similar to the surrounding normal tissue. According to the sensory function evaluation standard formulated by the British Medical Research Council in 1954,the result of skin flap sensory evaluation was assessed as S2 in two cases,S3 in four cases,S3 in three cases, with excellent and good rate as 77.8％.According to the assessment standard for upper limb function issued by Chinese Medical Association of hand surgery, the limb function were assessed as excellent in 6 cases, good in 2 cases, poor in 1 case, with the excellent and good rate as 88.9％. Conclusions: The large flowthrough venous flap has the advantages of simple operation, minimal donor site morbidity and satisfactory appearance. It is a feasible method to repair the wound at upper limb with artery defect.

[APPLICATION OF WRIST CREASE ISLAND FLAP BASED ON THE SUPERFICIAL PALMAR BRANCH OF THE RADIAL ARTERY FOR THUMB RECONSTRUCTION].

OBJECTIVE: To investigate the effectiveness of the island flaps based on the superficial palmar branch of the radial artery (SPBRA) to repair the thumb wound. METHODS: Between February 2012 and November 2013, 8 cases of thumb defects and bilateral artery defect were treated. There were 5 males and 3 females with an average age of 30.5 years (range, 19-51 years). The injury was caused by crush (4 cases), avulsion (3 cases), and twist (1 case). The injury located at the metacarpophalangeal joints in 3 cases, at the proximal palmar side in 2 cases, and at the interphalangeal joints in 3 cases. The defect size ranged from 3.5 cm x 1.5 cm to 6.5 cm x 2.0 cm. The digital artery defect was 2.5-8.5 cm (mean, 5.3 cm). The disease duration was 2.0-4.5 hours (mean, 3.2 hours). The reversed island flaps based on the SPBRA were designed, which size was 4.0 cm x 2.0 cm to 7.5 cm x 3.0 cm. The donor sites were closed directly. RESULTS: The operation was successfully completed in 7 patients except 1 patient having vascular variation. All flaps survived completely. Wound and incision at the donor site healed by first intention. All patients were followed up 6-18 months (mean, 13 months). The flaps had similar color and texture to adjacent skin. Linear scar was seen at the donor site in 1 patient, with no functional limitation. According to the functional assessment criteria of upper limb by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 6 cases, good in 1 case, and fair in 1 case, with an excellent and good rate of 87.5%. CONCLUSION: The reversed island flap based on the SPBRA is an ideal flap for the thumb reconstruction because the advantages of reliable blood supply, easy dissection, less injury at donor site, and good repair results.

Thumb reconstruction via a pedicled flap based on the superficial palmar branch of the radial artery from the wrist crease area.

BACKGROUND: The free flap based on the superficial palmar branch of the radial artery (SPBRA) has been extensively reported. A reversed pedicled flap based on the SPBRA, harvested from the wrist crease area, can be a potential candidate for the reconstruction of the soft-tissue and artery defects in the thumb. METHOD: Between January 2012 and October 2013, this flap was used in seven patients to reconstruct soft-tissue defects in the thumb. In three patients, blood circulation of the thumb was reestablished using flow-through flaps. The Michigan Hand Outcomes Questionnaire was used for patient self-evaluation. RESULTS: In one patient, the surgery was abandoned due to blood vessel variation. All the flaps and thumbs survived in the other six patients. The wounds healed primarily. All patients were followed up for a mean of 16.5 months (range, 12-26 months). At the last follow-up, the mean static two-point discrimination was 7.3 ± 0.9 mm on the affected side and 4.6 ± 0.7 on the contralateral side. The range of motion of the metacarpophalangeal joint and the interphalangeal joint were 66.8 ± 8.4° (contralateral, 85.2 ± 3.8°) and 67.0 ± 6.9° (contralateral, 80.5 ± 5.0°), respectively. Patient self-evaluations were good in five cases and fair in one case. CONCLUSION: The reverse island flap based on the SPBRA is feasible for soft-tissue defects and establishing blood circulation in the thumb. The donor site can be closed primarily, and the scar is inconspicuous in the wrist crease.

[APPLICATION OF FREE BILOBED MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING PENETRATING WOUND OF FOOT].

OBJECTIVE: To explore the effectiveness of the free bilobed medial sural artery perforator (BMSAP) flap to repair penetrating wound of the foot. METHODS: Between April 2012 and October 2014, 7 cases of foot penetrating wounds were treated with the BMSAP flap. There were 5 males and 2 females, aged from 21 to 43 years (mean, 31.5 years). The causes of injury included the crush injury (4 cases), blunt puncture (2 cases), and firearm injury (1 case). The wound was located at the left foot in 4 cases and at the right foot in 3 cases. There were longitudinal penetrating injury in 5 cases and transverse penetrating injury in 2 cases. The size of wound ranged from 4 cm x 3 cm to 9 cm x 7 cm. The interval between injury and admission was 0.5-5.5 hours (mean, 3.2 hours). The free BMSAP flap of 5 cm x 4 cm-10 cm x 8 cm in size was used to repair the wounds on both sides and to reconstruct the sensation. The donor site was sutured or repaired with skin graft. RESULTS: After operation, 1 case had distal flap necrosis, the flap survived after dressing change; 1 case had wound infection, and delayed healing was obtained after drainage; and the flap survived completely, and primary healing was obtained in the other 5 cases. The skin grafts survived and healing of incision by first intention was observed at donor sites. The patients were followed up from 7 to 24 months (mean, 12.5 months). The flap had soft texture and similar color to normal skin. According to the British Medical Research Council (BMRC) sensory function assessment system, 1 case was rated as S2, 4 cases as , and 2 cases as S3+. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 86-97 (mean, 93.6); the results were excellent in 6 cases and good in 1 case. CONCLUSION: The free BMSAP flap is very suitable to repair penetrating wound of the foot. The flap has the advantages of repairing the two wounds at the same time and reconstructing skin sensation as well.

[Application of venous flow-through flap in finger replantation with circularity soft tissue defect].

OBJECTIVE: To investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect. METHODS: Between January 2010 and December 2012, 11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps. There were 8 males and 3 females, aged 18-42 years (mean, 24.6 years). The cause of injury was squeeze injury in 6 cases, crush injury in 3 cases, and strangulation in 2 cases. Combined injuries included nerve defect in 3 cases (1.0, 2.0, and 3.5 cm in length), and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width, was 1/2-1 finger circumference in length, and was 2.0 cm x 1.0 cm to 7.0 cm x 4.5 cm in size. Six cases had complete circular defect (both finger artery and vein defects), and 5 cases had incomplete circular defect (only finger artery defect), and vascular defect was 1.0-4.5 cm in length. The time from injury to operation was 1.5-4.5 hours. RESULTS: Venous crisis occurred in 1 case at 2 days after operation, was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously. The other 6 flaps and replanted fingers survived completely, with primary healing of incision. Ten cases were followed up 12-18 months (mean, 15.5 months). Only a linear scar was seen at the donor sites, with no functional limitation. The flaps had similar color and texture to adjacent skin. The two-point discrimination was 6.5-13.0 mm (mean, 8.6 mm). According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association, the results were excellent in 6 cases, good in 3 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 90%. CONCLUSION: Venous Flow-through flap can repair both vascular defect and soft tissue defect, so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.

Use of a distal ulnar artery perforator-based bilobed free flap for repairing complex digital defects.

PURPOSE: To retrospectively evaluate the effectiveness and safety of using a distal ulnar artery perforator (DUAP)-based bilobed free flap (BFF) for the repair of complex digital defects in the hand. METHODS: We retrospectively studied 15 patients who sustained traumatic digital defects with complicating tendon and phalanx exposure and were hospitalized for repair using a DUAP-based BFF. Main outcome measures included patients' self-assessed physical appearance, total active motion, and 2-point discrimination. RESULTS: The flaps survived and the wounds healed with primary intention in all patients except one who experienced partial flap necrosis of the distal margin and required treatment with a second skin graft. Patients were observed for a mean of 13 months. The physical appearance and texture of the repaired fingers were assessed as good with minimal scarring. Total active motion and 2-point discrimination were 113° to 255° (contralateral, 255° to 275°) and 6 to 11 mm (contralateral, 5 to 8 mm), respectively. CONCLUSIONS: Use of the DUAP-based BFF is a feasible, effective, and safe treatment alternative for repairing complex digital defects with favorable aesthetic and sensorimotor outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.