Effective shape of ball-and-socket prosthesis in restoring range of thumb motion for total thumb carpometacarpal joint arthroplasty: three-dimensional motion analysis.

PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.

Development and validation of a nomogram to predict surgical site infection after soft-tissue sarcoma resection.

Aims: Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment. Methods: A total of 547 patients with STS who underwent tumour resection between 2005 and 2021 were divided into a development cohort and a validation cohort. In the development cohort of 402 patients, the least absolute shrinkage and selection operator (LASSO) regression model was used to screen possible risk factors of SSI. To select risk factors and construct the prediction nomogram, multivariate logistic regression was used. The predictive power of the nomogram was evaluated by receiver operating curve (ROC) analysis in the validation cohort of 145 patients. Results: LASSO regression analysis selected possible risk factors for SSI, including age, diabetes, operating time, skin graft or flap, resected tumour size, smoking, and radiation therapy. Multivariate analysis revealed that age, diabetes, smoking during the previous year, operating time, and radiation therapy were independent risk factors for SSI. A nomogram was developed based on the results of multivariate logistic regression analysis. In the development cohort, the incidence of SSI was 4.5% in the low-risk group (risk score < 6.89) and 26.6% in the high-risk group (risk score ≥ 6.89; p < 0.001). In the validation cohort, the incidence of SSI was 2.0% in the low-risk group and 15.9% in the high-risk group (p = 0.004). Conclusion: Our nomogram will enable surgeons to assess the risk of SSI in patients with STS. In patients with high risk of SSI, frequent monitoring and aggressive interventions should be considered to prevent this.

Seasonal variation of surgically treated distal radius fracture in Japan using inpatient database: cross-sectional study.

INTRODUCTION: The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. MATERIALS AND METHODS: The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. RESULTS: The total number of patients for the 5 years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50 years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0-19 years was higher from spring to autumn. CONCLUSION: Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50 years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures.

Medium-term Outcomes of Excision Using Surgical Microscope of Tenosynovial Giant Cell Tumors of the Hand.

BACKGROUND/AIM: The recurrence rate following the excision of tenosynovial giant cell tumors (TSGCT) of the hand is very high. Intraoperative application of a surgical microscope has been reported. However, to date, there are no reports of medium-term outcomes related to this technique. This study aimed to evaluate the medium-term outcomes of tumor excision using surgical microscope for TSGCT of the hand. PATIENTS AND METHODS: A total of 27 patients, who underwent an initial surgery for histologically-confirmed TSGCT of the hand, between 2008 and 2020, were included and evaluated. The mean follow-up time postoperatively was 6.8 years. Tumor recurrence and preoperative tumor characteristics were assessed. RESULTS: All tumors were adherent to tendons, tendon sheaths, neurovascular structures or periarticular ligaments and capsules. Bony lesions were observed in 11 tumors. The surgical microscope was used in 13 tumors. Recurrences were observed in three tumors (overall recurrence rate: 11%). Tumor characteristics were similar in both groups, but the recurrence rate in the group treated using the surgical microscope was 0%, whereas the recurrence rate in the group treated without the surgical microscope was 21%. Re-operations using the surgical microscope for recurrent tumors were performed, without recurrence postoperatively. CONCLUSION: Among patients with TSGCT of the hand treated with tumor excision using the surgical microscope, the postoperative recurrence rate was 0%. Based on the results of this study, the surgical microscope might be used for excision of TSGCTs of the hand.

Ultrasound Investigation of the Radial Nerve's Superficial Branch: Reducing the Risk of K-Wire Insertion Damage in Distal Radius Fractures.

BACKGROUND: Kirschner wire (K-wire) insertion during surgery for distal radius fractures carries a risk of damaging the radial nerve's superficial branch. In this prospective study, we investigated the relationship between the radial nerve's superficial branch and the radius using ultrasound to minimize risk. METHODS: We collected data from 101 healthy volunteers (202 limbs; 51 men; mean age: 40.6 years). We ultrasonographically assessed the courses of the radial nerve's dorsal and superficial palmar branches at 0, 1, 2, and 3 cm proximal to the radial styloid process tip. The positional relationship between the radial nerve's superficial branch and the radius was determined by splitting the radius's ultrasound map into 4 sections (R1-R4) from the palmar side. The section containing the dorsal and palmar branch midpoints was determined for each height. RESULTS: In many limbs, the dorsal branch tended to wrap from the proximal palmar to the distal dorsal side at 1 to 2 cm proximal to the radial styloid process tip. In approximately 90% of limbs, the palmar branch ran along the radius's palmar side rather than the radial surface. CONCLUSIONS: A small incision enabling direct view may be the best approach for avoiding nerve damage when the superficial branch is less than or equal to 2 cm proximal to the tip of the radial styloid process. Inserting the K-wire from the dorsal side of the radius may be safer for more proximal locations. We recommend a preoperative ultrasound examination to determine the course of the superficial branches of the radial nerve in each patient.

Coloration Modeling and Processing of Commodity Plastic Buttons in Supercritical Carbon Dioxide.

We examined the color processing of the commodity plastic buttons made of acrylic, polyester, nylon, and casein with scCO2. The buttons' dyeing color depth (K/S) was measured over a wide range of scCO2 and correlated accurately with the response surface method. Moreover, we measured the solubility of C.I. Disperse Red 22 in scCO2 to formulate a dye-sorption model for the K/S value in the color processing of the plastic buttons. Finally, the dye-sorption model for the K/S value combining the dye solubility in scCO2 with the dye diffusion inside the buttons successfully represented the color processing of the buttons.

Questionnaire survey about the effects of new lifestyles during the pandemic of COVID-19 on upper limb diseases.

BACKGROUND: The novel coronavirus (COVID-19) that emerged in 2019 and spread globally in 2020 has resulted in the imposition of lockdowns or a state of emergency in many cities worldwide. In Japan, a "new lifestyle" is being advocated. We hypothesize that the new lifestyle has changed people's use of their upper limbs during the COVID-19 pandemic. Therefore, through this questionnaire study, we aimed to determine the factors associated with exacerbation of symptoms during the pandemic and to investigate the current status of patients who require hand surgery. METHODS: This study was a prospective multi-center questionnaire survey. This study was conducted in Japan from December 2020 to July 2021 at university and general hospitals in nine prefectures. A questionnaire was administered to patients who visited a hospital with symptoms of nerve entrapment syndrome, osteoarthritis, or tenosynovitis. RESULTS: A total of 502 patients with a mean age of 63.8 years responded. The 240 patients who experienced exacerbation (exacerbated and markedly exacerbated) were compared with other patients (unchanged, improved, and markedly improved). An increase in the time spent on personal computers and smartphones was associated with exacerbation of hand symptoms. Patients who wanted to undergo surgery but were postponed due to COVID-19 accounted for 23.5% of the outpatients. The mean scores for pain, jitteriness, and anxious depression in these patients were significantly higher than those of patients who did not want surgery. CONCLUSIONS: Our results suggest that an increase in the time spent on personal computers and smartphones is associated with exacerbation of hand symptoms during the COVID-19 pandemic. Patients who wanted to undergo surgery but were postponed by COVID-19 experienced greater pain, jitteriness, and anxious depression.

Clinical Outcomes of Soft Tissue Sarcoma around the Elbow Joint: A Retrospective Single Institution Study.

Background: We report a retrospective case series analysis of clinical outcomes of patients with soft tissue sarcoma around the elbow. Methods: Twenty-two patients underwent surgical tumor excision between January 1999 and May 2017, with a mean follow-up of 85.2 months. Results: Six tumors were localized in the upper arm, nine in the elbow, and seven in the forearm. Sixteen tumors were deep-seated, and six were superficially located. Fifteen patients underwent wide excision, including one amputation, and 18 achieved (81.8%) negative margins histologically. Two local recurrences and four distant metastases developed. The mean Musculoskeletal Tumor Society score was 92.0% (range, 33.3-100). The 5-year local recurrence-free survival rate, metastasis-free survival rate, and overall survival rate were 90.0%, 77.0%, and 79.7%, respectively. Conclusions: Local control and limb function can have favorable outcomes when the tumor excised has a histologically negative margin without sacrificing the major structure.

Comparing exposed and buried Kirschner wires in fixation for pediatric supracondylar humerus fractures: A propensity score-matched study.

PURPOSE: To thoroughly compare the outcomes between exposed and buried Kirschner wires (K-wires) in fixation for pediatric supracondylar humerus fractures. METHODS: We examined patients who underwent surgery at our institution between January 2007 and June 2021. We investigated their age, sex, fracture pattern, number of K-wires used, whether they were exposed or buried, operative time, postoperative complications, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and perioperative radiographic parameters. After propensity score matching, intergroup comparisons were performed to assess the differences in postoperative complication rate, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and loss of reduction. RESULTS: Propensity score matching resulted in 43 pairs in both groups. Although more patients complained of skin irritation in the buried K-wire group, there was more backing out of the K-wire in the exposed K-wire group (p < 0.01). There were no significant differences in other complications. There were more outpatient visits in the buried K-wire group (p < 0.01). The duration from surgery to K-wire removal and the total length of hospitalization were significantly longer in the buried K-wire group (p < 0.01). There was no significant difference in the loss of Baumann's angle (p = 0.61), tilting angle (p = 0.48), or the development of rotation (p > 0.99) between groups. CONCLUSION: More outpatient visits and longer lengths of hospitalization in the buried K-wire group may lead to increased costs and burden on parents.

Do Liquid Nitrogen-treated Tumor-bearing Nerve Grafts Have the Capacity to Regenerate, and Do They Pose a Risk of Local Recurrence? A Study in Rats.

BACKGROUND: Under most circumstances, the resection of soft tissue sarcomas of the extremities can be limb-sparing, function-preserving oncologic resections with adequate margins. However, en bloc resection may require resection of the major peripheral nerves, causing poor function in the extremities. Although liquid nitrogen treatment has been used to sterilize malignant bone tumors, its use in the preparation of nerve grafts has, to our knowledge, not been reported. Hence, this study aimed to investigate the tumor recurrence and function after peripheral nerve reconstruction using liquid nitrogen-treated tumor-bearing nerves in a rat model. QUESTIONS/PURPOSES: (1) Do liquid nitrogen-treated frozen autografts have regeneration capabilities? (2) Do liquid nitrogen-treated tumor-bearing nerves cause any local recurrences in vivo in a rat model? METHODS: Experiment 1: Twelve-week-old female Wistar rats, each weighing 250 g to 300 g, were used. A 10-mm-long section of the right sciatic nerve was excised; the prepared nerve grafts were bridge-grafted through end-to-end suturing. The rats were grouped as follows: an autograft group, which underwent placement of a resected sciatic nerve after it was sutured in the reverse orientation, and a frozen autograft group, which underwent bridging of the nerve gap using a frozen autograft. The autograft was frozen in liquid nitrogen, thawed at room temperature, and then thawed in distilled water before application. The third group was a resection group in which the nerve gap was not reconstructed. Twenty-four rats were included in each group, and six rats per group were evaluated at 4, 12, 24, and 48 weeks postoperatively. To assess nerve regeneration after reconstruction using the frozen nerve graft in the nontumor rat model, we evaluated the sciatic functional index, tibialis anterior muscle wet weight ratio, electrophysiologic parameters (amplitude and latency), muscle fiber size (determined with Masson trichrome staining), lower limb muscle volume, and immunohistochemical findings (though neurofilament staining and S100 protein produced solely and uniformly by Schwann cells associated with axons). Lower limb muscle volume was calculated via CT before surgery (0 weeks) and at 4, 8, 12, 16, 20, 24, 32, 40, and 48 weeks after surgery. Experiment 2: Ten-week-old female nude rats (F344/NJcl-rnu/rnu rats), each weighing 100 g to 150 g, were injected with HT1080 (human fibrosarcoma) cells near the bilateral sciatic nerves. Two weeks after injection, the tumor grew to a 10-mm-diameter mass involving the sciatic nerves. Subsequently, the tumor was resected with the sciatic nerves, and tumor-bearing sciatic nerves were obtained. After liquid nitrogen treatment, the frozen tumor-bearing nerve graft was trimmed to a 5-mm-long tissue and implanted into another F344/NJcl-rnu/rnu rat, in which a 5-mm-long section of the sciatic nerve was resected to create a nerve gap. Experiment 2 was performed with 12 rats; six rats were evaluated at 24 and 48 weeks postoperatively. To assess nerve regeneration and tumor recurrence after nerve reconstruction using frozen tumor-bearing nerve grafts obtained from the nude rat with human fibrosarcoma involving the sciatic nerve, the sciatic nerve's function and histologic findings were evaluated in the same way as in Experiment 1. RESULTS: Experiment 1: The lower limb muscle volume decreased once at 4 weeks in the autograft and frozen autograft groups and gradually increased thereafter. The tibialis anterior muscle wet weight ratio, sciatic functional index, muscle fiber size, and electrophysiologic evaluation showed higher nerve regeneration potential in the autograft and frozen autograft groups than in the resection group. The median S100-positive areas (interquartile range [IQR]) in the autograft group were larger than those in the frozen autograft group at 12 weeks (0.83 [IQR 0.78 to 0.88] versus 0.57 [IQR 0.53 to 0.61], difference of medians 0.26; p = 0.04) and at 48 weeks (0.86 [IQR 0.83 to 0.99] versus 0.74 [IQR 0.69 to 0.81], difference of median 0.12; p = 0.03). Experiment 2: Lower limb muscle volume decreased at 4 weeks and gradually increased thereafter. The median muscle fiber size increased from 0.89 (IQR 0.75 to 0.90) at 24 weeks to 1.20 (IQR 1.08 to 1.34) at 48 weeks (difference of median 0.31; p< 0.01). The median amplitude increased from 0.60 (IQR 0.56 to 0.67) at 24 weeks to 0.81 (IQR 0.76 to 0.90) at 48 weeks (difference of median 0.21; p < 0.01). Despite tumor involvement and freezing treatment, tumor-bearing frozen grafts demonstrated nerve regeneration activity, with no local recurrence observed at 48 weeks postoperatively in nude rats. CONCLUSION: Tumor-bearing frozen nerve grafts demonstrated nerve regeneration activity, and there was no tumor recurrence in rats in vivo. CLINICAL RELEVANCE: A frozen nerve autograft has a similar regenerative potential to that of a nerve autograft. Although the findings in a rat model do not guarantee efficacy in humans, if they are substantiated by large-animal models, clinical trials will be needed to evaluate the efficacy of tumor-bearing frozen nerve grafts in humans.

Clinical Outcomes of Limb-sparing Tumor Surgery With Vascular Reconstruction for Bone and Soft-tissue Tumors.

BACKGROUND/AIM: This study aimed to retrospectively investigate clinical outcomes after tumor resection surgery and discuss reconstruction methods and postoperative complications. PATIENTS AND METHODS: We analyzed the clinical outcomes, such as graft survival and prognosis, of nine patients with bone and soft-tissue tumors of the extremities with major vascular invasion who underwent limb-sparing surgery with vascular reconstruction between January 2006 and December 2020. RESULTS: The primary tumor was malignant in eight cases and intermediate in one case, with a mean postoperative follow-up duration of 52.1 months. A total of 10 vascular reconstructions (arterial in eight patients and both arterial and venous in one) were performed with autologous vein grafts in four cases and synthetic grafts in five cases. Graft occlusion was observed in two cases reconstructed with the great saphenous vein measuring >200 mm in length, and the 5-year arterial patency rate was 8/9. Only one case showed local recurrence, and at 5 years, local control was achieved in eight out of nine patients. Limb-sparing was achieved in all cases and the 5-year overall and disease-free survival rates were 77.8%. Postoperative complications occurred in six patients and wound-related complications were improved by re-surgery, while the others were controlled by conservative treatment. CONCLUSION: Limb-sparing tumor resection surgery with vascular reconstruction has favorable clinical and oncological outcomes. Most postoperative complications related to this surgery can be controlled by conservative treatment, except for wound-related complications. In reconstructions with autologous vein grafts of a length exceeding 200 mm, the graft occlusion rate may increase, and synthetic grafts may be recommended.

Common peroneal nerve rupture with multiple ligament knee injury: A case report.

In peroneal nerve palsy with closed knee injury, most of the case improves by follow-up. We present a case of peroneal nerve rupture with closed multiple ligament knee injury, requiring nerve transplantation. In multiple ligament knee injury, it is necessary to consider the possibility of peroneal nerve rupture.

Optimal Center of Rotation for Ball-And-Socket Thumb Carpometacarpal Arthroplasty Identified Using Three-Dimensional Kinematic Analysis: A Pilot Study.

Total joint arthroplasty is one of the surgical option for thumb carpometacarpal (CMC) joint arthritis, however the optimal position the center of rotation (COR) has not been quantified. The purpose of this study is to identify ideal ball-and-socket thumb carpometacarpal joint implants and the optimal position of the COR. We obtained eight right thumb computed tomography images each from ten healthy men, comprising four images each of thumbs at various angles of flexion-extension and abduction-adduction. We reconstructed 3D bone models on 3D CAD, created virtual ball-and-socket implants with three variables (neck offset, implant height, neck rotation), and found the optimal COR where the position change in the COR was smallest across various thumb positions. When the offset was 4.5 mm, neck rotation angle was 130.6° from the radial side to the palmar side of the first metacarpal, and implant height from the distal end of the metacarpal was 43.6 mm, we could restore almost normal kinematics. This study could serve as a reference for implant development and surgical technique guidelines.

Radiological Outcomes of the Simplified Sauvé-Kapandji Procedure for Osteoarthritis of the Distal Radioulnar Joint.

Background: We have been using a simplified Sauvé-Kapandji (SK) procedure using a headless compression screw for the treatment of osteoarthritis (OA) of the distal radio-ulnar joint (DRUJ). Unlike a standard SK procedure, the simplified SK procedure does not require exposure of the DRUJ to prepare the opposing surfaces of the sigmoid fossa and the ulnar head or any procedures to stabilise the proximal stump of the ulna. The aim of this study is to report the radiological outcomes of the simplified SK procedure. Methods: We retrospectively reviewed data of all patients who underwent a simplified SK procedure for osteoarthritis of the DRUJ at our hospital between October 2008 and September 2020 with a follow-up of at least 25 weeks. Baseline demographic and clinical characteristics were investigated. We also measured radiographic parameters and performed statistical analyses to evaluate the shelf-forming region, ulnar stump and deviation of the carpal region. Results: Our study included 10 patients with a mean follow-up of 52.3 weeks. There was no instance of complications such as nonunion of DRUJ arthrodesis, callus formation at ulnar pseudoarthrosis and painful instability at the proximal stump of the ulna. According to the Wilcoxon signed rank test, no radiographic parameters significantly changed during the follow-up period. There was a significant negative correlation between radioulnar width and the variation of ulnar translation index. Conclusions: All radiographic parameters were well maintained, at least during the short follow-up period. There was no instance of nonunion of DRUJ arthrodesis. The simplified SK with simple headless compression screw insertion may be a reliable method for treating OA of the DRUJ. Level of Evidence: Level IV (Therapeutic).

In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger.

Although the index finger is generally used for sensory nerve conduction study in cases of carpal tunnel syndrome, there are reports that the middle finger should be used. The purpose of this study was to compare the results of sensory nerve conduction studies of the index finger and middle finger in patients with carpal tunnel syndrome. Among the 120 hands of 93 patients who were diagnosed with carpal tunnel syndrome and underwent carpal tunnel release surgery at our hospital, 54 hands of 48 patients who showed waveforms in sensory nerve conduction studies both index and middle fingers were included. 6 hands of 6 patients who showed no waveform in the index or middle finger, and 60 hands of 39 patients who showed no waveform in both index and middle finger were excluded. The subjects were 14 males and 34 females, and their ages were 66.2 years. The preoperative sensory nerve action potential (µV) and sensory nerve conduction velocity (m/s) of the index and middle fingers were tested using Wilcoxon's signed rank test. Spearman's rank correlation coefficient was also calculated for the results of the index and middle fingers. Sensory nerve action potentials were 2.0 in the index finger and 1.8 in the middle finger, with significantly lower in the middle finger. Sensory nerve conduction velocity was 30.1 in the index finger and 27.2 in the middle finger, with significantly lower in the middle finger. The correlation coefficients of sensory nerve action potentials and conduction velocities between the index finger and middle finger were 0.82 and 0.96, respectively, both of which showed a significant correlation. The results of the sensory nerve conduction studies of the middle finger were significantly worse than those of the index finger in cases of carpal tunnel syndrome. In addition, there was a strong correlation between the results of the index finger and the middle finger. The results of this study suggest that the nerve bundle to the middle finger may be more strongly affected than the nerve bundle to the index finger in cases of carpal tunnel syndrome.

Profunda femoris artery perforator flap for lateral knee joint reconstruction: A report of two cases.

The profunda femoris artery perforator flap (PAP) based on a proximal skin perforator is often used for breast reconstruction. We report two cases of lateral knee joint reconstruction using a PAP flap based on a distal skin perforator. Case 1 is a 16-year-old male adolescent who underwent inappropriate resection of a synovial sarcoma on the lateral aspect of the right knee joint, which necessitated additional wide resection that led to a soft tissue defect measuring 11 × 5 cm. We elevated a propeller PAP flap (23 × 7 cm) for defect reconstruction, and the flap survived completely. Case 2 is an 81-year-old woman who underwent wide resection of an undifferentiated pleomorphic sarcoma on the lateral aspect of the right knee joint showed a persistent soft tissue defect measuring 9 × 6 cm. We elevated a propeller PAP flap (25 × 7 cm) as described in Case 1, and the flap survived completely. Skin perforators of the profunda femoris artery are present both in the proximal and distal thigh; therefore, a PAP flap can also be elevated in the distal thigh. However, a few reports have discussed PAP flap elevation in the distal thigh for knee joint reconstruction. The PAP flap with a distal skin perforator can be elevated with a relatively large volume of skin paddle and may be a useful option for lateral knee joint reconstruction.

Iatrogenic sciatic nerve injury due to cerclage wiring for proximal periprosthetic femoral fracture: A rare case report.

Cerclage wiring is used to reinforce the stability of fractures and optimize plate fixations for femoral fractures such as periprosthetic fractures. However, cerclage wiring requires attention to neurovascular structures to prevent injuries. We have presented a case of iatrogenic sciatic nerve injury after osteosynthesis with cerclage wiring. A 71-year-old woman underwent osteosynthesis with cerclage wiring for a proximal periprosthetic femoral fracture. Immediately after the operation, the patient developed motor and sensory disorders, particularly in the sciatic nerve area, leading to a suspicion of nerve injury. Consequently, reoperation showed that the right sciatic nerve was strangulated by the cerclage wire, but the nerve was functional. Since the sciatic nerve was partially continuous and retained sensation to some extent, strangulation release was performed. Subsequently, both sensory and motor disorders improved. This case suggests that attention should be given to not only the blood vessels in the anterior region but also the sciatic nerve in the posterior region when performing cerclage wiring for femoral fractures.

Deep inferior epigastric artery as a collateral pathway to the lower extremities: A case report.

We describe a patient in whom the deep inferior epigastric artery served as a collateral pathway to the lower extremities, and free latissimus dorsi myocutaneous flap transfer was successfully used for reconstruction instead of the originally planned free rectus abdominis myocutaneous flap. A 74-year-old woman underwent subtotal tongue resection, followed by free flap tongue reconstruction for tongue cancer. Reconstruction using a free rectus abdominis myocutaneous flap was considered; however, preoperative contrast-enhanced computed tomography revealed complete occlusion of the bilateral external iliac arteries. Doppler ultrasonography revealed retrograde blood flow via the deep inferior epigastric artery, and the internal thoracic artery-deep inferior epigastric artery pathway served as a collateral pathway that supplied the lower extremities. The patient underwent reconstructive surgery using a free latissimus dorsi myocutaneous flap, and the flap completely survived. The internal thoracic artery-deep inferior epigastric artery pathway serves as a critical collateral pathway to the lower extremities in patients with aortoiliac occlusive disease. Blockage of the deep inferior epigastric artery in patients in whom this vessel shows retrograde blood flow may result in lower extremity ischemia. Therefore, preoperative Doppler ultrasonography is warranted to confirm the direction of the blood flow, in addition to evaluation of the deep inferior epigastric artery and its perforators before planning rectus abdominis myocutaneous flap or deep inferior epigastric artery perforator flap surgery.

Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors.

INTRODUCTION: Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. METHODS: Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. RESULTS: Mean patient age was 57.3 years (15-85 years) and the mean observation period was 72.5 months (14-181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS (p < 0.01). CONCLUSION: Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.