Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds.

Introduction Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure. Materials and Methods A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery. Results Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6-20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2-4). Mean wound size was 189 cm 2 with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes. Conclusion Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.

Use of a headless compressive screw for distal interphalangeal joint arthrodesis in digits: clinical outcome and review of complications.

PURPOSE: Arthrodesis of the distal interphalangeal joint (DIPJ) or thumb interphalangeal joints can be necessary to treat pain, deformity, or instability associated with arthritis. Compression and rigid fixation are thought to influence fusion rates and time to union favorably. The purpose of the study was to review the clinical outcome and complications associated with the use of a fully threaded headless compression screw for DIPJ arthrodesis. METHODS: Twenty-seven distal interphalangeal or thumb interphalangeal fusions were performed with an axial Mini-Acutrak screw in 22 patients. Charts, surgical reports, and preoperative and postoperative x-rays were reviewed to determine the incidence, time to union, and complications. The minimal follow-up period was 3 months. RESULTS: Twenty-three of the 27 arthrodeses achieved bony union. Complications included symptomatic nonunion (n=1, treated with secondary fusion), asymptomatic nonunion (n=2, left untreated), infection (n=4; 2 patients required implant removal that resulted in nonunion but declined revision) and nail bed injury (n=3). CONCLUSIONS: The Mini-Acutrak screw technique achieves healing rates that are comparable with but not superior to other techniques. Its main advantages are ease of execution, fully buried hardware, and early mobilization; however, the procedure is associated with complications and meticulous technique is required to avoid them. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Gerdy's tubercle as a source of cancellous bone graft for surgery of the upper extremity: description of technique.

Cancellous bone grafts can be harvested from Gerdy's tubercle on the proximal metaphysis of the tibia for surgical procedures on the upper extremity. This donor site, however, is used rarely by hand surgeons, possibly because of a lack of awareness.

Capsuloligamentous restraints to dorsal and palmar carpal translation.

PURPOSE: The purpose of this study was to determine biomechanically the relative contributions of the dorsal and palmar capsuloligamentous structures to dorsal and palmar carpal stability. METHODS: Seven fresh-frozen cadaver specimens were tested using a testing machine (MTS, Eden Prairie, MN) with low loads applied perpendicular to the axis of the radial diaphysis. We determined the loads required to achieve dorsal and palmar translation of the carpus on the radius as palmar and dorsal ligaments and capsule were sectioned sequentially. The relative contributions of the dorsal and palmar capsuloligamentous structures to dorsal and palmar stability were determined. RESULTS: The palmar structures provided a statistically significantly greater restraint (61%) to dorsal translation of the carpus than did the dorsal structures (2%). The palmar structures also provided a statistically greater restraint (48%) to palmar translation of the carpus than did the dorsal structures (6%). CONCLUSIONS: The palmar capsuloligamentous structures provided greater restraint to both dorsal and palmar translation of the carpus. We suggest that surgeons consider repair or reconstruction of traumatic injuries to these structures.