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Introduction Scarring and volume reduction of the axillary space resulting in persistent lymphedema is a side effect of axillary treatment in breast cancer patients. The aim of this paper is to describe the reduction of lymphedema achieved with a turnover flap. Materials and Methods Between October 2016 and May 2018, five patients with grade 2 lymphedema following breast cancer therapy underwent reconstructive surgery with a turnover flap. Complete excision of the symptomatic axillary scar tissue followed by re-augmentation using a turnover flap was performed. Subsequently, all patients underwent breast reconstruction using a distant flap reconnected to the thoracodorsal vessels. The circumference of both arms, quality of life and pain were measured before and after surgery. Results An average reduction in pain in the ipsilateral arm from 6 to 1 on the numerical scale as well as an improvement in quality of life (2.8 vs. 7.0) was observed. A decrease in lymphedema especially in the upper arm was identified. No complications such as secondary bleeding, infections or flap loss were observed. Conclusion Complete removal of the axillary scar tissue after breast cancer treatment and re-augmentation of the axilla with a turnover flap results in a reduction in ipsilateral lymphedema and an improvement in pain and quality of life. We interpret these findings as a result of the physiological re-alignment of the lymphatic vessels combined with a lymph node-containing local transposition flap. Therefore, re-augmentation with a turnover flap could be an effective non-microsurgical alternative to lymph node transplantation.
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PURPOSE: The aim of this study was to evaluate the biomechanical properties of the APTUS wrist fusion plate in comparison to those of the AO wrist fusion plate. MATERIAL AND METHOD: 6 APTUS wrist fusion plates (APTUS 2.5 TriLock Wrist Fusion Plate Long Bend) from Medartis (Basel, Switzerland) and 6 AO wrist fusion plates (= LCP Wrist Fusion Plate Standard Bend from Dupuy-Synthes, Bettlach, Switzerland) were installed according to the manufacturers' instructions on life-sized, fibre-glass reinforced polyamide models of a healthy human hand. Then fatigue testing with increasing loads on a monoaxial material testing machine was carried out and the force-movement measurements were recorded on a PC. For up to 50,000 cycles, loading was applied in a sinus-wave frequency of 4 Hz and a force ratio (FMin/FMax) of 0.1-70 N. After 50,000 cycles and then at every 10,000 cycles the load was increased by 15% until breakage or a deformation of over 15 mm at the point of force application of the implant occurred. In addition, the tear-out resistance of 5 screws of each type of plate was examined and the system tear-out resistance calculated. The mean values and standard deviations of fatigue strength, torsional moments and fatigue limits (load cycles) were checked for normal distribution and finally the results were compared by means of non-parametric and parametric statistical tests. RESULTS: Plate breakage occurred with the AO wrist fusion plate on average after 52,596 (SD±12,833) load cycles and with the APTUS wrist fusion plate after an average of 115,428 (SD±12,600) load cycles. For the AO wrist fusion plates, an average load of 6.3 (SD±0.8) Nm and for the APTUS plate one of 10 (SD±1.7) Nm led to failure. For the APTUS plate the screw tear-out resistance was calculated as 2,632 (SD±96) N while that for the AO plate was found to be 1,449 (SD±314) N. CONCLUSION: In comparison to the AO wrist fusion plate the APTUS wrist fusion plate has significantly higher fatigue resistance and tear-out strength. On the basis of 100,000 load cycles until bone healing in the case a wrist arthrodesis, use of the APTUS plate should enable bone healing to occur before the implant fails.