Background: Reconstruction of limb defects following wide resection of large soft-tissue sarcomas (STS) is challenging. Effectiveness of rhomboid flaps in covering these wounds remains to be addressed. Methods: From March 2018 through February 2019, we utilized modified rhomboid flaps to reconstruct limb defects following wide resection of the large STS (≥5 cm in diameter) in 6 patients. There were 3 males and 3 females. The average age was 65 years (47-77 years). Diagnoses included leiomyosarcoma in 3 patients, synovial sarcoma, undifferentiated pleomorphic sarcoma, and myxoid liposarcoma in 1 respectively. The anatomic locations included the anterior knee in 3 cases, upper arm in 2, and thigh in 1. The mean diameter of the tumor measured 10 cm (5-17 cm). The mean defect size was 113 cm2(38-270 cm2). Results: The mean follow-up duration was 10 months (range, 6-12 months), no patients were lost to follow-up. Skin grafts were utilized in 2 cases. The mean time to heal was 7 weeks (range, 3-13 weeks). At final follow-up, there were no recurrence and metastasis. One case had cerebral hemorrhage and 1 had wound dehiscence, whereas no reoperation was performed. The range of motion of the joints adjacent to the flap reconstructions were comparable to preoperative status. The mean Musculoskeletal Tumor Society score was 27 (range, 24-30). Conclusions: The modified rhomboid flap affords great versatility and is easy to design. This technique yields satisfactory effectiveness in reconstructing limb defects after resection of large STS. Long-term studies of large sample size are warranted.
Background: This study analyzed the advantages and disadvantages of different procedures for stage IIA progressive collapsing foot deformity (PCFD) through three-dimensional finite element models.
Methods: Medial column fusion (MCF), medializing calcaneal osteotomy (MCO), lateral column lengthening (LCL), and subtalar joint arthroereisis (SJA) operations were simulated. The maximum pressure on plantar soft tissue, medial column bone, and medial ligaments was compared before and after simulated single-foot weight loading.
Results: The maximum plantar stress of PCFD decreased with MCO and SJA but increased with MCF and LCL. MCF and LCL failed to significantly reduce the stress on the medial column fragments, thereby increasing their stress. Both MCO and SJA relieved medial plantar stress. MCF had no significant effect on stress relief of the medial ligament. MCO, LCL, and SJA were all shown to reduce the pressure on the medial plantar ligament, with LCL having the most obvious effect. All four procedures corrected the arch deformity; however, MCF was not as effective as the other methods. SJA is the best method for restoring arch height and correcting arch deformities. For stage IIA PCFD, isolated MCF failed to reduce pressure on the medial column; however, isolated MCO significantly reduced the pressure on the medial plantar and ligamentous soft tissues while restoring the foot’s arch and correcting the hindfoot valgus.
Conclusion:SJA with type II sinus tarsi implant effectively transferred pressure from the medial plantar tract to the lateral side and restored the arch. Isolated LCL was not found suitable for stage IIA PCFD.
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