Summary: Beyond being aesthetically unpleasing, metatarsal defects have been known to lead to several patient concerns such as intermetatarsal malpositioning and metatarsalgia. There are several reconstructive techniques that have been utilized for reconstruction of bony defects in the foot, including the free dorsal toe flap and dorsal metatarsal perforator flap. Our institution has utilized the free fibular flap for surgical management pertaining to tarsal reconstruction. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. A retrospective chart review was conducted at Beaumont Health System, Royal Oak for patients who underwent first metatarsal reconstruction with a free fibular flap between the years 2015 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. A total of two patients were isolated after chart review. Both patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical results. The free fibular flap may be used effectively in the management of metatarsal defects that have failed prior therapy. In our study, both patients who underwent surgical management with a free fibular flap were noted to have successful long-term results. With the right expertise and patient population, a free fibular flap can be highly successful in the repair of metatarsal defects.

Background: Ankle arthrodesis has become a common surgical procedure for individuals with end-stage ankle arthritis, chronic infection, and bony misalignment. Although arthrodesis is typically managed with arthrodesis in situ or realignment, reconstruction may be utilized for patients with more complicated cases that involve metatarsal defects. Our institution utilizes both the pedicled and free fibula flaps for surgical management pertaining to ankle arthrodesis. Our study looks to evaluate the work of a single plastic surgeon and identify patient postoperative outcomes. Methods: A retrospective chart review was conducted at Beaumont Health System, Royal Oak, for patients who underwent ankle arthrodesis with a pedicled fibula flap for nonunion or avascular necrosis of the talus between the years 2014 and 2022. Demographic data, operative details, complications, medical comorbidities, and patient outcomes were retrospectively gathered and analyzed. Results: A total of six patients were isolated, with three patients undergoing a free fibula approach and three patients undergoing the pedicled fibula approach. All patients were found to have tolerated the procedure well and had no intraoperative complications. In addition, all patients had clinically viable flaps and were satisfied with their surgical result. Conclusions: Both free and pedicled free fibula flaps may be used effectively in the management of ankle arthrodesis in patients who have failed prior therapy. In our study, free fibula flaps were utilized in a medial approach, while the pedicled fibula flap was utilized in a lateral approach. With the right expertise and patient population, the free and pedicled fibula flaps can be highly successful in the repair of ankle defects.

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Background: Spine surgery costs are notoriously high, and there are already criticisms and concerns over the economic effects. There is no consensus on cost variation with robot-assisted spine fusion (rLF) compared with a manual fluoroscopic freehand (fLF) approach. This study looks to compare the early costs between the robotic method and the freehand method in lumbar spine fusion. Methods: rLFs by one spine surgeon were age, sex, and approachmatched to fLF procedures by another spine surgeon. Variable direct costs, readmissions, and revision surgeries within 90 days were reviewed and compared. Results: Thirty-nine rLFs were matched to 39 fLF procedures. No significant differences were observed in clinical outcomes. rLF had higher total encounter costs (P , 0.001) and day-of-surgery costs (P = 0.005). Increased costs were mostly because of increased supply cost (0.0183) and operating room time cost (P , 0.001). Linear regression showed a positive relationship with operating room time and cost in rLF (P , 0.001). Conclusion: rLF is associated with a higher index surgery cost. The main factor driving increased cost is supply costs, with other variables too small in difference to make a notable financial effect. rLF will become more common, and other institutions may need to take a closer financial look at this more novel instrumentation before adoption. R obotic-assisted procedures are becoming increasingly common in orthopaedics, especially in total knee arthroplasty and spinal instrumentation. Pedicle screws are an established and widely accepted method used for spinal fixation for the treatment of deformities, traumas, and neoplasms of the thoracolumbar spine. 1 Robot-guided pedicle screw placement is meant to provide improved accuracy and precision in pedicle screw placement along with a reduction in exposure to radiation for the surgeon,

In this case study, we discuss the observed anatomical variant of bilateral extensor indicis medii communis (EIMC) muscle. During a routine anatomical dissection of 48 upper limbs from 24 cadavers, two female cadavers (75 and 79 years of age) demonstrated bilateral EIMC (8.3%), while one male cadaver (86 years of age) demonstrated unilateral EIMC (4.2%). The noted EIMC shared a muscle belly with the extensor indicis, but had a distal attachment in the extensor hood of the third digit. This is a rare instance of a bilateral presentation of the extensor indicis medii communis muscle. There has been a limited number of cases in which a bilateral EIMC was discovered; however, such findings have been limited to one cadaver and at a lower frequency. This finding may demonstrate that bilateral EIMC may not be as rare as previously thought. Ultimately due to its infrequency, awareness of this variation may help physicians avoid improper muscle recognition when visualizing the area during procedures regarding the dorsum of the hand, as well as providing a possible site of tendon harvesting.