The coverage of defects of the Achilles tendon, malleoli, and heel remains a challenge to reconstructive surgeons. The distally based superficial sural artery island flap is vascularized by the median superficial sural artery, posterolateral septal perforators originating from the peroneal artery, neurovascular arteries of the sural nerve, and combinations of these systems as suprafascial plexus. We used distally based superficial sural artery island flaps for the reconstruction of defects of ankle, malleolus, and heel in 17 patients between 1991 and 1997. The largest flap we have used until today was 12 cm in width and 15 cm in length. All flaps have survived. However, we observed venous congestion and edema in two flaps. Also, marginal necrosis occurred in two flaps for which we had not taken the sural nerve with the flap. After these complications, we made some modifications. We left a skin extension over the fasciovascular pedicle and used it as a roof of the tunnel. We took the sural nerve and the deep fascia in all cases. The main advantage of this flap is a constant and reliable blood supply without sacrifice of a major artery. In addition, this is a one-stage, safe and easy procedure that can be used for large defects.

Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy and kinesio taping in lateral epicondylitis Abstract Background/aim: The aim of this study was to compare the clinical and sonographic effects of the ultrasound (US) therapy, extracorporeal shock wave therapy (ESWT), and Kinesio taping (KT) in the lateral epicondylitis (LE). Materials and methods: A total of 40 patients with LE were included in the present study. The patients were randomly assigned to three treatment groups: US (n = 13), ESWT (n = 14), and KT (n = 13) groups. Results: The visual analog scale (VAS) scores significantly decreased in all groups (p < 0.05). Grip strength significantly increased after eight weeks in only the KT group (p < 0.05). The Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) scores significantly decreased after two weeks and after eight weeks in the US and ESWT groups and after eight weeks in the KT group (p < 0.05). The common extensor tendon (CET) thicknesses significantly decreased after eight weeks in only the ESWT group (p < 0.05). Conclusion: The US therapy, KT, and ESWT are effective in reducing pain and improving functionality. However, none of these treatment methods were found to be superior to the others in reducing the pain and improving functionality.

No abstract