Our minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. The SLFJ implant showed good osteointegration. Further longer-term prospective studies with various types of currently available implants are needed.
We report two cases with triggering at the distal end of the A2 pulley. One was caused by enlargement of the flexor digitorum profundus (FDP) tendon and the other by enlargement of both slips of the flexor digitorum superficialis (FDS) tendon. Both were relieved by reduction tenoplasty and short releases, or venting, of the distal A2 pulley.
Although the pedicled extensor digitorum brevis (EDB) muscle flap is a versatile flap, there are not many reports about it. Furthermore, there are few reports about the reverse vascular flow EDB muscle flap. The lateral tarsal artery coming from the dorsalis pedis artery nourishes the EDB muscle flap. Cutting the dorsalis pedis artery proximal to the flap can elevate this flap with reverse vascular flow. The authors treated eight patients with a reverse vascular flow EDB muscle flap. All flaps survived, with minor repair in two cases. The follow-up period ranged from 4 months to 1 year. This flap has two pivot points for creating a reverse vascular flow pedicled flap and a large arc of rotation for coverage of the dorsal foot. The authors confirmed that this flap is very versatile for soft-tissue reconstruction of the distal dorsum of the foot. The blood supply is reliable and the operative procedure is not complicated and can be performed under regional anesthesia. With this flap, a well-vascularized bed can be prepared for coverage with a skin graft. The major disadvantage is numbness in the first web of the foot, but this does not cause problems in daily life.
The traditional pedicled gastrocnemius muscle flap has often been used to repair soft-tissue defects caused by trauma. However, it is difficult to cover skin defects in the distal third of the lower extremity because of its range of excursion. We have attempted use of a free ipsilateral gastrocnemius muscle flap for coverage of skin defects in the distal third of the lower extremity. In three patients with skin defects due to Gustilo type III open fractures, a free gastrocnemius flap was used for coverage of the same leg. The follow-up period ranged from 12 months to 2 years. Microsurgical anastomosis of the vascular pedicle to the tibialis posterior vessels was performed by end-to-side anastomosis proximally to the ankle. The postoperative course was uneventful and showed stable coverage of the wound. All free flaps were successfully transferred, and the defects healed primarily. Bone fusion in all of the patients in this series progressed satisfactorily. This free muscle flap is useful for reconstruction of defects in the distal third of the lower extremity in Gustilo III open fractures.
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