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Handchir Mikrochir Plast Chir 2022 Jun 22. Epub 2022 Jun 22.

Städtisches Klinikum Sankt Georg Leipzig, Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum.

Background: Soft tissue defects in the achilles tendon region occur after trauma, but also as a complication after open recon- struction of the tendon with subsequent infection.

Objectives: Recommendations for the treatment of soft tissue injuries involving the Achilles tendon are presented.

Materials And Methods: A search of the German, French and English literature on reconstruction of soft tissue defects of the Achilles tendon region was performed, which were differentiated into singular and combined tendocutaneous defects. Read More

J Craniofac Surg 2022 May 26;33(3):951-955. Epub 2021 Oct 26.

Division of Plastic and Reconstructive Surgery, Department of Surgery.

Abstract: Even though there are many options for mandibular reconstruction, a free fibula osteocutaneous flap is regarded as the most frequently used flap. Despite having some previous anatomical studies pertaining to syndesmotic ligaments, there is no study pointing out that surgical landmarks can be used while free fibula osteocutaneous flaps are performed and used for surgical landmarks in order to avoid syndesmotic ligament injuries. Therefore, this study investigates the characteristics and relationship between inferior syndesmotic ligaments and fibula in cadavers. Read More

Clin Podiatr Med Surg 2022 Jul;39(3):521-533

Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA. Electronic address:

The objective of this article is to review the biomechanical stresses that occur during normal physiologic function of lower extremity soft tissue anatomic structures and to use this as a baseline for a critical analysis of the medical literature because it relates to surgical reconstruction following injury. The Achilles tendon, anterior talofibular ligament, plantar plate, and spring ligament are specifically evaluated. Read More

Clin Podiatr Med Surg 2022 Jul;39(3):421-435

Stamford Health Medical Group, 800 Boston Post Road, Suite 302, Darien, CT 06820, USA.

The lesser metatarsophalangeal joint plantar plate and calcaneonavicular (spring) ligament are highly specialized soft tissue structures within the foot, consisting partly of fibrocartilage and capable of withstanding high compressive and tensile loads. Preoperative advanced imaging, in the form of point-of-care ultrasound and MRI, has become indispensable for surgeons hoping to confirm, quantify, and better localize injuries to these structures before surgery. This article describes the technical considerations of ultrasound and MRI and provides examples of the normal and abnormal appearances of these structures. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022 Jun;36(6):766-769

Department of Trauma and Microreconstructive Surgery, Orthopaedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China.

Objective: To investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle.

Methods: Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). Read More

Clin Orthop Relat Res 2022 May 16. Epub 2022 May 16.

Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Gyeonggi, Korea.

Background: Many orthopaedic surgical teams practice double gloving or use colored indicator gloving techniques to reduce contamination intraoperatively. Although the likelihood of glove perforation can be affected by the procedure type and surgeon habits, as well as the surgeon's technique, these factors have not been considered in order to determine the glove perforation rate, and the role of colored under gloving during operations seems less investigated.

Questions/purposes: (1) What proportion of foot and ankle procedures result in perforation of outer gloves or under gloves? (2) What factors (such as the type or duration of operation) appear to be associated with the likelihood of glove perforation? (3) Does the use of a colored indicator under glove make it more likely that a surgeon would perceive the perforation of an outer glove intraoperatively?

Methods: Between September 2020 and August 2021, I performed 577 surgical foot or ankle procedures. Read More

Injury 2022 Jun 7. Epub 2022 Jun 7.

Department of Orthopedic Hand Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, No.16 Chunhui Avenue, Longma Tan District, Luzhou, Sichuan 646,000, China. Electronic address:

Background: Extensive soft-tissue defects around the ankle and foot pose a difficult challenge to surgeons. Considering that natural contour, the ideal solution should match a thin and pliable skin flap to allow shoe fitting and provide a functional move. As the conjoined flaps were increasingly utilized in covering various defects, we present our experience using the bipedicle conjoined flap on the lower abdomen and groin site. Read More

Zhonghua Wai Ke Za Zhi 2022 Jun;60(6):524-527

Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou 221009, China.

In recent years,the application of minimally invasive techniques in the treatment of chronic Achilles tendon rupture has become more and more mature,and it also faces many controversies and challenges.The concept of minimally invasive technique is to minimize the dissection of soft tissue around the Achilles tendon and reduce the occurrence of postoperative wound complications.Minimally invasive small incision surgery does not expose the Achilles tendon stump,and either tendon transposition or tendon transplantation can be achieved using this technique,but there is a risk of accidental injury to the peripheral nerve. Read More

Arthroscopy 2022 May 20. Epub 2022 May 20.

Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include: drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Read More

Acta Biomed 2022 03 10;92(S3):e2021578. Epub 2022 Mar 10.

Orthopaedics and Traumatology Unit, Cattinara Hospital- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Strada di Fiume 447, 34149 Trieste (Italy).

Achilles tendon reconstruction with substance loss and infection in the overlying soft tissues is a challenge. There is no standardized treatment in literature for these cases. We describe a one-stage tendon reconstruction, using flexor hallucis longus (FHL) tendon transfer and an anterolateral thigh flap with vascularized fascia lata in a patient with re-rupture of the Achilles tendon, soft tissue infection and a tendon defect of 10 cm in length. Read More

J Foot Ankle Surg 2022 Apr 25. Epub 2022 Apr 25.

Fellowship-Trained Foot and Ankle Surgeon, Assistant Professor, Georgetown University School of Medicine, Washington, DC.

Currently, there is no consensus on surgical approach for posterior malleolar fracture fragments with significant posteromedial involvement. The Bartonicek type III/Haraguchi type II posterior malleolar morphologies typically involve large posteromedial fragments, behaving like a pilon injury and have been reported as pilon variant fractures. We performed a retrospective chart review at 2 large healthcare institutions, evaluating patients that underwent surgical management of pilon variant posterior malleolar fractures and determining clinical outcomes including: time to union, union rates, soft tissue complications, infection and time to weight bearing. Read More

Cureus 2022 Apr 17;14(4):e24204. Epub 2022 Apr 17.

Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR.

Tibial plafond fractures (TPFs) are uncommon but potentially devastating injuries to the ankle. Operative treatments include internal and external fixation modalities. This article provides a systematic review of the clinical and functional outcomes of TPFs treated specifically with circular external fixation (CEF). Read More

Foot Ankle Int 2022 May 19:10711007221092761. Epub 2022 May 19.

Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.

Background: To compare the clinical and radiographic outcomes between the conventional delayed and staged approaches for intra-articular calcaneus fractures in which early definite fixation could not be performed because of severe soft tissue injury.

Methods: From January 2015 to May 2019, a total of 32 cases with acute intra-articular calcaneal fractures met criteria and were enrolled in the study. We compared the outcomes of intra-articular calcaneal fractures that underwent delayed internal fixation between groups treated with a conventional delayed approach (non-EF group) vs a temporary medial external fixation (EF group). Read More

BMC Musculoskelet Disord 2022 May 19;23(1):476. Epub 2022 May 19.

Department of Orthopedics, The First Affiliated Hospital of Naval Military Medical University, Shanghai, 20000, China.

Objective: To investigate the clinical effect of internal fixation of a Ni-Ti arched shape-memory connector in the treatment of distal tibiofibular syndesmosis ligament injury.

Methods: From January 2013 to January 2016, 108 cases of ankle fracture with distal tibiofibular syndesmosis ligament injury in our hospital were selected, and all of them were fixed with ASCs or screw fixation. The functional evaluation and efficacy evaluation were performed according to the Olerud Molander Ankle Score (Omas) and SF-36. Read More

Orthop Surg 2022 May 18. Epub 2022 May 18.

Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Objective: To describe our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in the management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.

Methods: A pedicled flap with a marked perforator artery was applied for soft tissue coverage after radical debridement and temporary external fixation. In the second stage, the Ilizarov external fixator was used in place of the temporary external fixator for reconstruction of the segmental bone defect by distraction osteogenesis. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022 Jan;47(1):79-85

Department of Orthopedics, Second Xiangya Hospital, Central South University, Changsha 410011, China.

Objectives: To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line.

Methods: The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. Read More

PLoS One 2022 11;17(5):e0268359. Epub 2022 May 11.

Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland.

Introduction: Local soft tissue status (STS) guides the timing for definitive surgical treatment strategies of fracture fixation around the ankle joint. The aim of this study was to assess different types of new technical devices in relation to the surgical treatment in closed ankle and pilon fractures.

Methods: This study was designed as a cohort study. Read More

J Arthroplasty 2022 May 6. Epub 2022 May 6.

Connecticut Joint Replacement Institute, Hartford, Connecticut.

Background: The objective of this study was to investigate the impact of alignment and soft tissue release on patient outcomes following total knee arthroplasty (TKA).

Methods: In a multicenter study, soft tissue releases during TKA were prospectively documented in 330 robotic-assisted TKAs. Knee Injury and Osteoarthritis Outcome Scores (KOOS) were captured postoperatively. Read More

J Plast Reconstr Aesthet Surg 2022 Apr 21. Epub 2022 Apr 21.

Yinfeng cryomedicine technology company, Ltd. No. 1109, the 3rd Gangxing Rd, Jinan 250012, China.

Degloving injury is a common and intractable injury with the bone and tendon exposed and contamination, the stripped skin cannot be replanted immediately and will be discarded, although auto-graft is needed for subsequent wound repair. In this study, autologous skin cryopreservation technique was applied to the treatment of severe limb degloving injuries. The clinical data of 9 patients from January 2016 to December 2018 were analyzed retrospectively. Read More

Arthrosc Tech 2022 Apr 28;11(4):e669-e673. Epub 2022 Mar 28.

Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.

Joint-spanning external fixation in acute ankle trauma is a means to provide temporary stability and restoration of length, alignment, and articular congruency. This allows for soft-tissue consolidation before definitive fixation to decrease the risk of wound complications. Traction is commonly used during definitive fixation to aid in fracture reduction and to maintain reduction during placement of internal hardware. Read More

Arch Orthop Trauma Surg 2022 Apr 25. Epub 2022 Apr 25.

University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.

Background: Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few cases have been reported with different treatment regimens.

Methods: Here, we report on a 46-year-old female patient with complex foot trauma consisting of complete avulsion of the heel pad at the hindfoot and a soft tissue defect at the posterior aspect of the heel accompanied by rupture of the anterior tibial tendon and fractures of the talus, calcaneus and midfoot. Read More

Acta Ortop Mex 2021 Sep-Oct;35(5):390-393

Departamento de Medicina General Integral. Policlínico Universitario Tula Aguilera. Universidad de Ciencias Médicas. Camagüey. Cuba.

Introduction: Tibial pylon fractures are difficult to manage injuries due to their anatomical situation, mechanism of production, and damage to the surrounding soft tissue. Surgical treatment is the most widely used, including external fixation that can be used temporarily or permanently.

Objective: To evaluate the use of external fixation in patients with tibial pylon fractures. Read More

Musculoskelet Surg 2022 Apr 18. Epub 2022 Apr 18.

Department of Orthopaedics and Traumatology, Rovereto Hospital, Rovereto, Italy.

Background: Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Read More

J Foot Ankle Surg 2021 Nov 15. Epub 2021 Nov 15.

Trauma and Orthopaedic Consultant, Kings College Hospital, London, UK. Electronic address:

This retrospective case series aimed to identify whether trans-articular screws, dorsal bridging plates or if a 4-corner compression plate offers better functional outcome after B2 Lis Franc injuries. Thirty-eight patients underwent surgical fixation for these injuries over 5 years in a Level 1 Trauma Centre. Patients were treated in 1 of 3 treatment arms: trans-articular screw, dorsal bridge plate, or 4-corner compression plate fixation. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022 Apr;36(4):456-460

Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China.

Objective: To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers.

Methods: Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). Read More

Injury 2022 Jul 7;53(7):2657-2665. Epub 2022 Apr 7.

Orthopedics and Traumatology Department, Hand and Microsurgery Unit, Sohag University, Egypt.

Introduction: Management of soft tissue defects around the ankle is a difficult and challenging situation for all reconstructive surgeons. A microsurgical free flaps coverage can solve this problematic situation especially with large defects that is not available in all trauma centers. Moreover, long operating time and suitable operative demands are considered obstacles. Read More

J Orthop Surg (Hong Kong) 2022 Jan-Apr;30(1):10225536221094258

Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China.

Purpose: To evaluate the clinical efficacy of using free tissue flap combined with contralateral instep thick plantar skin in reconstructing complex plantar forefoot defects.

Methods: During the past 8 years, 15 patients, aged 25-60 years, with defects in the soft-tissue and composite bone of the forefoot were treated. Their defects were caused by trauma. Read More

Injury 2022 Jun 25;53(6):2274-2280. Epub 2022 Mar 25.

Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.

Introduction: Ankle fractures are amongst the most common open fracture injuries presenting to major trauma centres (MTC) and their management remains a topic of debate. Incidence is increasing particularly in the elderly population however the optimal surgical approach and risk factors for unplanned reoperation remain scarce. We therefore conducted a retrospective case study to analyse our institution's outcomes as well as identify risk factors for early unplanned reoperation. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2022 ;122(3):72-77

«Probiotech» LLC, Moscow, Russia.

Objective: Evaluation of the therapeutic efficacy, safety and tolerability of the drug Alental cream for external use (VERTEX, LLS, Russia) compared with the original drug - Aertal cream for external use (Gedeon Richter, LLS, Hungary) for local therapy of acute nociceptive pain syndrome in patients who have suffered traumatic ankle injury.

Material And Methods: The study included 131 patients who had suffered an injury to the soft tissues of the ankle joint. The 1st comparison group received the drug Alental cream, the 2nd group - Aertal cream. Read More

Injury 2022 Jun 29;53(6):1789-1795. Epub 2022 Mar 29.

Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland.

Introduction: Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. Read More