We present an anatomical study and the description of a new surgical technique for the arthroscopic treatment of scapholunate ligament injuries.
First, a standard wrist arthroscopy was performed, and two bone tunnels were made. One across the scaphoid, through the 3/4 portal from its dorsal face to the tubercle, and another through the 4/5 portal to the lunate, perpendicular to its axis. The plasty of the FCR was obtained by a volar approach, and it was passed through the tunnel of the scaphoid. Subsequently, the plasty was passed from the 3/4 portal to 4/5, through a small 3-cm arthrotomy on this site. Finally, we introduced the plasty in the lunate tunnel with a biotenodesis screw. At this manner the tenodesis Bone (insertion of FRC) - Tendon (FRC) - Tenodesis (FRC in lunate) was completed.
With this arthroscopic technique three objectives are achieved. First, it reduces soft tissue damage, scar tissue and the section of secondary stabilizers of the wrist. Secondly, it ensures that, without doing and arthrotomy, the injured of IP nerve is avoided maintaining proprioception of the wrist and the properly function of the dynamic stabilizers. And finally the use of a stronger implant will shorten the time of immobilization.
However clinical trials in patients are needed to confirm with scientific rigor the new technique described.
A descriptive study was developed in 5 formaldehyde preserved cadavers, 50 fingers (3 men and 2 women, average age at time of death 60,6 years, range 52–81). US identification of topographic markings was followed by USGAR and open dissection. Measurements included real (RL) and US (UL) A1 length and distances from: markers to proximal (MP) and distal A1 edges (MD); markers to A2 (MA) and neurovascular (NV) bundles (MN); and from the surgical release to A2 (SA) and NV (SN). The length of any incomplete release (IR) and damage to adjacent structures were recorded. Mean values, Standard deviation and range were gathered. ANOVA was used to analyze differences (significant at p <
0.05).
We present in this work our experience with the sural fasciocutaneous flap to treat coverage defects following a lower limb posttraumatic lesion. This work is a review of the fasciocutaneous sural flaps carried out in different centres between 2000 and 2005. The series consist of 14 patients, 12 men and 2 women with an average age of 38 years (23–54) and with a medium follow-up time of 2 years (12–48 months). In all of the cases, aetiology was a lower limb injury being the most frequent the distal tibial fracture (eight patients), followed by sequelae from Achilles tendon reconstruction (two patients), fracture of the calcaneus (two patients) and osteomyelitis of the distal tibia (two patients) secondary to an open fracture. Associated risk factors in the patients for performing a fasciocutaneous flap were diabetes (1 case) and cigarette smoking (4 cases). The technique is based on the use of a reverse-flow island sural flap with the superficial sural artery dependent on perforators of the peroneal arterial system. The anatomical structures which constitute the pedicle are the superficial and deep fascia, the sural nerve, external saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The flap was viable in 13 of 14 patients. Only in one case, a diabetic patient, the graft failed. No patient showed signs of infection. Slight venous congestion of the flap occurred in two cases. No further surgical intervention of the donor site was required because of morbidity. In two cases partial necrosis of the skin edges occurred which resolved satisfactorily with conservative treatment. The sural fasciocutaneous flap is useful for the treatment of complex injuries of the lower limbs. Its technical advantages are: easy dissection with preservation of more important vascular structures in the limb, complete coverage of the soft tissue defect in just one operation without the need of microsurgical anastomosis. All of that results in a well vascularised cutaneous islet and thus a reliable flap