Dataset Information

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture - A case report.

ABSTRACT:

Introduction

The challenging issue that still remains for reverse sural flap is the withstand of the flap against time, the width of coverage area, and the donor site morbidity such as pain after the medial or lateral sural cutaneous nerve harvested.

Presentation of case

A 55 years old male was suffered from traumatic Achilles tendon rupture for 3 months and was repaired with Krakow's technique in a medical center in Pemalang, Indonesia. After the surgery, the defect was revealed as another surgery was planned to cover the skin defect. The author had chosen the bipedicled reverse sural fasciocutaneous flap in regular basis which addressed the superiority and viability of the flap, thus the donor site morbidity was also concerned as the preservation of medial and lateral sural cutaneous nerve, which leading to good quality of life as the patient still could feel and sensate his medial and lateral leg.

Discussion

The bipedicled reverse sural fasciocutaneous flap was successfully covered the skin defect on post traumatic Achilles tendon reconstruction, with retained medial sural nerve on its place, and the remaining harvested skin area was leave opened without skin graft which healed spontaneously.

Conclusion

Bipedicled reverse sural fasciocutaneous flap with retained medial sural nerve offer a good clinical outcome either the viability of the flap and the maintained sensation along the medial and lateral sural cutaneous nerve distribution.

SUBMITTER: Novriansyah R

PROVIDER: S-EPMC7776118 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture - A case report.

Novriansyah R R Prabowo I I Laras S S

International journal of surgery case reports 20201216

<h4>Introduction</h4>The challenging issue that still remains for reverse sural flap is the withstand of the flap against time, the width of coverage area, and the donor site morbidity such as pain after the medial or lateral sural cutaneous nerve harvested.<h4>Presentation of case</h4>A 55 years old male was suffered from traumatic Achilles tendon rupture for 3 months and was repaired with Krakow's technique in a medical center in Pemalang, Indonesia. After the surgery, the defect was revealed ...[more]

PMID: 33373919

Similar Datasets

Project description:ObjectiveProfessional Basketball players are at high risk of Achilles tendon rupture. Despite this, there remains limited research into the factors affecting rehabilitation and the long term outcomes of these players. Our aim is to quantify the effect of a player's Achilles tendon rupture on their post-injury performance, and also to explore for correlations between their recovery timeline and pre-injury characteristics. Creation of an injury timeline of past incidents will allow injured players to better track their progress and also inform them about the probable impact on their careers.HypothesisPlayers with Achilles tendon rupture injury will exhibit decreased performance compared to their pre-injury self and their non-injured peers after recovery.MethodsProfessional basketball players who sustained a unilateral Achilles tendon rupture from 1992 to 2016 were collected. 12 players met our inclusion criteria and their Player Efficiency Ratings (PER) were obtained as primary outcome measures; matched controls were chosen based on the PER, Age and playing position. The players' index season PER was compared against the PER during the 10 games immediately following the players' return and the PER of their post-injury peak performing season. The same data analysis was performed against their control group. To investigate the factors affecting the recovery and long-term consequences of their injury, we correlated the variables of Age, BMI, Time of Injury and pre-injury PER with the player's time to return to play and their post-injury PER.Results2 out of 12 players failed to return to playing in the elite professional league following an Achilles Tendon Rupture, others returned after a mean recovery time of 10 months. When compared to players' index PER, the mean PER reduction during the 10 games immediately following the players' return was 7.15 (P < .000). Players on average took 1.8 seasons to reach their post-injury peak performance, with only 1 player returning to his pre-injury performance. Others suffered a mean PER reduction of 3.5 (P = .004) when compared to their index PER and 5.4 (P = .045) against their matched controls.ConclusionAchilles tendon rupture can be a career-ending injury for professional basketball players. They are expected to miss 10 months for rehabilitation and reach their post-injury peak performance level at the 2nd season back. The post-injury peak performance is significantly worse than the pre-injury level, but is similar to matched non-injured players.

Project description:Background:Animal models are one of the first steps in translation of basic science findings to clinical practice. For tendon healing research, transgenic mouse models are important to advance therapeutic strategies. However, the small size of the structures complicates surgical approaches, histological assessment, and biomechanical testing. In addition, available models are not standardized and difficult to compare. How surgery itself affects the healing outcome has not been investigated yet. The focus of the study was to develop a procedure that includes a transection and microsurgical reconstruction of the Achilles tendon but, unlike other models, preserves the sciatic nerve. We wanted to examine how distinct parts of the technique influenced healing. Methods:For this animal model study, we used 96 wild-type male C57BL/6 mice aged 8-12 weeks. We evaluated different suture techniques and macroscopically confirmed the optimal combination of suture material and technique to minimize tendon gap formation. A key element is the detailed, step-by-step illustration of the surgery. In addition, we assessed histological (Herovici and Alcian blue staining) outcome parameters at 1-16 weeks postoperatively. Microcomputed tomography (micro-CT) was performed to measure the bone volume of heterotopic ossifications (HOs). Biomechanical analyses were carried out using a viscoelastic protocol on the biomechanical testing machine LM1. Results:A modified 4-strand suture combined with a cerclage for immobilization without transection of the sciatic nerve reliably eliminated gap formation. The maximal dorsal extension of the hindlimb at the upper ankle joint from the equinus position (limited by the immobilization cerclage) increased over time postoperatively (operation: 28.8 ± 2.2°; 1 week: 54 ± 36°; 6 weeks: 80 ± 11.7°; 16 weeks: 96 ± 15.8°, p > 0.05). Histological staining revealed a maturation of collagen fibres within 6 weeks, whereas masses of cartilage were visible throughout the healing period. Micro-CT scans detected the development of HOs starting at 4 weeks and further progression at 6 and 16 weeks (bone volume, 4 weeks: 0.07604 ± 0.05286 mm3; 6 weeks: 0.50682 ± 0.68841 mm3; 16 weeks: 2.36027 ± 0.85202 mm3, p > 0.001). In-depth micro-CT analysis of the different surgical elements revealed that an injury of the tendon is a key factor for the development of HOs. Immobilization alone does not trigger HOs. Biomechanical properties of repaired tendons were greatly altered and remained inferior 6 weeks after surgery. Conclusion:With this study, we demonstrated that the microsurgical technique greatly influences the short- and longer-term healing outcome. When the sciatic nerve is preserved, the best surgical reconstruction of the tendon defect is achieved by a 4-strand core suture in combination with a tibiofibular cerclage for postoperative immobilization. The cerclage promotes a gradual increase in the range of motion of the upper ankle joint, comparable with an early mobilization rehabilitation protocol. HO, as a key mechanism for poor tendon healing, is progressive and can be monitored early in the model. The translational potential of this article:The study enhances the understanding of model dependent factors of healing. The described reconstruction technique provides a reproducible and translational rodent model for future Achilles tendon healing research. In combination with transgenic strains, it can be facilitated to advance therapeutic strategies to improve the clinical results of tendon injuries.

Dataset Information

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture - A case report.

Introduction

Presentation of case

Discussion

Conclusion

Publications

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture - A case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets