Strategies in Trauma and Limb Reconstruction

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2010 | December | Volume 5 | Issue 3

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Original Article

Shahram Nazerani, Mohammad Hosein Kalantar Motamedi, Mohammad Reza Keramati, Tara Nazerani

Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the “spiral” reconstruction technique

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:6] [Pages No:115 - 120]

Keywords: Expanded latissimus dorsi musculocutaneus flap, Circumferential defects, Reconstruction

   DOI: 10.1007/s11751-010-0090-z  |  Open Access |  How to cite  | 


We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upper extremity defects via resurfacing and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue expander (TE) was inserted under the LD muscle to expand the flap in a longitudinal direction thereby forming a “long” flap rather than a “wide” one. After excising the circumferential lesion, the expanded “elongated” flap was wrapped spirally around the extremity to cover the defect; the donor site was closed as usual. The 5 patients we treated via LDMC flaps in a spiral fashion were free of complications, and all were satisfied with the outcome. All the flaps survived and the spiral reconstruction allowed for a tension-free donor site closure and near complete recipient coverage. This technique is indicated for large circumferential extremity skin defects and deformities. Application of expanded LDMC flaps in a spiral fashion can be used by the reconstructive surgeon to resurface large circumferential upper extremity lesions when indicated. The idea of a long and thinned expansion flap must be in a longitudinal direction and we need this long expanded and thin flap to “spiral” it around the extremity to cover a large defect. The “spiral” flap coverage introduced here for large circumferential extremity defects enables the surgeon to cover the defect with simultaneous donor site closure and good results.


Original Article

Alfred O. Ogbemudia, Anire Bafor, Efosa Igbinovia, Peter E. Ogbemudia

Open interlocked nailing without a targeting device or X-ray guidance for non-union of the femur: a case series

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:5] [Pages No:121 - 125]

Keywords: Kuntscher nail, Interlocked intramedullary nailing, Femur, Cortical window

   DOI: 10.1007/s11751-010-0095-7  |  Open Access |  How to cite  | 


From October 2005 to August 2007, we operated on six patients who had femoral non-unions and performed interlocked intramedullary nailing without X-ray guidance or a targeting device. There were three fractures of the distal femur, two fractures of the mid-shaft and one of the proximal femur. Fatigue failure of a non-interlocked Kuntscher nail and one nail migration were the presenting features in two patients. The presence of sclerosis of the bone ends in four cases and a need for cancellous bone grafts at the site of non-union in all patients made wide dissection and open reduction unavoidable. There was a limb length discrepancy in all patients before surgical intervention. Partial weight bearing was commenced at 6 weeks post-operation. There was no case of wound infection. There was no misplaced screw. Minimum range of knee flexion was 105° at 2 months post-operation. These early results call for a closer look at this cheap, safe and effective means of handling femoral non-union in third world societies where there is paucity of instrumentation and implants for interlocked nailing.


Original Article

Said Saghieh, Abdo Bashoura, Ghina Berjawi, Nadim Afeiche, Rayan Elkattah

The correction of the relapsed club foot by closed distraction

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:9] [Pages No:127 - 135]

Keywords: External fixator, Club foot, Ilizarov technique

   DOI: 10.1007/s11751-010-0097-5  |  Open Access |  How to cite  | 


Correction of a relapsed clubfoot deformity by distraction with an external fixator is a recognized alternative to open surgery. Most published series report a good outcome but none are prospective observational studies using the scoring system of the International Clubfoot Study Group (ICFSG). We present a series of 9 relapsed club feet treated with closed gradual distraction using this scoring method.



Selvadurai Nayagam

Femoral lengthening with a rail external fixator: tips and tricks

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:8] [Pages No:137 - 144]

Keywords: Bone lengthening, Femur, External fixator

   DOI: 10.1007/s11751-010-0098-4  |  Open Access |  How to cite  | 


Lengthening the femur with an external fixator is commonly practised for a wide variety of pathologies. This technical report includes tips derived from observation and experience in a busy limb reconstruction unit. It focuses on the use of a rail fixator, although some of the descriptions are applicable to lengthening by circular fixators.



Abdul Halim Abd Rashid, Sharaf Ibrahim

Hypertrophic nonunion of the ulna in a child: treatment with an elastic stable intramedullary nail without bone graft

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:3] [Pages No:145 - 147]

Keywords: Paediatric diaphyseal fracture, Ulna, Nonunion, Elastic stable intramedullary nail, Bone graft

   DOI: 10.1007/s11751-010-0089-5  |  Open Access |  How to cite  | 


Nonunion following diaphyseal forearm fracture is an uncommon complication in children. Compression plate fixation with bone grafting has been the standard method to treat this complication. We report a case of hypertrophic nonunion of the ulna in a child who was treated surgically using an elastic stable intramedullary nail (ESIN) without bone grafting. The nonunion healed 4 months after surgery.



Freih Odeh Abu Hassan, Akram Shannak

Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC)

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:6] [Pages No:149 - 154]

Keywords: Resection, Giant ABC, Bone tumor, Non-vascularized fibular graft

   DOI: 10.1007/s11751-010-0093-9  |  Open Access |  How to cite  | 


The aim of this study was to present the results of non-vascularized fibular graft for reconstruction of bone defects after en block resection of giant aneurysmal bone cyst (ABC) of the extremities. Between 1998 and 2006, three patients, aged 6, 8 and 23 years, with giant aneurysmal bone cysts were treated. The cysts were located in the humerus, proximal femur and metatarsal. All patients were given en bloc resection of the cyst followed by non-vascularized fibular bone graft, with the graft length ranging from 6 to 18 cm. All patients needed supplementary fixation with a single Kirschner wire or plate and screws. At the final follow-up, bony union was achieved in each case, and there was no recurrence, limitation of range of motion or disability. In addition, complete regeneration of the fibula at the donor site was seen in the two children. We propose a criterion for giant ABC, when the transverse diameter of the cyst is up to three times or more of the transverse diameter of the nearby bone, it is then called a giant ABC. Non-vascularized fibular graft is an optimal and valuable method for the reconstruction of bone defects after resection of giant ABC in the extremities.



Gursel Turgut, Mahmut Ulvi Kayalı, Özkan Köse, Lütfü Baş

Repair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:4] [Pages No:155 - 158]

Keywords: Lower extremity reconstruction, Cross-leg bridge anastomosis, Latissimus dorsi serratus anterior free flap, Combined

   DOI: 10.1007/s11751-010-0094-8  |  Open Access |  How to cite  | 


Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would not be feasible, the lower limb can be salvaged with a cross-leg free flap procedure. We present a case with a large composite tissue loss that was reconstructed with cross-leg free transfer of a combined latissimus dorsi and serratus anterior muscle flap. This case indicates that this large muscle flap can survive with the cross-leg free flap method and this technique may be a viable alternative for large lower extremity defects that have no reliable recipient artery.



P. Mukherjee, M. J. Ashworth

A new device to treat intra-capsular fracture neck of femur non-union

[Year:2010] [Month:December] [Volume:5] [Number:3] [Pages:4] [Pages No:159 - 162]

Keywords: Femoral neck fracture, Non-union, Dynamic hip screw, Gottfried percuteneous compression plate, Vertical shear fracture

   DOI: 10.1007/s11751-010-0096-6  |  Open Access |  How to cite  | 


In adolescents and young adults, femoral neck fractures often result from high-velocity trauma. These fractures are usually of vertical shear pattern. There is an increased incidence of avascular necrosis and non-union, which is difficult to treat. Non-union of fractured neck of femur in young adults is a serious problem. There is growing evidence that these fractures should be treated with an angle-stable device to improve biomechanics at the fracture site. An ideal implant should prevent varus deformation and retroversion of the fracture in order to prevent failure of the osteosynthesis and thus preventing cut-out of implant and non-union at the fracture site. We report the first use of an Orthofix Gottfried Percutaneous Compression Plate (PC.C.P.) (Orthofix, Guilford, UK) to treat a non-union of an intra-capsular fractured neck of femur. We recommend this, in combination with autologous bone grafting, via a mini hip modification of the Smith–Petersen approach.


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