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      Single-stage reconstruction of a traumatic tendocutaneous defect of the Achilles using free composite anterolateral thigh flap with vascularized fascia lata

      case-report

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          Abstract

          Combined tendocutaneous defect of Achilles tendon remains a complex reconstructive challenge whereby both the soft tissue coverage and tendon reconstruction have to be considered to achieve a good functional and aesthetic outcome. A 14-year-old boy who sustained an open right calcaneum fracture (Gustilo-Anderson IIIB) with a transected Achilles tendon and huge skin defect from motorcycle wheel spoke injury was admitted. The Achilles tendon repair site broke down following initial surgical debridement and primary repair, resulting in a sizeable combined tendocutaneous defect. Simultaneous soft tissue coverage and tendon defect reconstruction using composite sensate free anterior lateral thigh (ALT) fasciocutaneous flap with vascularized fascia lata was performed subsequently. The vascularized fascia lata was tubularized to wrap the native proximal stump of Achilles tendon and secured using the modified Krakow suturing technique. The distal end of tubularized fascia lata was, then, secured by drilling across right calcaneum bone, passing the suture transosseously and screwed. He led an uneventful postoperative recovery with satisfactory functional and aesthetic outcomes at one year of follow-up. In conclusion, the present case demonstrates the reliability of this technique and its advantages over other flap choices in reconstruction of a huge combined tendocutaneous defect.

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          Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog.

          R Warren, Albert P Torzilli, Steven Arnoczky … (1993)
          Our study evaluated tendon-to-bone healing in a dog model. Twenty adult mongrel dogs had a transplantation of the long digital extensor tendon into a 4.8-millimeter drill-hole in the proximal tibial metaphysis. Four dogs were killed at each of five time-periods (two, four, eight, twelve, and twenty-six weeks after the transplantation), and the histological and biomechanical characteristics of the tendon-bone interface were evaluated. Serial histological analysis revealed progressive reestablishment of collagen-fiber continuity between the bone and the tendon. A layer of cellular, fibrous tissue was noted between the tendon and the bone, along the length of the bone tunnel; this layer progressively matured and reorganized during the healing process. The collagen fibers that attached the tendon to the bone resembled Sharpey fibers. High-resolution radiographs showed remodeling of the trabecular bone that surrounded the tendon. At the two, four, and eight-week time-periods, all specimens had failed by pull-out of the tendon from the bone tunnel. The strength of the interface was noted to have significantly and progressively increased between the second and the twelfth week after the transplantation. At the twelve and twenty-six-week time-periods, all specimens had failed by pull-out of the tendon from the clamp or by mid-substance rupture of the tendon. The progressive increase in strength was correlated with the degree of bone ingrowth, mineralization, and maturation of the healing tissue, noted histologically.
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            Which articles do the editors prefer to publish?

            O. Atik (2022)
            The editors prefer publishing original scientific research article with valuable data in all academic journals, since readers prefer reading something original and important.[1,2] Manuscripts may be rejected without peer review by the Editor-in-Chief, if they do not comply with the Instructions to Authors, in case of an ethical issue or plagiarism, and if they are beyond the scope of the journal. The title of the article should be concise, brief but comprehensive. It should provoke the readers to read the full text. The title should accurately reflect the outcome of the study.[3] It should also be the research question or the answer of it. The abstract must summarize the manuscript. No discrepancies between the abstract and the article must be. Keywords must be concordant with the National Library of Medicine (NLM) Medical Subject Headings (MeSH) vocabulary terms, and three to six keywords should be listed.[4] The study must be based on the review of the relevant literature in the Introduction section. The objective of the study must be clearly defined. A hypothesis or a research question must exist.[1,2] The authors must have Informed Consent and Ethical Committee Approval (date and number) in the Patients/Materials and Methods section. The methods should explain the steps taken to produce the results. It should contain adequate details for other researchers to replicate the study.[1,2] The results must be presented in logical sequence in the text, tables, and illustrations. Data in the text should not be repeated in the tables or illustrations. Avoid repeating yourself.[5] In the Discussion section, start emphasizing the new and the most important finding(s) of the study. Relate the observations to other relevant studies. Finally, present limitations and conclusion short and clear enough.[6] The format of the references and abbreviated title of the journal must be according to the style used by the PubMed/MEDLINE with year, volume, and inclusive page numbers. Recent references must be preferred. Illustrations and figures must be original, professionally drawn, and photographed. Finally, the authors must check the following list to reduce the possibility of rejection.[7] • Has the manuscript adhered to all the author instructions? • Does the manuscript add something to the existing literature? • Is the title reflective of the content of the manuscript? • Does the abstract convey the key message clearly? • Is the purpose, research question/hypothesis clearly stated in the Introduction? • Is the methodology detailed? • Are the statistics in a clear and detailed manner presented? • Are the results explicitly presented? • Is the Discussion relevant to the manuscript’s core theme? • Are the strengths and limitations addressed? • Are the conclusions clearly supported by the data?
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              Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair.

              Nobuyuki Yamamoto, Yilihamu Tuoheti, Eiji Itoi … (2005)
              The contact pressure and contact area at the tendon-bone interface after the most commonly used rotator cuff repair methods have not been investigated. There are no significant differences among the transosseous, the single-row suture anchor, and the double-row suture anchor techniques in terms of contact pressure, contact area, and pressure patterns at the tendon-bone interface. Controlled laboratory study. After creating a full-thickness supraspinatus tendon tear in 10 cadaveric shoulder specimens, we inserted pressure-sensitive film between the tendon stump and the bone, and we repaired the tear by (1) transosseous, (2) single-row suture anchor, and (3) double-row suture anchor techniques. The contact area of the double-row technique was 42% greater than that of the transosseous technique (P < .0001) and 60% greater than that of the single-row technique. The contact area of the transosseous technique was 31% greater than that of the single-row technique (P = .0015). The average pressures of the single-row and double-row techniques were 18% (P = .014) and 16% (P = .03) greater, respectively, than that of the transosseous technique, but there was no significant difference between the single-row and double-row techniques (P = .915). The double-row technique produced the greatest contact area and the second-highest contact pressure, whereas the single-row technique created the highest contact pressure and the least contact area. The transosseous technique produced the second-greatest contact area and the least contact pressure. The double-row suture anchor technique and the transosseous technique may provide a better environment for tendon healing.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Jt Dis Relat Surg
                Journal ID (iso-abbrev): Jt Dis Relat Surg
                Title: Joint Diseases and Related Surgery
                Publisher: Bayçınar Medical Publishing
                ISSN (Print): 2687-4784
                ISSN (Electronic): 2687-4792
                Publication date Collection: December 2022
                Publication date (Electronic): 21 October 2022
                Volume: 33
                Issue: 3
                Pages: 673-679
                Affiliations
                [1 ] Department of Surgery, Plastic & Reconstructive Surgery Unit, University of Malaya, Kuala Lumpur, Malaysia
                [2 ] Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
                Author notes
                Siew Cheng Chai, MD. Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia. scchai513@ 123456gmail.com .
                Author information
                http://orcid.org/0000-0002-5530-1770
                http://orcid.org/0000-0003-2157-9069
                http://orcid.org/0000-0002-6872-1272
                http://orcid.org/0000-0001-7655-1093
                Article
                DOI: 10.52312/jdrs.2022.843
                PMC ID: 9647665
                PubMed ID: 36345197
                SO-VID: a8b4b48a-9859-44b8-8a4b-8ef37cc06e45
                Copyright © Copyright © 2022, Turkish Joint Diseases Foundation
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 21 September 2022
                Date accepted : 22 September 2022
                Categories
                Subject: Case Report

                Keywords: achilles tendon,anterolateral thigh flap,combined tendocutaneous defect,compound-free flap,reconstruction,sensate,vascularized fascia lata.
                Data availability:
                Keywords: achilles tendon, anterolateral thigh flap, combined tendocutaneous defect, compound-free flap, reconstruction, sensate, vascularized fascia lata.

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