OBJECTIVE: To investigate of effectiveness of free fascia lata flap assisted by indocyanine green angiography (ICGA) in treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures. METHODS: A clinical data of 14 patients with Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures between March 2020 and June 2024 was retrospectively analyzed. All Achilles tendon defects were repaired with the free fascia lata assisted by ICGA during operation. There were 12 males and 2 females with an average age of 45.4 years (range, 26-71 years). The causes of Achilles tendon rupture included sports injury in 10 cases, Achilles tendon-related tendinopathy in 3 cases, and glass laceration injury in 1 case. The time from Achilles tendon rupture to operation was 4-40 weeks (median, 4.5 weeks). Preoperative MRI examination showed that the defect length of the Achilles tendon was 2-5 cm (mean, 3.2 cm). The operation time and intraoperative blood loss were recorded. The color Doppler ultrasound (CDU) and MRI were taken to observe the foot blood vessels and the tendon healing. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Achilles Tendon rupture score (ATRS), and range of motion of the ankle joint were used to estimate the pain and function of ankle joint. RESULTS: All operations of the 14 patients were successfully completed. The operation time ranged from 3.00 to 4.50 hours (mean, 3.60 hours). The intraoperative blood loss ranged from 10 to 50 mL (mean, 36.4 mL). After operation, 1 patient had exudation at the recipient site, which healed after dressing change; the other incisions healed by first intention. All incisions at the donor sites healed by first intention. All patients were followed up 6-36 months (mean, 11.4 months). The CDU of the foot at 1 month after operation showed that the blood flow signal of the perforating vessels of the fascia lata flap was clear. The ankle MRI at 2 months after operation showed the good continuity of the Achilles tendon. No complication such as the Achilles tendon re-rupture, ankle stiffness, or scar contracture occurred during follow-up. Compared with preoperative score, the AOFAS score, ATRS score, and plantar flexion range of motion significantly increased at 1, 3, and 6 months after operation ( P<0.05), while the VAS score and dorsiflexion range of motion significantly decreased ( P<0.05). The AOFAS score, ATRS score, and VAS score at 3 and 6 months further improved when compared with those at 1 month ( P<0.05); however, there was no significant difference in the range of motion of the ankle joint ( P>0.05). There was no significant difference in above indicators between 3 and 6 months after operation ( P>0.05). CONCLUSION The treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures with free fascia lata flaps under the guidance of ICGA has the advantages of precise design, fast healing, and a wide range of adaptability.
Humans ; Achilles Tendon/diagnostic imaging* ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Indocyanine Green ; Rupture/surgery* ; Aged ; Fascia Lata/transplantation* ; Angiography/methods* ; Free Tissue Flaps/blood supply* ; Plastic Surgery Procedures/methods* ; Tendon Injuries/diagnostic imaging* ; Treatment Outcome ; Chronic Disease

OBJECTIVE: To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects. METHODS: From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up. RESULTS: All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good. CONCLUSION Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.
Achilles Tendon/surgery* ; Adult ; Fascia Lata ; Female ; Humans ; Male ; Retrospective Studies ; Rupture ; Treatment Outcome

Fascia Lata/transplantation* ; Humans ; Rupture, Spontaneous ; Tendons/surgery* ; Wrist ; Wrist Joint/surgery*

OBJECTIVE: To explore clinical effects of turning over rough surface of aponeurosis of gastrocnemius with fascia graft for Achilles tendon rerupture. METHODS: From July 2013 to April 2017, 11 patients with Achilles tendon reruptures were repaired by turning over rough surface of aponeurosis of gastrocnemius with fascia graft, including 10 males and 1 female aged from 25 to 48 years old. The patients were all manifested weakness of plantar flexion strength injured foot, and positive of single heel rise test before operation. Postoperative complications was observed, and AOFAS score at 6 months after operation was applied to evaluate clinical efficacy. RESULTS: All patients were followed up for 6 to 11 months. All wound were healed at stage I without skin necrosis, wound infection, deep vein thrombosis and rerupture. The length of tendon defect ranged from 4 to 7 cm, the full weight-bearing time ranged from 8 to 11 weeks. Postoperative AOFAS score at 6 months was for 79 to 100, and 9 patients got excellent results, and 2 good. CONCLUSIONS For patients with recurrent ruptures of Achilles tendon, turning over rough surface of aponeurosis of gastrocnemius with fascia graft has advantages of stable repair, less complications and good recovery of function.
Achilles Tendon ; Adult ; Aponeurosis ; Fascia Lata ; Female ; Humans ; Male ; Middle Aged ; Rupture ; Tendon Injuries ; Treatment Outcome

Congenital hypoplasia of the depressor anguli oris muscle is a rare cause of asymmetrical crying facies in newborns. The clinical manifestations range from mild to severe asymmetry and may persist up to adulthood. In the current case, the patient did not exhibit other congenital anomalies or paralysis of other branches of the facial nerve. This adult patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth. A chromosomal study for the detection of 22q gene deletion yielded negative results. The electromyography findings of the lower lip were insignificant. Depressor labii inferioris muscle resection was not effective, but bidirectional (horizontal and vertical) fascia lata grafting improved the aesthetic appearance of the asymmetrical lower lip. The patient showed improved lower lip symmetry during full mouth opening at 1 year after the surgery. Therefore, the details of this rare case are reported herein.
Adult ; Congenital Abnormalities ; Crying ; Electromyography ; Facial Nerve ; Facies ; Fascia Lata ; Gene Deletion ; Humans ; Infant, Newborn ; Lip ; Mouth ; Paralysis ; Parturition ; Transplants

PURPOSE: This study examined the most efficient exercise position to activate the gluteus medius (GM) and tensor fascia latae (TFL) in hip abduction in side-lying (HA-SL), clam in side-lying (CL-SL), and sling bridging in side-lying (SB-SL), which are the most representative GM exercises. METHODS: Twenty-four healthy male adults aged from 20 to 40 years, whose body mass index was under 25, participated in this experiment. While all participants conducted three different positions with a counterbalanced manner, such as in AB, CL, and BR, activation of the GM and TFL was measured using 8-channel wireless EMG. Exercise was performed for 10 seconds three times in total with a five minute-break session. RESULTS: Significant differences in GM and TFL activation were observed among the three positions (p<0.05). The highest activation of 60.69 was observed in BR followed in order by 46.03 and 12.92 in HA-SL and CL, respectively. TFL activation in HA-SL was 42.01, followed in order by 35.98 and 14.01 in BR and CL, respectively. On the other hand, there was no significant difference in TFL muscle activation between BR and HA-SL. CONCLUSION: These findings suggest that both BR and HA-SL in GM can be done selectively. CL has remarkably low muscle activation in GM and TFL, which makes it less valuable in GM and TFL exercise. In conclusion, selective BR and HA-SL exercise should be applied to maximally and effectively activate the GM.
Adult ; Bivalvia ; Body Mass Index ; Exercise ; Fascia Lata ; Hand ; Hip ; Humans ; Male

BACKGROUND: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. METHODS: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. RESULTS: All patients were men, and the average age was 59.5 ± 4.18 years (range, 53–65 years).The minimum follow-up was 18 months with a mean follow-up was 27.33 ± 7.58 months (range, 18–36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. CONCLUSIONS: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.
Allografts ; California ; Classification ; Elbow ; Fascia Lata ; Follow-Up Studies ; Humans ; Male ; Range of Motion, Articular ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Surgeons ; Tears ; Transplants

Surgical treatments for arthritis in the first metatarsophalangeal joint include arthrodesis, interposition arthroplasty using silicone or meniscus cartilage, and rarely arthroplasty. Although arthrodesis was performed successfully, pain can persist if the angle of fusion was inappropriate. Interposition arthroplasty can be tried for the treatment of persisting pain after the arthrodesis. Interposition arthroplasty using tensor fascia lata is known that has low risk of adhesions and easy to harvest. Compared to autologous grafts, grafting rates is high and low risk of rejection additionally. Herein, we report a successfully managed arthritis with severe pain with interposition arthroplasty using tensor fascia lata after a failed metatarsophalangeal joint arthrodesis.
Arthritis ; Arthrodesis* ; Arthroplasty* ; Cartilage ; Fascia Lata* ; Fascia* ; Metatarsophalangeal Joint* ; Silicon ; Silicones ; Transplants

PURPOSE: The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA). MATERIALS AND METHODS: Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches. RESULTS: The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients. CONCLUSION: Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Bleeding Time ; Butylated Hydroxyanisole ; Fascia Lata ; Fluoroscopy ; Hemiarthroplasty ; Hemorrhage ; Hip* ; Humans ; Intraoperative Complications ; Leg ; Prostheses and Implants ; Tears

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a 3×5 cm pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to 5×8 cm in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.
Arteries ; Debridement ; Fascia Lata ; Femur* ; Hematoma ; Humans ; Male ; Middle Aged ; Pressure Ulcer* ; Relaxation ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries