PURPOSE: To evaluate the diagnostic accuracy of the observational chart for traumatic limb swelling (OCTLS) for osteofascial compartment syndrome (OCS). METHODS: This was a descriptive-longitudinal study. Data of 316 patients who underwent surgical treatment for tibial fractures in our department from January 2015 to December 2023 were collected. Patients with Gustilo type II or higher open fractures, vascular injury, or bilateral fractures were excluded from the study. Two groups of double-blinded investigators independently assessed patients for the presence of OCS using 2 distinct diagnostic methods. Three senior orthopedic trauma surgeons evaluated patients with post-fracture calf swelling for OCS and the need for fasciotomy based on clinical signs and their extensive clinical experience. Subsequently, fasciotomy was performed according to their judgment, followed by postoperative examination of muscle and soft tissue conditions. Additionally, a follow-up evaluation was conducted to assess for complications such as ischemic muscle contracture. Another 3 trained researchers used OCTLS to grade swelling severity and determine the need for fasciotomy. The final diagnostic gold standard of OCS was determined by referring to whether there was escape of muscles at fasciotomy and/or color change in the muscles or muscle necrosis intraoperatively, and neurological abnormality or contracture at the last follow-up. The results of the 2 diagnostic methods were compared with the final diagnostic result. Kappa consistency test, paired χ² test (McNemar test), and receiver operating characteristic curve were used to evaluate the diagnostic efficacy of the 2 diagnostic methods. RESULTS: Of the 316 patients, 211 were finally included in the study, including 160 males and 51 females, with an average follow-up time of (14.5 ± 2.7) months. Among the 211 patients with tibial fracture-associated swelling, 42 were definitively diagnosed with OCS. Based on clinical symptoms and signs judgment, among the 65 fasciotomy patients, 38 were confirmed as correct, while among the 146 non-fasciotomy patients, 4 developed ischemic muscle contractures. Based on the OCTLS for assessment, fasciotomy was correctly recommended in 36 out of 43 cases, while 6 out of 168 non-fasciotomy patients developed OCS. Compared to the use of the gold standard, clinical signs judgment showed moderate consistency (McNemar's test p < 0.001, Kappa = 0.618, p < 0.001), whereas OCTLS demonstrated strong agreement (McNemar's test p = 1.000, Kappa = 0.808, p < 0.001). Receiver operating characteristic analysis revealed higher diagnostic accuracy for OCTLS (area under curve = 0.908, 95% CI: 0.843 - 0.972) compared to clinical signs judgment (area under curve = 0.872, 95% CI: 0.812 - 0.933). OCTLS achieved superior accuracy (93.8% vs. 85.3%, χ² = 8.221, p < 0.001) and a lower fasciotomy rate (20.4% vs. 30.8%, χ² = 6.023, p = 0.014). CONCLUSION Compared to clinical signs judgment, OCTLS significantly reduces unnecessary fasciotomy, improves diagnostic accuracy for OCS, and enables non-invasive, dynamic, and quantitative assessment, making it a valuable tool for clinical practice.
Humans ; Compartment Syndromes/etiology* ; Male ; Female ; Adult ; Tibial Fractures/surgery* ; Middle Aged ; Fasciotomy ; Edema/etiology* ; Longitudinal Studies ; Aged ; Young Adult

INTRODUCTION: Gastrocnemius recession and radiofrequency microtenotomy treat plantar fascia via different mechanisms. While studies have shown additive effects in performing plantar fasciotomy in conjunction with gastrocnemius recession, no such study exists examining the effects of performing radiofrequency microtenotomy with gastrocnemius recession. We hypothesised that performing both gastrocnemius recession and radiofrequency microtenotomy concurrently for recalcitrant plantar fasciitis is more effective than performing either procedure individually. MATERIALS AND METHODS: We analysed all patients who underwent either a radiofrequency microtenotomy, a gastrocnemius recession, or both procedures concurrently between 2007 and 2014. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the SF-36 Health Survey, and 2 questions regarding patient satisfaction and met expectations were assessed preoperatively and postoperatively up to 1-year. RESULTS: Patients who underwent both procedures concurrently had significantly higher vitality scores on the SF-36 Health Survey at 1-year postoperatively compared to patients who underwent either procedure individually. Type of intervention offered and preoperative factors were not predictive for patient outcomes. CONCLUSION Combining radiofrequency microtenotomy and gastrocnemius recession in patients with recalcitrant plantar fasciitis and an underlying gastrocnemius contracture shows favourable medium- term outcomes compared to performing either procedure in isolation.
Combined Modality Therapy ; Fasciitis, Plantar ; surgery ; Fasciotomy ; Humans ; Muscle, Skeletal ; surgery ; Orthopedic Procedures ; Patient Satisfaction ; Radiofrequency Therapy ; methods ; Retrospective Studies ; Tenotomy ; methods ; Treatment Outcome

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.
Adult ; Anterior Cruciate Ligament Reconstruction/*adverse effects ; *Compartment Syndromes ; Fasciotomy ; Humans ; *Iatrogenic Disease ; Male ; Necrosis ; *Postoperative Complications ; Republic of Korea ; Tibia/*surgery ; Tibial Arteries/*injuries

Denonvilliers fascia is a dense structure between the rectum and the genitourinary system, and plays as a barrier. In recent years, along with in-depth study of TME, scholars have taken many discussions on Denonvilliers fascia structure and the dissection plane. On the one hand, some consensus have been made on Denonvilliers fascia structure, but still needs to further clarify its microstructure. On the other hand, scholars have generally recognized the neurovascular bundles are on Denonvilliers fascia sides. They should be protected during rectal surgery, however, the details should be clarified. Based on "Fascial Surgery" theory, this article describes Denonvilliers fascia structure and clinical application combined with previous research and our research results.
Digestive System Surgical Procedures ; Dissection ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Male ; Rectum ; anatomy & histology ; surgery

Anatomy is the foundation of surgical techniques. With the development of surgery, anatomy also divided into traditional anatomy, surgical anatomy and embryonic development anatomy. Complete mesocolic excision (CME) is one of classic radical operation for colon cancer, based on the modern anatomy. CME advocates correct operation plane, and describes the mobilization and separation of the colon together with the entire regional mesocolon. With the evolution of anatomy, the definition and content of CME-related anatomic landmarks such as mesentery, fascia and space have been changed. This article elaborates theses anatomical structures and their distribution, in order to improve the understanding of colorectal surgeons on CME-related traditional anatomy, surgical anatomy and embryonic developmental anatomy.
Colectomy ; Colonic Neoplasms ; surgery ; Digestive System Surgical Procedures ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Mesentery ; Mesocolon ; anatomy & histology ; surgery

PURPOSETo report complications in the management of complex closed proximal tibial fractures.

METHODA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.

RESULTSThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.

CONCLUSIONProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Adult ; Fasciotomy ; Female ; Fracture Fixation ; adverse effects ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Tibial Fractures ; surgery

OBJECTIVETo investigate the curative effect of penile elongation with four differentoperative approaches.

METHODSThrough four different operative approaches (the coronary sulcus ringincision, Y or Z shaped incision or Z shaped incision combined with coronary sulcus ring incision), thepenile skin and fascia were degloved until the penile root. Then the superficial and deep dorsal penilesuspensory ligament were cut off. After electric coagulation of the residue ends, the two-side tissue at thefront of the pubic symphysis was sutured. Then the penile skin and fascia were repositioned and the incisionat the inner and outer plate was closed.

RESULTSThe increased penile static length was (2.9 ± 0.2) cmwith abdominal wall Y incision (12 cases); (3.1 ± 0.3) cm with transabdominal modified Z incision (260 cases); (3.9 ± 0.7) cm with coronary sulcus ring incision (363 cases); (3.4 ± 0.8) cm with combined incision (39 cases). The lengthening effect was significantly different between the coronary ring incision and abdominal wall Y/Z incision (P < 0.05). The postoperative follow-up period was 6 months to 5.5 years without serious complications. Only 3 cases of subcutaneous hematoma occurred with treatment of debridement and drainage. 4 cases with ischemic necrosis at distal penile skin, were treated with debridement, dressing and physiotherapy, leaving no scar.

CONCLUSIONSPenile lengthening surgery are safe and effective through different approaches. The coronal ring incision has the best therapeutic effect.

Bandages ; Debridement ; Drainage ; Electrocoagulation ; Fasciotomy ; Follow-Up Studies ; Humans ; Ligaments ; surgery ; Male ; Necrosis ; surgery ; Organ Size ; Penis ; anatomy & histology ; pathology ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin ; Time Factors

OBJECTIVETo investigate the clinical application of expanded flap based on cutaneous branch of transverse cervical artery for reconstruction of cervical cicatricial contracture.

METHODSBased on the clinical anatomy of cutaneous branch of transverse cervical artery flap, we design the corresponding subclavicular area for expansion. The incision was usually located at the anterior axillary fold, 5-8 cm in length. The expander was implanted under the deep fascial layer, without injury of the vascular pedicle. Fixation sutures were put about 1 cm apart from the incision to prevent the expander from transposition and exposure. After expansion, the cervical cicatricial contracture was excised and released. According to the defect, the expanded flap based on the cutaneous branch of transverse cervical artery was designed, with the pedicle located at the posterior margin of sternocleidomastoid and 1. 8 cm above median point of clavicle. "S" shape incision was made at the location of vascular pedicle. Subcutaneous dissection was performed 1.5 cm in width along the incision on both sides. Then the flap was harvested under the deep fascial layer and rotated to cover defect without tension. It was not necessary to dissect the vascular pedicle further. The defect at donor site was closed directly.

RESULTS17 cases were treated with the island flap. The contracture of the cervical scar was corrected completely with aesthetic appearance.

CONCLUSIONSExpanded flap based on cutaneous branch of transverse cervical artery has reliable blood supply. It' s an ideal flap for the treatment of cervical cicatricial contracture.

Arteries ; Cicatrix ; surgery ; Clavicle ; Contracture ; surgery ; Dissection ; methods ; Fasciotomy ; Humans ; Neck ; blood supply ; Neck Muscles ; anatomy & histology ; Surgical Flaps ; blood supply

OBJECTIVETo investigate the long-time effects of nylon fixation at the internal and external canthus combined with skin graft for recurrent lower eyelids ectropion.

METHODSUnder local anesthesia, the cicatricial contraction was released to repostion the lower eyelid. Then nylon thread was implanted in the fascial tissue at the upper margin of tarsus and was fixed on the periosteum at the internal and external canthus. The skin graft was applied on the wound of lower eyelids.

RESULTS12 patients with lower eyelids ectropion at 19 sides were treated with primary healing. The patients were followed up for 6-24 months. All cases were satisfied with functional and cosmetic results. No complication and no recurrence happened.

CONCLUSIONSThe technique of nylon fixation at the internal and external canthus combined with skin graft is an effective method for recurrent lower eyelids ectropion.

Ectropion ; surgery ; Eyelids ; surgery ; Fasciotomy ; Humans ; Nylons ; Periosteum ; Skin Transplantation ; methods

OBJECTIVE: This paper highlights the therapeutic effect of tragus cartilage and temporalis fascia graft on repairing bone and skin defect in external auditory canal. METHOD: Forty-one surgical patients were recuited, including 39 cases of external auditory canal cholesteatoma and 2 cases of osteoma. External auditory canal bone wall and skin defect and mastoid air cells exposure were found during operation. We followed up these cases periodically (in 3 weeks, 3 months, 6 months and 1 year later respectively) after repairing the patients' external auditory canal bone wall and skin with tragus cartilage and temporalis fascia graft. RESULT: Twenty-nine cases healed perfectly while other 12 cases grew small granulation in 3 weeks. After shaving granulations and tamping Tela Iodoformum, wounds healed in the following week. The epithelization of the external auditory canal in our patients was complete after 3 months and no stenosis were found. Natural morphology of external auditory canal was maintained without mastoid air cells exposure after 6 months to 1 year of time. CONCLUSION It is not only convenient to acquire the tragus cartilage and temporalis fascia, but also easy to repair the defect of external auditory canal bone wall and skin. It can reconstruct the wall of external auditory canal, obliterate mastoid cells and perfectly maintain the normal form of external auditory canal via the cartilage.
Adolescent ; Adult ; Cartilage ; surgery ; Child ; Ear Auricle ; surgery ; Ear Canal ; surgery ; Fasciotomy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult