BACKGROUND:Ligament rupture and defect of the lateral or medial malleolus caused by high-energy injuries are common challenges in foot and ankle surgery.Their neighboring core tendons are often used as grafts to reconstruct the deficient ligaments.It is of paramount importance to investigate the mechanical properties of such tendons in the context of ligament defects to provide a suitable donor tendon.OBJECTIVE:To investigate the interactive dynamics and biomechanical alterations among their core tendons during ankle joint motions under varying degrees of lateral or medial malleolar ligament defect.METHODS:Based on CT imaging data of the left foot of a 50-year-old healthy male,a surface stereolithography model was extracted and constructed using MIMICS software.After Geomagic Wrap software was employed to fit the surfaces,a bone-cartilage-ligament-tendon ankle complex model incorporating varying degrees of ligament deficiencies was created within SOLIDWORKS software.Finite element analysis was then conducted using Ansys Workbench software,and the model's validity was verified through a simulated anterior drawer test.Following validation,the mechanical response of the ankle under the conditions of internal and external rotation,as well as inversion and eversion,was simulated.The variation and distribution patterns of the maximum Von-Mises stress in the peroneus brevis and longus tendons,as well as the anterior and posterior tibial tendons,were observed.RESULTS AND CONCLUSION:(1)In the anterior drawer test,the maximum talar displacement reached 5.208 5 mm,which was similar to the data in the previous literature,thereby the effectiveness of the model was validated.(2)Under four loading conditions,the defect of unilateral single-bundle ligaments exerted minimal influence on the maximum stress of adjacent core tendons,whereas the defect of unilateral multi-bundle ligament significantly increased the maximum tendon stress.Except for the consistently high stress across segments of the anterior tibial tendon,the high-stress regions in the long and short peroneal tendons and posterior tibial tendon were concentrated at their distal ends near the insertions.(3)Regarding the defect of the lateral malleolar ligament,the maximum stress and its variation in the peroneus brevis tendon during inversion and internal rotation were higher than those in the peroneus longus tendon.During inversion under the condition of the defect of the anterior talofibular ligament,the maximum stress in the short peroneal tendon increased by 0.951 2 MPa compared to that of normal condition,while that in the long peroneal tendon decreased by 0.065 1 MPa.Under the condition of the defect of the calcaneofibular ligament during internal rotation,the maximum stress in the short peroneal tendon increased by 2.352 9 MPa,while the maximum stress in the long peroneal tendon decreased by 0.269 2 MPa.(4)During eversion and external rotation under the defect of medial malleolar ligament,the variations in the maximum stress of the anterior and posterior tibial tendons were complex and depended on the type of ligament defect.Notably,full-thickness ligament defect significantly augmented the maximum stress in both tendons.

BACKGROUND:Ligament rupture and defect of the lateral or medial malleolus caused by high-energy injuries are common challenges in foot and ankle surgery.Their neighboring core tendons are often used as grafts to reconstruct the deficient ligaments.It is of paramount importance to investigate the mechanical properties of such tendons in the context of ligament defects to provide a suitable donor tendon.OBJECTIVE:To investigate the interactive dynamics and biomechanical alterations among their core tendons during ankle joint motions under varying degrees of lateral or medial malleolar ligament defect.METHODS:Based on CT imaging data of the left foot of a 50-year-old healthy male,a surface stereolithography model was extracted and constructed using MIMICS software.After Geomagic Wrap software was employed to fit the surfaces,a bone-cartilage-ligament-tendon ankle complex model incorporating varying degrees of ligament deficiencies was created within SOLIDWORKS software.Finite element analysis was then conducted using Ansys Workbench software,and the model's validity was verified through a simulated anterior drawer test.Following validation,the mechanical response of the ankle under the conditions of internal and external rotation,as well as inversion and eversion,was simulated.The variation and distribution patterns of the maximum Von-Mises stress in the peroneus brevis and longus tendons,as well as the anterior and posterior tibial tendons,were observed.RESULTS AND CONCLUSION:(1)In the anterior drawer test,the maximum talar displacement reached 5.208 5 mm,which was similar to the data in the previous literature,thereby the effectiveness of the model was validated.(2)Under four loading conditions,the defect of unilateral single-bundle ligaments exerted minimal influence on the maximum stress of adjacent core tendons,whereas the defect of unilateral multi-bundle ligament significantly increased the maximum tendon stress.Except for the consistently high stress across segments of the anterior tibial tendon,the high-stress regions in the long and short peroneal tendons and posterior tibial tendon were concentrated at their distal ends near the insertions.(3)Regarding the defect of the lateral malleolar ligament,the maximum stress and its variation in the peroneus brevis tendon during inversion and internal rotation were higher than those in the peroneus longus tendon.During inversion under the condition of the defect of the anterior talofibular ligament,the maximum stress in the short peroneal tendon increased by 0.951 2 MPa compared to that of normal condition,while that in the long peroneal tendon decreased by 0.065 1 MPa.Under the condition of the defect of the calcaneofibular ligament during internal rotation,the maximum stress in the short peroneal tendon increased by 2.352 9 MPa,while the maximum stress in the long peroneal tendon decreased by 0.269 2 MPa.(4)During eversion and external rotation under the defect of medial malleolar ligament,the variations in the maximum stress of the anterior and posterior tibial tendons were complex and depended on the type of ligament defect.Notably,full-thickness ligament defect significantly augmented the maximum stress in both tendons.

BACKGROUND:Calcaneal defects are common in clinical practice.It is difficult for surgeons to evaluate the effect of calcaneal reconstruction due to the complex anatomical structure and motor function of the heel.Finite element analysis has become an effective method for biomechanical behavior simulation and numerical analysis. OBJECTIVE:To compare the clinical effect and biomechanical characteristics of total calcaneal reconstruction with the Ⅱ-shaped and V-shaped fibular flap. METHODS:CT images of one left foot of a healthy 50-year-old male were acquired.Mimics software was used to obtain the preliminary three-dimensional model.Geomagic software was used to trim and curve the model.The model was imported into Solidworks software to simulate calcaneal reconstruction and complete the pre-processing of finite element calculation.Finally,Ansys software was used to solve the problem.The simulation results were compared with previous literature results to verify the effectiveness of the model.The surgical effect and biomechanical characteristics of the foot in different gait phases based on the simulated stress results were analyzed. RESULTS AND CONCLUSION:(1)Both Ⅱ-shaped and V-shaped fibular flaps could be used to reconstruct completely missing calcaneus,which could restore the length,width and height of normal calcaneus,and fill up the missing calcaneus bone.(2)Compared with the normal calcaneus,both configurations of fibular flaps showed a tendency for over-concentration of stress after loading.The normal calcaneus stress was mostly concentrated around the calcaneus nodule,the subtalar process and the calcaneus groove,while the stress of the two fibular flaps was mostly concentrated at the junction between the bone flap with the talus and cuboid bones.(3)The maximum stress of calcaneus was different between the two models and normal calcaneus under different simulation conditions,with statistically significant differences(P＜0.05).Compared with the V-shaped fibular flaps,Ⅱ-shaped fibular flaps had less force change in different gaits and were closer to the normal calcaneus.The V-shaped fibular flap bore excessive stress during the period of push-off,and the grafted bone material may yield under this condition and have the risk of fractures.

Objective:To analyze the feasibility of applying transcutaneous electrical nerve stimulator and high-frequency ultrasound in superficial nerve positioning for detection anatomical location in the area of lateral lip of the iliac crest by lateral cutaneous branch of subcostal nerve(LCSN). The significance of using the nerve as a free sensory superficial circumflex iliac artery perforator flap was discussed.Methods:The data of patients who underwent the repair of defects on limbs with free perforator flap or composite flap of superficial iliac circumflex artery carrying sensory nerve and the volunteers who agreed to have the location of the LCSN measured between October, 2018 and October, 2020 were collected. The LCSN were located by percutaneous electrical nerve stimulation and ultrasound, and the patients were measured and located during surgery. Using Passing-Bablok regression and Bland-Altman graph to evaluated the consistency between transcutaneous electrical nerve stimulation, ultrasound and the surgical positioning.Results:A total of 43 subjects, including 22 patients and 21 volunteers, were selected for locating the LCSN. Thirty-nine males and 4 females, with an average age of 39 years old and an average BMI of 24.08. The operation time of percutaneous nerve electrical stimulation was(6±1) min, and the detection distance was(80.7±5.9) mm. The high-frequency ultrasound was(23±4) min, and the distance was(81.2± 6.6) mm. The average operation time of surgical measured distance was(80.9±8.2)(65-100) mm, the diameter of nerve was(2.3±0.8)(1.0-4.0) mm, and the operation time was(5±1) min. A 95% CI of Passing-Bablok regression intercept and slope of operation, percutaneous electrical nerve stimulation and ultrasoundincluded 0 and 1, respectively. The points on Bland-Altman plot were distributed on both sides, and 95% CI of total mean difference, total intercept and slope included 0. Therefore, it was can be considered that the application of percutaneous electrical nerve stimulation and ultrasound in LCSN localization has good consistency.Conclusion:The location point of the LCSN crossing the iliac crest which detected by transcutaneous electrical nerve stimulation and high-frequency ultrasound detection was close to the measurement taken during the operation. It was also showed that both of them can be used for preoperative locationing of the sensory branch of the sensory nerve flap, optimizing the design of the flap, shortening the operation time, and reducing the unnecessary injury in operation.

The Asian Society of Gynecologic Oncology International Workshop 2018 on gynecologic oncology was held in the Ajou University Hospital, Suwon, Korea on the 24th to 25th August 2018. The workshop was an opportunity for Asian doctors to discuss the latest findings of gynecologic cancer, including cervical, ovarian, and endometrial cancers, as well as the future of fertility-sparing treatments, minimally invasive/radical/debulking surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Clinical guidelines and position statement of Asian countries were presented by experts. Asian clinical trials for gynecologic cancers were reviewed and experts emphasized the point that original Asian study is beneficial for Asian patients. In Junior session, young gynecologic oncologists presented their latest research on gynecologic cancers.
Antineoplastic Agents ; Asian Continental Ancestry Group ; Drug Therapy ; Education ; Endometrial Neoplasms ; Female ; Gyeonggi-do ; Humans ; Immunotherapy ; Korea ; Ovarian Neoplasms ; Radiotherapy ; Uterine Cervical Neoplasms