Current concepts in medial thighplasty

Lockwood's changes in surgical design of the medial thigh lift have improved results and decreased complications but still have the fundamental problem of poor tissue fixation to rigid tissue. To provide increased support to the medial thigh incisions, modifications to this technique have been tried. This article describes the authors' approach to the medial thigh lift in both those patients who have undergone traditional weight loss and the massive weight-loss thigh-lift patient.     

Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients

Patellar instability is a common knee disorder encountered in young athletes. Patients with normal osseous anatomy and mechanical alignment of the lower extremity are candidates for soft-tissue reconstructive procedures. In skeletally immature patients, surgical techniques that address patellar instability must avoid disruption of open physes and therefore must rely on soft-tissue techniques. Biomechanical research demonstrates that the medial patellofemoral ligament is the primary soft-tissue restraint to lateral subluxation of the patella, and the medial patellotibial ligament is an important secondary stabilizer. We present a novel physeal-sparing surgical technique that anatomically reconstructs both the medial patellofemoral and medial patellotibial ligaments using semitendinosus autograft.     

Tibial osteotomy in medial gonarthrosis

Summary In a prospective series of 52 knees selected for high tibial osteotomy because of early medial arthrosis, special care was taken to obtain a final over-correction in valgus. The operative procedure and the pre- and post-operative radiographic examinations were standardized and the follow up was 1–3 years. 49 of the 52 knees had obtained a normal or over-corrected mechanical axis. 45 of these had improved painfree walking distance, and 31 were painfree. In 45 knees the arthrotic condition had not progressed, and in 5 of these there were signs of cartilage restitution.It is concluded that precise correction of medial gonarthrosis can be achieved, and this provides a rational basis for definitive treatment of early stages of this condition; for the majority an endoprothesis operation should not be needed in the future.Financial support has been obtained from Stiftelsen Konsul Thure Carlssons Minne, Stiftelsen för Bistånd åt Vanföra i Skåne, Alfred Österlunds Stiftelse, and Swedish Medical Research Council, project No. B81-17X-02031-15C.     

Anatomy of the medial suprapatellar plica and medial synovial shelf

The anatomy of the medial suprapatellar plica and medial synovial shelf was studied arthroscopically in 500 knees. The medical suprapatellar plica extended up to one third of the way across the suprapatellar pouch in 64.2% of knees, between one and two thirds in 4%, and two thirds or more in 31.6%. The medial synovial shelf was absent or vestigial in 36% of knees and broader than 1 cm in 13.2%. When both knees were examined arthroscopically, the similarity between the appearances of the plica and the shelf in the two knees was statistically significant. No relationship between age and the pattern of plica or shelf could be found. There was no association between large plicae and large shelves, but the shelf was absent significantly more often in knees with a narrow plica.     

Gastrocnemius medial flaps

With reference to the data reported in the literature and to the anatomical vascular basis, the authors expose different techniques and maneuvers used for dissection of gastrocnemius flaps. The use of muscular and myocutaneous gastrocnemius flaps and some modifications of the standard surgical technique aiming to gain more versatility are described. So that, the range of these flaps can be planned to cover the greatest part of the lower extremity of the leg.     

Outcome of medial versus combined medial and lateral hamstring lengthening surgery in cerebral palsy

Pre- and postoperative gait analysis and static measurements from 37 children with cerebral palsy who underwent hamstring lengthening were evaluated. Significant improvements in static and kinematic measures were noted after surgery in both groups. Although the differences were not statistically significant, there was a suggestion that combined medial/lateral hamstring lengthening may provide greater improvement in popliteal angle and maximum knee extension in stance. However, there also appears to be a greater risk of knee hyperextension during gait after combined medial and lateral hamstring lengthening than after medial hamstring lengthening alone. Postoperative calf spasticity also appears to be a risk factor for postoperative knee hyperextension. Assessment of calf spasticity may be important in patients undergoing medial and lateral hamstring lengthening. Additional treatments such as bracing and/or botulinum toxin injections to the calf to control equinus and knee hyperextension may be beneficial.     

Discoid medial meniscus

A discoid medial meniscus is an extremely rare anomaly. We present 4 cases of symptomatic discoid medial meniscus. Furthermore, magnetic resonance imaging (MRI) of the unaffected knee was obtained in 3 cases, and 1 patient had bilateral discoid medial menisci as well as a unilateral discoid lateral meniscus proven by MRI. Another patient had bilateral discoid medial menisci. In one of the other 2 cases, an MRI of the unaffected knee was not obtained. However, in the involved knees of both cases, medial and lateral menisci were discoid. The incidence of bilateral discoid medial menisci is unknown. In the past, the diagnosis of a discoid meniscus was made with an arthrogram or at arthrotomy. Therefore, whether some of the unilateral cases reported in the literature might have been bilateral is unknown. The reported prevalence of bilateral discoid medial menisci will probably increase, because when a discoid medial meniscus is encountered currently, an MRI is used to find knee disorders, including in the contralateral knee. Axial multiplanar gradient-recalled-echo imaging could provide images of the discoid meniscus, depicted in its entirety in one section. This would make the recognition of a discoid meniscus simple.     

Precaruncular medial canthopexy

OBJECTIVES: To describe a new 3-dimensional technique for medial canthal repositioning, precaruncular medial canthopexy (PMC), and to present an outcome study demonstrating its efficacy. METHODS: Data (age, sex, cause, and initial symptoms) were collected prospectively on patients with malposition of the lower eyelid. All patients were photographed before and after surgery in a set protocol. The type and severity of eyelid malposition were documented using the Ectropion Grading Scale (EGS) before and after each procedure. Surgical outcome was evaluated by objective improvement of ectropion grading and subjective resolution of symptoms. RESULTS: Precaruncular medial canthopexy was performed on 30 eyelids of 27 consecutive patients (10 were revisions) for correction of medial eyelid laxity or malposition. Twenty-six patients had ectropion, and 1 had bilateral entropion. The most common cause of eyelid malposition was facial paralysis (n = 21). Ancillary procedures, most commonly lateral transorbital canthopexy (for correction of lateral ectropion), were performed on 60% of the eyelids at the time of PMC. Twenty-eight procedures resulted in complete restoration of the medial canthus to a normal position (EGS grade I). Two patients had minimal residual medial scleral show after surgery (EGS grade II) but experienced symptom relief. There were no wound infections or perioperative complications. CONCLUSIONS: Precaruncular medial canthopexy rapidly and safely restores support in all 3 dimensions without blocking the visual field or damaging the lacrimal system, with minimal morbidity and excellent wound healing. In addition to being a primary technique for correcting medial eyelid malposition, PMC should be routinely considered as an adjunct procedure when correcting lateral eyelid malposition.     

Hearing preservation in medial vestibular schwannomas

OBJECT: Vestibular schwannomas (VSs) with no or little extension into the internal auditory canal have been addressed as a clinical subentity carrying a poor prognosis regarding hearing preservation, which is attributed to the initially asymptomatic intracisternal growth pattern. The goal in this study was to assess hearing preservation in patients who underwent surgery for medial VSs. METHODS: A consecutive series of 31 cases in 30 patients with medial VSs (mean size 31 mm) who underwent surgery between 1997 and 2005 via a suboccipitolateral route was evaluated with respect to pre- and postoperative cochlear nerve function, extent of tumor removal, and radiological findings. Intraoperative monitoring of brainstem auditory evoked potentials was performed in all patients with hearing. Patients were reevaluated at a mean of 30 months following surgery. RESULTS: Preoperative hearing function revealed American Academy of Otolaryngology-Head and Neck Surgery Foundation Classes A and B in 7 patients each, Class C in 4, and D in 9. Four patients presented with deafness. Hearing preservation was achieved in 10 patients (Classes A-C in 2 patients each, and Class D in 4 patients). Tumor removal was complete in all patients with hearing preservation, except for 2 patients with neurofibromatosis. In 4 patients a planned subtotal excision was performed due to the individual's age or underlying disease. In 1 patient a recurrent tumor was completely removed 3 years after the initial procedure. CONCLUSIONS: The cochlear nerve in medial VSs requires special attention due to the atypical intracisternal growth pattern. Even in large tumors, hearing could be preserved in 37% of cases, since the cochlear nerve in medial schwannomas may not exhibit the adherence to the tumor capsule seen in tumors with comparable size involving the internal auditory canal.     

Osteoid osteoma in the medial malleolus

A case of osteoid osteoma in an unusual location is reported. The osteoma was diagnosed, and the nidus was localized to the anterior colliculus of the medial malleolus based on the clinical symptoms and on the findings in radionuclide bone scanning, tomography, and computerized tomographic (CT) scanning. After precise radiographic localization of the nidus, it was determined that the lesion could be excised surgically without compromising the ankle joint. The tumor was removed by en block excision and curettage. At 10 months follow-up, the patient was free of pain without impairment of function.     

Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer

Objective

To explore the feasibilities between operational approaches for laparoscopic complete mesocolic excision (CME) to right hemicolon cancer.

Methods

This prospective randomized controlled trial included patients admitted to a Shanghai minimally invasive surgical center to receive laparoscopic CME from September 2011 to January 2013 randomized into two groups: hybrid medial approach (HMA) and completely medial approach (CMA). The feasibilities and strategies of the two techniques were studied and compared. Furthermore, the operation time and vessel-related complications were designed to be the primary end points, and other operational findings, including the classification of the surgical plane and postoperative recovery, were designed to be the secondary end points for this study.

Results

After screening, 50 cases were allocated to the HMA group and 49 to the CMA group. Within the HMA group, there were 48 cases graded with mesocolic plane and 2 with intramesocolic plane. For the CMA group, there were 42 cases graded with mesocolic plane and seven with intramesocolic plane. The differences between the two were insignificant, as were the number of lymph nodes retrieved. The mean±standard deviation total operation time for the CMA group was 128.3 ± 36.4 min, which was significantly shorter than that for the HMA group, 142.6 ± 34.8 min. For the CMA group, the time involved in central vessel ligations and laparoscopic procedures was 58.5 %, 14.1 and 81.2 ± 23.5 min, respectively, which were shorter than the HMA group. The vessel-related complication rate was significantly higher in the HMA group.

Conclusions

Laparoscopic CME via the total medial approach is technically feasible after the precise identification of the surgical planes and spaces for the right hemicolon. The procedure has a shorter operation time and fewer vessel-related complications.     

Quadriceps dislocation medial approach for intraarticular and medial structures of the knee

To minimize possible complications such as patellar subluxation, quadriceps atrophy and skin tightness and slough which interfere with successful rehabilitation following knee surgery, the author employed a quadriceps dislocation medial approach for total knee arthroplasty and ligament (medial and both cruciates) surgery. The results of this approach (99 knees) were compared with a medial capsular incision approach (111 knees), a lateral capsular incision approach (114 knees), and Hughston's medial hockey stick incision approach (122 knees). The skin slough, patellar subluxation, and sense of tightness during rehabilitation occurred least with the quadriceps dislocation medial approach (P less than .05). The quadriceps dislocation medial approach was also the most convenient approach of the four.     

Neurosensory testing of the medial calcaneal and medial plantar nerves in patients with plantar heel pain

Eighty-two patients with a chief complaint of plantar heel pain were evaluated for sensory abnormalities within the cutaneous distribution of both the medial calcaneal nerve and the medial plantar nerve, using quantitative neurosensory testing with a pressure-specified sensory device. The results showed that 22.68% of the patients displayed isolated abnormal sensory function within the distribution of the medial calcaneal nerve, whereas 49.48% of the patients displayed abnormal function within the distribution of both the medial calcaneal and the medial plantar nerves. Thus, 72.17% of the patients displayed abnormal sensory function within the distribution of the medial calcaneal nerve. Statistical analysis of the results, using the Pearson chi-square statistic and odds ratio, indicated that a significant percentage of patients with plantar heel pain, even early in the clinical course of plantar heel pain, display abnormal sensibility within the branches of the posterior tibial nerve, and specifically, within the distribution of the medial calcaneal nerve (P <.0008) and the medial plantar nerve (P <.0001).     

改良内侧入路治疗内侧柱压缩性Pilon骨折

目的:探讨改良内侧切口治疗内侧柱压缩性Pilon骨折的临床疗效,并评估其安全性.方法:回顾性分析自2015年1月至2019年1月,西安交通大学附属红会医院足踝外科连续住院手术治疗的31例内侧柱压缩性Pilon骨折患者.根据入院时的影像学资料,31例均诊断为闭合性Pilon骨折,术前X线片及三维CT均显示为内侧柱压缩性骨...     

Triple-flap medial canthal reconstruction

A patient with a medial facial defect, following oncological resection involving the medial canthus, nose, upper and lower eyelids, and the cheek, is presented. The defect was reconstructed using a combination of local flaps to provide tissue similar to native tissue, addressing both functional and aesthetic aspects.     

The management of medial ligament tears in patients with combined anterior cruciate and medial ligament lesions

The management of patients with combined medial collateral (MCL) and anterior cruciate (ACL) rupture remains controversial. We studied 25 such patients who elected to have the ACL lesion treated conservatively; 14 underwent MCL repair with early mobilization and 11 were treated with immobilization for two weeks. The mean follow up was 5.9 years (2 to 11). There was no difference in the clinical assessment of ligamentous laxity, KT-1000 measurements or Tegner activity scores between the two groups but there were significantly higher Lysholm function scores in the operated group.

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Résumé Le traitement optimal des cas associant des lésions du ligament croisé antérieur (ACL) à des lésions médiales collatérales (MCL) est controversé. Nous avons réalisé une étude sur le suivi du traitement de telles lésions dans le but d’évaluer si le traitement opératoire des déchirures de MCL peut apporter une amélioration des résultats fonctionnels pour des patients choisissant de ne pas subir une reconstruction de ACL. Notre étude portait sur 14 patients ayant subi une reconstruction du MCL et 11 patients traités sans opération. Nous n’avons pas observé de différences significatives entre les deux groupes pour les tests de relachement manuel, ni pour les mesures KT-1000, ni pour les niveaux d’activité de Tegner. En revanche les patients du groupe opératoire ont obtenu un meilleur score fonctionnel de Lysholm.

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Accepted: 7 December 1999