Deltoid ligament reconstruction with autologous gracilis tendon in chronic medial ankle instability after ankle fracture surgery: A case report

IntroductionThe repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.Case reportA 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.DiscussionThe deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.ConclusionIn the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

Iterative reconstruction algorithms

In this paper a survey of recent results on iterative reconstruction algorithms is given. These results, many of which have not yet appeared elsewhere, are applicable to a very general formulation of the reconstruction problem based on the series expansion approach. A set of optimization criteria and a number of iterative reconstruction algorithms are stated, together with theorems on the convergence of the algorithms to optimum images. The efficacy of the algorithms is compared to that of the convolution method. In particular, the falseness of the claim that ART and the backprojection method are the same is demonstrated.     

声门型喉癌T_3病变喉部分切除术后疗效评价

目的　探讨喉部分切除术对声门型喉癌T3 病变的可行性及修复材料的选择。方法　对 1986年 1月～ 1994年 1月 78例行喉部分切除术的声门型喉癌T3 病变患者的术式及修复方法进行了回顾性分析。结果　患者 3年、5年生存率分别为 88 5 %、75 6 % ,局部复发率 15 4%。应用了梨状窝粘膜 甲状软骨板外侧软骨膜、会厌软骨瓣及带状肌双肌双蒂瓣 3种方法修复创面 ,均获得了较好的喉功能恢复。结论　喉部分切除术是根治声门型喉癌T3 病变合理、有效的方式 ,但不能完全替代全喉切除术 ,应根据切除范围选择合理的修复方式。     

残胃贲门癌切除、空肠“9”字袢代胃及幽门重建术12例

目的探讨残胃贲门癌手术切除,消化道重建的方法。方法总结1989年8月至1999年12月12例残胃贲门癌切除、空肠“9”字袢代胃及幽门重建术的治疗经验。结果无手术死亡,无倾倒综合征,无返流性食管炎。钡剂在“9”字环内有循环,下方重建凼门处有钡荆停留。全组均随访,随访时间最长4年3个月,最短4个月。其中1年内死亡2例,1～2年死亡4例,2～3年死亡2例,另4例生活良好。结论术后并发症少,有抗返流作用,利于营养支持,病人生活质量较高。     

A case with breast cancer under the nipple who underwent breast conserving treatment

Although breast conserving treatment (BCT) has become the standard therapy for early breast cancer, breast removal is still recommended for patients with a tumor beneath the nipple or with Paget’s disease. We have employed transposition of a latissimus dorsi myocutaneous (LD-MC) flap after wide local excision of a tumor with the nipple-areola complex. A new nipple-areola complex was reconstructed on the LD-MC flap after breast irradiation. Utilizing reconstructive techniques, BCT will likely become the treatment of choice for more patients with early breast cancer.