Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
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Comparative Study
Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware.
Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. ⋯ The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply.
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Case Reports
Bilateral anterior dislocation of the shoulders at the start of a backstroke competition.
Bilateral anterior dislocation of the shoulders is very rare. A 20-year-old man presented with bilateral anterior shoulder dislocation as a result of a diving incident. He complained of pain and restriction of movement in both shoulders with abducted and externally rotated arms. ⋯ The patient was treated with closed reduction and was able to resume swimming 3 months later. To our knowledge, this is the first bilateral anterior dislocation of the shoulders during a backstroke swimming competition that was caused by this mechanism of injury. The rarity of this lesion and its uncommon mechanism prompted us to relate this observation.