The fascial system has gained recognition for its integral role in connecting skin, superficial and deep fasciae, and underlying muscles. However, consensus on its microstructure depending on its topography remains elusive as well as its implications in clinical practices, such as reconstructive surgery and physiotherapy techniques. This study focuses on the iliotibial tract (ITT) implicated in the iliotibial band syndrome. The goal is to describe microstructural characteristics using classical 2D histology and cryogenic contrast-enhanced microcomputed tomography (cryo-CECT) such as the total thickness, number of layers, layer thickness, fibre orientation and tortuosity, according to the specific topography. The total thickness of the ITT varied across topographic regions, with the superior part being on average thicker but non-significantly different from the other regions. The inferior part showed heterogeneity, with the anterior region (AI) being the thinnest and the posterior one (PI) the thickest. The ITT exhibited 1-3 layers, with no significant differences among regions. Most commonly, it consisted of two layers, except for the antero-superior (AS) and antero-middle (AM) regions, which sometimes had only one layer. The posterior regions frequently had 2 or 3 layers, with the PI region having the highest mean (2.7 layers). The intermediate layer was the thickest one, varying from the AI region (0.368 mm ± 0.114) to the PI region (0.640 mm ± 0.305). The superficial layer showed regional variability, with the AS region being the thinnest. The deep layer appeared thinner than the superficial one. Fibre orientation analysis indicated that the intermediate layer mainly consisted of oblique longitudinal fibres, orientated downward and forward, while the superficial and deep layers had transversal or oblique transversal fibres. Cryo-CECT 3D observations confirmed these findings, revealing distinct orientations for different layers. Fibre tortuosity exhibited differences based on orientation. Transversal fibres (>65°) were significantly less tortuous than longitudinal fibres (<25°) and oblique intermediate fibres (25°-65°), aligning with 3D plot observations. This quantitative study highlights various microstructural characteristics of the ITT, offering insights into its regional variations. The analysis accuracy is increased due to the novel technology of cryo-CECT which emerges as a valuable tool for precise assessment of 3D fibre orientation and tortuosity. These findings contribute to a deeper understanding of the ITT structure, useful in clinical practices, such as reconstructive surgery and physiotherapy, and future research endeavours.

UNASSIGNED: Elbow osteoarthritis is a debilitating disease for patients. Surgical options are to be considered when conservative management becomes unsatisfactory. Total elbow arthroplasty is an effective surgical option for patients older than 65 years and those with a sedentary lifestyle. Meanwhile, interposition elbow arthroplasty is suitable for young, high-demand patients. The retrospective study aimed to evaluate the surgical outcomes of interposition elbow arthroplasty for elbow osteoarthritis.
UNASSIGNED: Eight patients who underwent interposition elbow arthroplasty from 2018 to 2020 in our center were retrospectively reviewed. Interposition elbow arthroplasty was performed using fascia lata autografts. Mayo elbow performance score; disability of arm, shoulder, and hand scores; and range of motion were evaluated and compared with that of the preoperative state.
UNASSIGNED: The mean Mayo elbow performance score significantly improved from 53.7 ± 14.6 (before surgery) to 85.6 ± 12.1 (after surgery). The mean disability of arm, shoulder, and hand score also significantly improved from 93.1 ± 11.8 (before surgery) to 57.5 ± 15.9 (after surgery). The mean arc of motion increased by 85.8°, from a mean before surgery value of 6.2° ± 5.8° to 92.0° ± 34.0° after surgery. Satisfaction rate was 92.5%.
UNASSIGNED: Interposition elbow arthroplasty is a nonprosthetic reconstruction that respects the joint and does not burn any bridge for further total elbow arthroplasty if needed. It provides favorable surgical outcomes with high satisfaction rates among young patients with elbow osteoarthritis.
UNASSIGNED: Therapeutic IV.

Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children.

BACKGROUND: Nasal septal perforation (NSP) is a structural flaw that affects the mucosa, cartilage, and bone of the nasal septum, often stemming from septoplasty as the most frequent cause. The natural healing of a perforated septum is uncommon; on the contrary, it tends to deteriorate progressively. Various surgical methods have been outlined for the repair of NSP. In this research, the authors introduce an innovative approach utilizing fascia lata graft with PRP for the restoration of NSP across diverse sizes.
METHODS: The researchers conducted a retrospective analysis involving 25 patients who underwent repair for nasal septal perforation (NSP) from January 2021 to January 2023. Grafts were obtained, and the perforation was addressed using an open rhinoplasty technique, followed by the insertion and suturing of the graft.
RESULTS: The mean size of the septal perforations was 17 mm horizontally and 18 mm vertically. The mean follow-up period was 12 months. Complete closure of NSP was achieved in 23 out of 25 patients (92%). Among the cases, 17 were male (68%), and the age ranged from 25 to 45 years with a mean of 38.7. Eight cases (32%) were smokers. At 12 months postoperatively, three large-sized NSPs were closed successfully, while two medium-sized NSPs did not achieve closure due to smoking.
CONCLUSIONS: The Fascia Lata and Platelet-Rich plasma fusion technique for the closure of nasal septal perforations is a secure and dependable method, demonstrating a notable success rate. This approach should be regarded as a viable option for individuals dealing with nasal septal perforation.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .

UNASSIGNED: Massive irreparable rotator cuff tears (MIRCTs) are among the most challenging shoulder conditions to treat surgically. Supraspinatus tendon reconstruction (STR) is a recently introduced technique for MIRCTs based on fascia lata-muscle interface healing, which completely differs from the classic bridging technique with fascia lata-tendon interface healing. However, histological and biomechanical comparisons of the fascia-muscle and fascia-tendon interfaces have not been performed.
UNASSIGNED: To investigate the histological and biomechanical healing of the fascia-bone interface and fascia-muscle interface after chronic MIRCTs in a rat model using different surgical methods.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: The authors established a chronic MIRCT model in the right shoulder of rats and then repaired it using the STR or bridging repair technique. Evaluations were performed at 2, 4, 8, and 12 weeks, including histological, imaging, biomechanical, and functional analyses.
UNASSIGNED: Both techniques resulted in good fascia-bone interface healing based on the histological results. The STR group had significantly more cartilage formation at 8 and 12 weeks and higher Modified Tendon Maturity Score after 12 weeks at the fascia-bone interface compared with the bridging repair group and formed the typical 4-layered structure. Collagen fibers in the fascia-muscle and fascia-tendon interfaces exhibited normal muscle-tendon interface characteristics at 12 weeks. However, the STR group had more improvement in fatty infiltration compared with the bridging repair group. The ultimate failure load and stiffness did not differ between the STR and bridging repair groups 4 weeks postoperatively in both the fascia-bone interface and supraspinatus muscle-fascia-bone integrity. Movement distance and grasp time were significantly longer in the STR group than in the bridging repair group at 12 weeks and attached the level in the normal control groups.
UNASSIGNED: These results suggest that the fascia-muscle interface from the STR technique is histologically and functionally better than the fascia-tendon interface. Moreover, this study provides a theoretical basis for the clinical use of the STR technique.
UNASSIGNED: The fascia-muscle interface and fascia-tendon interface were the key points of the STR and bridging techniques, respectively. The fascia-muscle interface is histologically and functionally superior to the bridging technique, and the STR technique might be a better choice for the treatment of MIRCTs.

Last twenties, tissue engineering has rapidly advanced to address the shortage of organ donors. Decellularization techniques have been developed to mitigate immune rejection and alloresponse in transplantation. However, a clear definition of effective decellularization remains elusive. This study compares various decellularization protocols using the human fascia lata model. Morphological, structural and cytotoxicity/viability analyses indicated that all the five tested protocols were equivalent and met Crapo\'s criteria for successful decellularization. Interestingly, only the in vivo immunization test on rats revealed differences. Only one protocol exhibited Human Leucocyte Antigen (HLA) content below 1% residual threshold, the only criterion preventing rat immunization with an absence of rat anti-human IgG switch after one month (N=4 donors for each of the 7 groups, added by negative and positive controls, n=28). By respecting a refined set of criteria, i.e. lack of visible nuclear material, <50ng DNA/mg dry weight of extracellular matrix, and <1% residual HLA content, the potential for adverse host reactions can be drastically reduced. In conclusion, this study emphasizes the importance of considering not only nuclear components but also major histocompatibility complex in decellularization protocols and proposes new guidelines to promote safer clinical development and use of bioengineered scaffolds.

OBJECTIVE: Interposition arthroplasty of the elbow involves the interposition of a fascia lata or dermis autograft or allograft between the distal humerus and the ulna or radius, while preserving the original form of articulation.
METHODS: Interposition arthroplasty is indicated for young patients with high functional demands who suffer from end-stage elbow arthritis and associated pain or joint stiffness.
METHODS: Contraindications include acute or subacute infection, skeletal immaturity, bone loss, deformity, or gross instability.
METHODS: Once the ulnar nerve has been secured, joint access is established via a posterior approach. The radial collateral ligament (RCL) and the common extensor tendon origin (CEO) are detached, while preserving the anconeus muscle and the lateral ulnar collateral ligament (LUCL). Subsequently, a capsular release is required to maintain adequate joint exposure and address the accompanying stiffness. Three to four transosseous drill holes are placed at the level of the distal humerus to secure the graft. After the graft has been positioned successfully within the joint space using two guide sutures, it can be secured to the distal humerus using a horizontal mattress stitch. Finally, the detached tendon and ligament structures are reconstructed.
METHODS: After initial immobilization, early functional exercise of the elbow is performed in the motion orthosis, avoiding valgus or varus stress.
RESULTS: The efficacy of elbow interposition arthroplasty has been demonstrated, particularly for young and active patients with severe inflammatory or post-traumatic osteoarthritis. Despite the results in terms of postoperative function and pain reduction are satisfactory, the current literature reports high complication, subsequent treatment, and revision rates. In the event of interposition arthroplasty failure, revision with another interposition procedure or conversion to endoprosthesis may be considered.
UNASSIGNED: OPERATIONSZIEL: Im Rahmen der Interpositionsarthroplastik des Ellenbogens wird ein Faszien- oder Dermis-Auto- bzw. -Allograft zwischen distalen Humerus und Ulna bzw. Radius interponiert, wobei die ursprüngliche Artikulationsform erhalten bleibt.
UNASSIGNED: Die Indikation zur Interpositionsarthroplastik kann insbesondere bei jungen Patienten mit hohen funktionellen Ansprüchen gestellt werden, die unter endgradiger dysfunktionaler Kubitalarthrose und damit assoziierten Schmerzen bzw. Gelenksteife leiden.
UNASSIGNED: Akute oder subakute Infektionen, grobe Instabilitäten, skelettale Unreife sowie knöcherner Substanzverlust oder Deformitäten gelten als Kontraindikationen.
UNASSIGNED: Über einen posterioren Zugang erfolgt nach Sicherung des N. ulnaris die Etablierung des Gelenkzugangs. Das radiale Kollateralband (RCL) und der gemeinsame Strecksehnenursprung (CEO) werden unter Erhalt des M. anconeus und des lateralen ulnaren Kollateralbandes (LUCL) abgelöst. Um eine ausreichende Gelenkexposition zu erhalten und die begleitende Steife zu adressieren, ist ein anschließendes, aggressives Kapselrelease erforderlich. Zur Fixierung des Transplantats werden 3 bis 4 transossäre Bohrlöcher auf Höhe des distalen Humerus gesetzt. Nach erfolgreicher Positionierung im Gelenkspalt mittels zweier Führungsfäden kann das Transplantat mit horizontalen Matratzennähten am distalen Humerus befestigt werden. Abschließend erfolgt die Rekonstruktion der abgelösten Sehnen- bzw. Bandstrukturen.
UNASSIGNED: Nach initialer Ruhigstellung erfolgt eine frühfunktionelle Beübung des Ellenbogens in der Bewegungsorthese unter Vermeidung von Valgus- bzw. Varusstress.
UNASSIGNED: Die Interpositionsarthroplastik stellt ein „Salvage-Procedure“ für junge und aktive Patienten mit schwerer inflammatorischer oder posttraumatischer Arthrose des Ellenbogens dar. Trotz zufriedenstellender Ergebnisse hinsichtlich postoperativer Funktion und Schmerzreduktion berichtet die aktuelle Literatur über hohe Komplikations‑, Nachbehandlungs- und Revisionsraten. Bei Versagen der Interpositionsarthroplastik ist eine Revision mittels eines weiteren Interpositionsverfahrens oder eine Konversion zur Endoprothese möglich.

BACKGROUND: A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options.
METHODS: Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared.
RESULTS: A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9).
CONCLUSIONS: The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.

Salivary collection (SC) following surgery for oral cancer represents an underreported and unrecognized complication. Our study aimed to evaluate the efficacy of parotideomasseteric fascia flap (PFF) in preventing postoperative SC, comparing its effectiveness with other conventional methods. Between November 2019 and January 2023, 221 patients diagnosed with oral squamous cell carcinoma (OSCC) undergoing wide tumor ablation and neck dissection at Xiangya Hospital were included in the study. Patients were randomly allocated into four groups based on different intraoperative techniques to assess the preventive efficacy of PFF against SC. The incidence of SC in the PFF group was only 5.9%, which was significantly lower than the other three groups (p < 0.05). Among the 221 patients, the highest SC incidence occurred in buccal cancer cases (19.6%). However, in the PFF group, the incidence was not significantly different (9.5%; p > 0.05). Univariate analysis revealed a higher SC incidence associated with advanced clinical T stage (p = 0.02), N(+) stage (p = 0.01), low average serum albumin (SA) level (p = 0.00), and a large parotid wound (p = 0.00). In multivariate analysis, only average SA (p = 0.01; odds ratio [OR] 4.104; 95% CI 0.921-11.746) emerged as the most prevalent factor predisposing to SC. The utilization of PFF demonstrated a notable reduction in the incidence of postoperative SC, establishing it as a safe, effective, and convenient method for patients undergoing radical ablation for OSCC.

OBJECTIVE: The deep fascia has recently been a current topic in many medical fields, including rehabilitation. Some research has already focused on assessing deep fascia, however results of individual authors differ in certain aspects. This study focuses on the inter-rater reliability of ultrasound (US) measurement of the thickness of deep fascia and loose connective tissue (LCT). The aim was to define the causes of any discrepancies in measurement that could contribute to the unification of management of evaluating fascia.
METHODS: An observational study was performed including 20 healthy individuals in whom fascia lata of the anterior thigh was examined by US imaging and then measured in Image J software. Three raters participated in this study: the first with 6 years of US imaging experience, other two were newly trained. The measurement of fascial parameters was conducted in two phases with special consultation between them resulting in an agreement of the research team on the more precise way of measurement.
RESULTS: Results revealed the value of inter-rater reliability ICC3,1 = 0.454 for deep fascia thickness and ICC3,1 = 0.265 for LCT thickness in the first phase and any significant difference in the second phase. This poor inter-rater reliability led to a search for possible causes of discrepancies, which authors subsequently highlighted.
CONCLUSIONS: The findings of the study show the main pitfalls of deep fascia measurement that should contribute to the unification of evaluation.