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 .

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.

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.
目的：探讨颅鼻沟通瘤切除与硬脑膜颅底修复重建方法。 方法：收集2018-2022年接受颅鼻沟通瘤切除术后行硬脑膜颅底重建的31例患者的临床资料，并随访3～41个月。 结果：总计31例患者，其中男20例，女11例；年龄19～74岁，中位年龄57岁。良性病变17例（血管瘤、Rathke囊肿、鳞状上皮乳头状瘤、颅咽管瘤各1例，脑膜脑膨出、内翻性乳头状瘤、脑膜瘤Ⅰ级各2例，神经鞘瘤3例，垂体瘤4例），恶性病变14例（骨肉瘤、低分化癌各1例，内翻性乳头状瘤恶变、嗅神经母细胞瘤、腺癌、腺样囊性癌各2例，鳞癌4例）。鼻内镜联合颅面切口16例，单纯鼻内镜手术15例。31例患者均行肿物手术全切及硬脑膜颅底重建，游离组织修复8例（阔筋膜5例，鼻腔黏膜3例）；带蒂皮瓣修复23例（单纯鼻中隔黏膜瓣11例，鼻中隔黏膜瓣联合游离移植物6例，帽状腱膜联合游离移植物6例）；31例患者中有8例行颅底骨性修复。术后脑出血1例，脑脊液漏1例，颅内感染2例，治疗后均顺利出院。放疗后脑脊液漏伴颅内感染1例，保守治疗康复。17例良性病变患者均生存；14例恶性患者术后13例行放疗，9例无复发生存；5例复发，其中2例带瘤生存，1例再次手术，2例死亡。 结论：颅鼻沟通瘤是前中颅底的高危疾病，肿物完整切除后修复方式多种多样，良好的修复重建及多学科协作对患者的预后至关重要。.

OBJECTIVE: The Iliotibial band (ITB) is a fibrous thickening of the fascia lata originating at the iliac crest and inserting at Gerdy\'s tubercle on the lateral tibia. The ITB significantly contributes to lateral knee stabilisation. Due to its size, tensile strength and easy access, it is widely used in orthopaedic surgery as an autograft during reconstruction procedures. Although ITB harvesting may result in complications, such as reduced knee extension or hip flexion, no safety margins or guidelines have been proposed for the procedure. Our aim was to determine the maximal safe length of an ITB graft, that is, that does not harm the lateral collateral ligament (LCL), tensor fasciae latae (TFL), gluteus maximus (GM) or adjacent structures, and reduce the complication rate.
METHODS: The study included 50 lower limbs of 25 human cadavers, previously fixed in 10% formalin solution. The inclusion criterion was the lack of visible signs of surgical interventions in the study region. Forty lower limbs were included in the study: 16 female (mean age 83.1 ± 3.4 years) and 24 male (mean age 84.2 ± 6.8 years). Dissection was performed with a previously established protocol. Morphometric measurements were then obtained twice by two researchers.
RESULTS: The mean femur length was 404.8 mm [female (F) = 397.3 mm, male (M) = 409.9 mm, standard deviation (SD): F = 23.8 mm, M = 24.1 mm]. The mean ITB length was 318.9 mm (F = 309.4 mm, M = 325.2 mm, SD: F = 25.7 mm, M = 33.7 mm). Longer femurs were associated with longer ITB (p < 0.05). The mean distance from the insertion of the GM to the myofascial junction of TFL and ITB was 34.6 mm (F = 34.5 mm, M = 34.6 mm, SD: F = 3.2 mm, M = 3.3 mm). The longer femurs or ITBs demonstrated a greater distance from GM insertion to the myofascial junction of the TFL and ITB (p < 0.05).
CONCLUSIONS: ITB grafts longer than 21 cm may contribute to the greater risk of TFL rupture. Based on simple measurements of the femur length, the surgeon may assess approximate ITB length, and thus assess the length of the maximal graft length. Moreover, to avoid harming the LCL, the incision should be performed 5 cm proximal to the articular surface of the lateral femoral condyle or 13 mm proximal to the lateral femoral epicondyle. Such preparation and preoperative planning may greatly reduce the risk of complications during ITB harvesting, while performing, for instance, the over-the-top technique for anterior cruciate ligament reconstruction in skeletally immature patients.
UNASSIGNED: Basic I.

UNASSIGNED: Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion.
UNASSIGNED: To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: A total of 8 fresh-frozen cadaveric shoulder specimens were used. There were 4 conditions tested: (1) intact rotator cuff, (2) stage III rotator cuff tear (complete supraspinatus tendon and superior one-half of the infraspinatus tendon), (3) unsecured tensor fascia lata graft, and (4) secured tensor fascia lata graft. Both superior and posterior translation of the humeral head were calculated in each condition. A 4-cm × 5-cm × 6-mm tensor fascia lata graft was used in the subacromial space to act as a spacer. Grafts were secured at the lateral edge of the native rotator cuff footprint with 2 knotless anchors.
UNASSIGNED: With unbalanced loading, both secured and unsecured grafts varied in their ability to limit superior and posterior translation at various rotation angles back to levels seen with intact rotator cuffs at 0° and 20° of abduction. During balanced loading, both unsecured and secured grafts limited superior and posterior translation more than those seen in the rotator cuff-deficient condition (P < .01) and similar to those seen in the intact condition (P > .05). The secured and unsecured grafts allowed similar amounts of translation at every position with both unbalanced and balanced loading (P > .05). Finally, total graft motion was <7 mm in all positions.
UNASSIGNED: Unsecured tensor fascia lata grafts were biomechanically equivalent to secured grafts when used during allograft spacer procedures.
UNASSIGNED: While both grafts were successful at limiting superior and posterior translation of the humeral head during early range of motion, the unsecured graft represents a cheaper, easier option to utilize during allograft spacer procedures.

The nasal skull base is located into the deep position of nasal cavity and closely related to important nerves and vessels. The complete removal of tumors in this area poses a complex surgical challenge.In order to investigate the clinical efficacy of utilizing free middle turbinate mucosa (FMT), fascia lata, and pedicled nasal septum flap (known as the Hadad-Bassagasteguy flap, HBF) for the treatment of cerebrospinal fluid (CSF) rhinorrhea, a retrospective analysis was conducted on clinical data from 65 patients who underwent skull base reconstruction following endoscopic resection of nasal-skull base tumors. The selection of the repair material was based on the size and location of the defect. For defects less than 1.5 cm (n = 24), FMT was chosen, while for defects greater than or equal to 1.5 cm (n = 16), HBF was preferred. In cases where HBF was not available or not suitable (specifically, when the defect was located on the posterior wall of the frontal sinus), fascia lata was selected (n = 25). The repair outcomes of all 65 patients were summarized, and subsequently, a comparison was made between the use of fascia lata and HBF. The overall success rate for one-time repairs was 93.8 %. Specifically, the success rates for repairs using FMT, fascia lata, and HBF were 91.7 %, 96.0 %, and 93.8 %, respectively. Throughout the follow-up period, there were 2 cases of postoperative CSF leakage out of 24 patients who underwent FMT reconstruction, 1 case out of 25 patients who underwent fascia lata reconstruction, and 1 case out of 16 patients who underwent HBF reconstruction. The occurrence of postoperative complications, such as intracranial infection, lung infection, and epistaxis, was observed in both the fascia lata group and the HBF group. However, there were no statistically significant differences between the two groups. The transnasal endoscopic reconstruction of skull base defect using HBF, fascia lata, and FMT demonstrated satisfactory repair effects in managing CSF rhinorrhea. Generally, FMT has been found to be a dependable repair material for small defects measuring less than 1.5 cm, while in the case of larger defects equal to or exceeding 1.5 cm, both HBF and fascia lata can be utilized with comparable repair outcomes. The selection of fascia lata becomes a viable option when HBF is unavailable or not suitable.