Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report

Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities

Appropriate Wound Closure after Malignant Soft Tissue Tumor Excision : Need for Flap Surgery in Recurrent Tumors

In recent years, multidisciplinary treatment advances have made limb salvage possible even in cases of recurrent malignant tumors. The key to prevent deep infection is successful wound closure. We investigated reconstruction techniques and clinical outcomes after wide resections of soft tissue tumors in 146 patients. There were 103 properly resected primary tumors, 15 improperly resected primary tumors, and 28 recurrent tumors. Among 107 cases in which direct wound closure was performed, 105 epithelialized without additional surgery other than secondary suturing, while 2 required additional surgery. In contrast to the 80％ of properly resected primary tumor cases that employed direct wound closure, among improperly resected primary tumors, only 33％ employed direct wound closure, while flaps were required in 40％. All recurrent cases that required reconstruction employed skin flap surgery. In improperly resected cases, preparing for skin reconstruction is essential. In recurrent cases, preparation must be made for flap reconstruction.近年，悪性骨軟部腫瘍の集学的治療の進歩により再発症例においても患肢温存が可能になってきている．創閉鎖の成否は深部感染の予防の鍵を握っている．今回我々は，146 人の軟部腫瘍広範切除後患者の再建法と臨床成績を調査した．初回適切切除は103 例，初回不適切切除は15例，再発は28例であった．直接縫合が行えた107 症例のうち105 例は二次縫合以外の追加手術なしで上皮化したが，2 例で追加再手術を要した．適切切除症例では80％で直接縫合が行えたのに対して，不適切切除症例では33％しか直接縫合が行えず，40％で皮弁を要した．再発例で再建を要する場合は全て皮弁術であった．不適切切除症例は皮膚再建の準備が必要である．再発症例は皮弁による再建を準備すべきである