Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children

Purpose: Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. Methods: Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8-18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. Results: The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12–13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. Conclusions: ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively

A Protocol for the Use of a Combined Microvascular Free Flap with Custom-Made 3D-Printed Total Temporomandibular Joint (TMJ) Prosthesis for Mandible Reconstruction in Children

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes

Microvascular nose reconstruction after extended tumor resection

Introduction: The nose is the central and probably the most important organ of the face. In view of the three-dimensional shape and variety of tissues, reconstructive surgery after tumor resection in this anatomical region requires the surgeon’s knowledge of anatomy. Materials and Method: In the years 2010–2019, 48 patients were treated in the Oncological and Reconstructive Surgery Clinic for extended nasal tumors, which required the use of free microvascular flaps after resection for functional and aesthetic supply of anatomical structures of the nose. Results: In 48 patients, a total of 92 free microvascular flaps were used for nasal reconstruction including: radial forearm free flap in 24 patients, radial forearm free flap with radial bone in 14 patients, auricular free flap in 16 patients, radial forearm free flap in combination with auricle free flap in 7 patients, double auricular free flap in 6 patients, radial forearm free flap in combination with double auricular free flap in 4 patients. Total necrosis of the free flap was noted in 4 cases, partial in 6 patients. Conclusions: The presented surgical techniques using microvascular free flaps constitute a recognized method of treatment and should be used in everyday surgeon practice. The results demonstrated in this article allow to obtain optimal functional and aesthetic effects

Rekonstrukcje mikronaczyniowe nosa po rozległych resekcjach z powodu nowotworów złośliwych

Wstęp: Nos jest centralnym i prawdopodobnie najważniejszym narządem twarzy. Zabiegi rekonstrukcyjne tej okolicy wymagają od operatora dużej znajomości anatomii, z uwagi na trójwymiarowy kształt i różnorodność tkanek, które ją tworzą. Brak jest jednolitych standardów postępowania czy algorytmów po rozległych resekcjach. Materiały i metody: W latach 2010–2019 w Klinice Chirurgii Onkologicznej i Rekonstrukcyjnej leczonych z powodu rozległych nowotworów nosa było 48 pacjentów, którzy wymagali po zabiegach resekcyjnych zastosowania wolnych płatów mikronaczyniowych, celem funkcjonalnego i estetycznego zaopatrzenia struktur anatomicznych nosa. Wyniki: U 48 pacjentów do rekonstrukcji nosa zastosowano łącznie 92 wolne płaty mikronaczyniowe, w tym: płat promieniowy u 24 chorych, płat promieniowy z fragmentem kości promieniowej u 14 chorych, płat z małżowiny usznej u 16 chorych, połączenie płata promieniowego z płatem z małżowiny usznej u 7 chorych, podwójny płat z małżowiny usznej u 6 chorych, połączenie płata promieniowego z dwoma płatami z małżowiny usznej u 4 chorych. Całkowitą martwicę wolego płata zanotowano w 4 przypadkach, częściową u 6 chorych. Wnioski: Przedstawione powyżej techniki operacyjne z użyciem wolnych płatów mikronaczyniowych stanowią uznaną metodę postepowania leczniczego i powinny być stosowane w codziennej praktyce chirurga. Opisane w pracy metody z zakresu chirurgii rekonstrukcyjnej pozwalają na uzyskanie optymalnego efektu funkcjonalnego i estetycznego