Alessandro Crosio

Traumatic amputations and non-reconstructable sub-amputations with soft-tissue loss of the lower limb are highly disabling events. The calcaneus osteocutaneous fillet flap should be considered in lower leg amputations and non-reconstructable sub-amputations to preserve length and convert an above-knee amputation to a below-knee amputation without further donor site morbidity. Preserving the knee joint in an amputated limb is associated with faster rehabilitation and a quicker, more natural gait. Some complications can occur and must be appropriately managed during the postoperative days and the following months. This report presents a case of a fillet flap successfully performed in a young woman, with an extended 6-year follow-up. Three consecutive complications, i.e., osteosynthesis revision, painful saphenous nerve amputation neuroma, and surgical scar dehiscence, were successfully managed in the postoperative weeks. At 6 years from injury, the patient had a physiological gait and walked a distance of 200 m in 2 min without shortness of breath. She scored optimally (82 out of 100 points) in all the items of the Short-Form Health Survey SF-36 test (compared with the standard scores for below-knee amputated patients). She scored 63 out of 80 on the Orthotics and Prosthetics User's Survey (OPUS) test. No further revision surgery was necessary. No sensory disturbances persisted after the first year from the trauma. The patient reported occasional mood swings coinciding with episodes of phantom limb pain that continued throughout the years and needed painkillers.

Background and Clinical Significance: Neurological complications in extension-type-III supracondylar humeral fractures (SCHFs) in children represent 11% of cases. An extension-type-III SCHF with posterolateral displacement of the distal fragment is commonly associated with damage to the median nerve and the anterior interosseous nerve (AIN). Neurological complications are often unnoticed, and their immediate postoperative diagnosis is difficult, particularly in young children. Neurapraxia, the most common complication, usually undergoes spontaneous nerve recovery. Case Presentation: We report a case of a 7-year-old patient with postoperative median nerve palsy after an SCHF (Gartland type III) who was referred to our unit from another hospital due to a lack of spontaneous recovery. In addition, motor and sensory functions were absent. As ultrasound (US) indicated nerve kinking at the fracture site, an exploration was performed. The nerve was trapped within the fracture and the callus. It was surgically extracted, and intraoperative examination with US indicated that resecting the kinked nerve, freeing the two stumps, and attempting a primary end-to-end suture represented the best course of action. We present this case with a 5-year follow-up surgery, which showed a good clinical outcome. Conclusions: This case is noteworthy because of its diagnostic and therapeutic pathways, and it is complemented by surgical and ultrasound images that can assist other surgeons in similar circumstances.

As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.

Introduction Perineural scar formation is responsible for pain and loss of function after surgical procedures. Neurolysis and application of anti‐adhesion gels are required to restore a gliding surface. We tested a carboxymethylcellulose (CMC) and polyethylene oxide (PEO) gel on mouse sciatic nerve to describe its safety and efficacy. Methods Adult mice underwent a surgical procedure in which we burned the muscular bed of the sciatic nerve bilaterally (Burned group) and applied anti‐adhesion gel to 1 of the nerves (Burned+gel group). After 3 weeks, we studied scar tissue by biomechanical and histological evaluation. Results Both histological and biomechanical analysis showed that the gel reduced perineural scarring. The difference between the Burned and Burned+gel groups was statistically significant. Conclusions CMC‐PEO gel can reduce perineural scar tissue. In histological section, scar tissue was present in both groups, but in the Burned+gel group a gliding surface was identified between scar and nerve. Muscle Nerve 53: 304–309, 2016