OKOJ, Volume 12, No. 8

Coverage Techniques for Soft-tissue Defects Around the Knee

Loss of the quadriceps tendon, patella, and patellar tendon creates an anterior defect in the leg that may be difficult to close, and compromises the strength of extension of the knee. Allografting of the extensor mechanism of the knee can be used to substitute for severe quadriceps deficiency, but late failure is common with such substitution, and major quadriceps deficiency occurs after removal of the allograft material. This article describes a surgical procedure that uses transfer of the vastus medialis or vastus lateralis muscle and these muscles' tibial attachments, or both muscles and their distal expansions, together with the use of flaps of the gastrocnemius and soleus muscles, to cover major deficiencies in the anterior portion of the knee. All patients who have been treated with this method of knee reconstruction have healed without synovial fluid leakage or flap necrosis, and have regained extensor function of the knee. The magnitude of the extensor lag following reconstruction tends to be smaller in knees that include a gastrocnemius or soleus muscle transfer. The vastus medialis and vastus lateralis muscles provide adequate coverage for anterior soft-tissue deficits of the knee.

    • Keywords:
    • total knee arthroplasty

    • muscle flap

    • reconstruction

    • quadriceps function

    • Subspecialty:
    • Adult Reconstruction

Dermatologic Conditions of the Foot

Dermatologic disorders of the foot can be a major source of discomfort, pain, and disability. The adequate diagnostic differentiation of benign from pathologic disorders of the foot, and the treatment of each such disorder, can be challenging. To facilitate their diagnosis, diseases involving the foot can be classified into the three major categories of: (1) infectious disorders (tinea pedis, onychomycosis, acute paronychia, mycetoma, and chromoblastomycosis); (2) neoplasms, including benign growths (warts and corns, pyogenic granulomas, fibromas, mucous cysts, glomus tumors, and longitudinal melanonychia), and malignant tumors (melanoma, squamous-cell carcinoma, and Kaposi sarcoma); and (3) inflammatory diseases (bullosis diabeticorum, diabetic ulcers, pernio, rheumatoid papules, pigmented purpuras, palmoplantar keratodermas, palmoplantar pustulosis, and reactive arthritis). This article describes these entities, summarizes clues to their diagnosis, and provides strategies for their management.

    • Keywords:
    • pathologic foot disorder

    • infectious foot disorder

    • inflammatory foot disorder

    • tinea pedis

    • onychomycosis

    • acute paronychia

    • mycetoma

    • chromoblastomycosis

    • neoplasm

    • wart

    • corn

    • pyogenic granuloma

    • fibroma

    • mucous cyst

    • myxoid cyst

    • glomus tumor

    • longitudinal melanonychia

    • malignant tumor

    • melanoma

    • squamous-cell carcinoma

    • Kaposi sarcoma

    • bullosis diabeticorum

    • diabetic ulcer

    • pernio

    • rheumatoid papule

    • pigmented purpura

    • palmoplantar keratoderma

    • palmoplantar pustulosis

    • reactive arthritis

    • Subspecialty:
    • Foot and Ankle

Scapulothoracic Fusion

Scapular winging can result from multiple dystrophic and nondystrophic etiologies. These conditions lead to alteration in the kinematics of the shoulder with subsequent pain, loss of motion, and an unacceptable cosmetic appearance. This leads to an articulation that does not align with the chest wall. An understanding of the multiple causes of scapular winging is important for determining the appropriate treatment. Scapulothoracic fusion is a salvage procedure designed to alleviate the pain and chronic disability associated with scapular winging. The procedure is an option in patients who are refractory to nonsurgical management or when muscle transfer is not indicated. Following successful fusion, the cosmesis and function of the shoulder are improved, and pain is subsequently decreased. Scapulothoracic fusion is a technically demanding procedure that requires a thorough knowledge of the periscapular anatomy. Attention to a meticulous surgical technique promotes a solid fusion while minimizing complications.

    • Keywords:
    • scapular winging

    • scapulothoracic arthrodesis

    • facioscapulohumeral muscular dystrophy

    • tendon transfer

    • Subspecialty:
    • Shoulder and Elbow