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In peroneal nerve palsy with closed knee injury, most of the case improves by follow‐up. We present a case of peroneal nerve rupture with closed multiple ligament knee injury, requiring nerve transplantation. In multiple ligament knee injury, it is necessary to consider the possibility of peroneal nerve rupture. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to clarify the relationship between seasonal variation and distal radius fractures using diagnosis procedure combination data in Japan. Materials and Methods: The participants were hospitalized patients who underwent surgical treatment for distal radius fracture as the primary injury at hospitals that introduced the diagnosis procedure combination system between April 2011 and March 2016. We obtained a summary table of the month of admission, region of residence, age at admission, and sex of the patients from the Ministry of Health, Labour and Welfare and evaluated it by month, region, age group, and sex. Results: The total number of patients for the 5 years from 2011 to 2016 was 105,025. There were 29,224 male and 75,801 female participants, with a female-to-male ratio of 2.6. The mean age was 60.2 (standard deviation, 20.8) years. Distal radius fractures occurred more frequently in the winter, especially among female individuals in eastern Japan. Female participants aged ≥ 50 years tended to have a higher incidence of distal radius fracture in winter. The incidence of distal radius fracture among male participants aged 0–19 years was higher from spring to autumn. Conclusion: Surgically treated distal radius fractures occur frequently during the winter months among female individuals in eastern Japan or those aged ≥ 50 years and increase from school age to adolescence, especially in male individuals from spring to autumn. We should be aware of the high incidence of distal radius fractures in winter, especially in regions with snowfall and cold temperatures. [ABSTRACT FROM AUTHOR]

Nafamostat mesylate (NM) has been used to treat pancreatitis and disseminated intravascular coagulation during hemodialysis (HD). However, there have been some reports of adverse effects related to anaphylactic reactions. We present a case in which anaphylactic reactions caused by NM during preoperative HD caused repeated postponement of surgery for carpal tunnel syndrome. Symptoms including fever, shivering, chills, low blood pressure, tachycardia, nausea, and vomiting appeared during preoperative HD, and surgery was postponed thrice. Initially, the patient was misdiagnosed with sepsis because of elevated C-reactive protein and procalcitonin levels. However, since the symptoms appeared only when NM was administered and disappeared quickly after the administration of NM was terminated, the condition was diagnosed as anaphylactic reactions caused by NM. Therefore, it is essential to consider anaphylactic reactions caused by NM as differential diagnoses, when symptoms, such as fever, are observed during perioperative HD. [ABSTRACT FROM AUTHOR]

Purpose: While many studies have been conducted on peripheral nerve regeneration, few have focused on strengthening the nerve autografts. This study hypothesized that adding autologous stromal vascular fraction (SVF) to a nerve autograft will improve nerve regeneration. The purpose of this study was to compare the results of nerve autograft with and without SVF. Methods: An adipose tissue sample was excised from the right inguinal region of female Wistar rats, and SVF was separated by centrifugation. The left sciatic nerve was resected at a length of 15 mm and the defect was bridged by a resected nerve autograft. We added SVF with collagen gel around the nerve autograft in the SVF group and added saline in the control group. At 12 weeks after surgery, the wet muscle weight, distal latency, and amplitude of the compound muscle action potential of the tibialis anterior were evaluated by the ratio of left and right sides. Sciatic functional index (SFI) was also evaluated. Results: The wet muscle weight was significantly better in the SVF group than in the control group. The results of distal latency, amplitude, and SFI were not significantly different between the two groups; however, these results tended to be better in the SVF group than in the control group. Conclusion: SVF added to artificial nerve grafts has been reported to promote axonal regeneration through secretion of angiogenic, neurotrophic, and anti-apoptotic factors. This study indicates that SVF may also be effective for nerve autografts and improve the clinical result of nerve autograft. [ABSTRACT FROM AUTHOR]

Background: We evaluated how artificial nerves filled with adipose-derived stem cell (ADSC) sheets could facilitate peripheral nerve regeneration.Methods: We prepared ADSC sheets following previously described protocols. We transected the sciatic nerve in 12-week-old Wistar rats, fixed the nerve ends to the artificial conduit, and prepared three groups: (1) conduits alone (control group); (2) conduits filled with ADSCs (ADSCs group), and (3) conduits filled with ADSC sheets (ADSC sheet group). We assessed the subjects 4 and 12 weeks post-transplantation (n = 24). We investigated βIII-tubulin and anti-S100 expression at 4 and 12 weeks post-transplantation, in longitudinal- and cross-sections of the central portion in the regenerated tissues. The vascular endothelial growth factor A (VEGFA) and neuregulin-1 expressions were analyzed using real-time reverse-transcription polymerase chain reaction (real-time RT-PCR). We evaluated the tibialis anterior muscle wet weight (affected/healthy sides, %) and sciatic function index (SFI) 12 weeks post-transplantation.Results: The ADSC sheet group comprised more S100-positive cells than the other groups. The regenerated axon length in the ADSC sheet group was markedly the longest among the studied groups. The immunostaining revealed a positive area in the regenerated tissue center in all groups, tending to be the largest in the ADSC sheet group. The muscle wet weight indicated that the ADSC sheet group exhibited significantly higher weight than the control. The mean SFI showed that the ADSC sheet group exhibited significantly better results than the control. The VEGFA expression was higher both in the ADSC and the ADSC sheet group than in the control. The neuregulin-1 expression was higher both in the ADSC and the ADSC sheet group than in the control.Conclusions: The ADSC sheets could potentially support transplanting an adequate number of ADSCs at the target site. Compared with the conventional method of attaching ADSCs, the use of ADSC sheets promotes accelerated nerve regeneration. [ABSTRACT FROM AUTHOR]

Background: Despite the movement of the thumb carpometacarpal joint has been studied, many unclarified points remain regarding the movement of this joint. The purpose of this study was to evaluate the in vivo kinematics of the thumb carpometacarpal joint during flexion and abduction using computed tomography images. Methods: The subjects were 9 healthy males. Computed tomography images were obtained in 4 equally-divided positions from maximum extension to maximum flexion, and maximum adduction to maximum abduction of the thumb. A three-dimensional model was constructed from these images, and the models of each position were superimposed with reference to the trapezium. The amount of angular change around the bone axes of first metacarpal bone and rotation axes were evaluated. Results: We found that the first metacarpal bone showed relatively simple behavior during abduction. However, during flexion, it exhibited a particular movement in which the amount of angular change of the metacarpal bone with respect to the trapezium rapidly increased with deep flexion. Conclusions: These results suggest that the thumb carpometacarpal joint exhibits a special movement during flexion, especially deep flexion. [ABSTRACT FROM AUTHOR]

Introduction: Many reports have indicated that adipose-derived stem cells (ADSCs) are effective for nerve regeneration. We investigated nerve regeneration by combining a polyglycolic acid collagen (PGA-c) tube, which is approved for clinical use, and Schwann cell-like differentiated ADSCs (dADSCs).Methods: Fifteen-millimeter-long gaps in the sciatic nerve of rats were bridged in each group using tubes (group I), with tubes injected with dADSCs (group II), or by resected nerve (group III).Results: Axonal outgrowth was greater in group II than in group I. Tibialis anterior muscle weight revealed recovery only in group III. Latency in nerve conduction studies was equivalent in group II and III, but action potential was lower in group II. Transplanted dADSCs maintained Schwann cell marker expression. ATF3 expression level in the dorsal root ganglia was equivalent in groups II and III.Discussion: dADSCs maintained their differentiated state in the tubes and are believed to have contributed to nerve regeneration. [ABSTRACT FROM AUTHOR]

The most common surgical treatment for congenital pseudarthrosis of the clavicle (CPC) is resection of the pseudarthrosis, placement of an autologous bone graft, and Kirschner wire or plate fixation. However, in some cases, bone fusion cannot be achieved at the first surgery, and an additional surgery is required. We present a case report of a boy with a right CPC who failed radiographic bone union after the first surgery. He subsequently underwent revision surgery with resection of the pseudarthrosis, plate fixation, and establishment of a vascularized medial femoral condyle (MFC) flap to ensure bone union. Three months after the revision surgery, a radiographic bone union was achieved, and no symptoms were observed for one year after the operation. There have been no previous reports of the use of a vascularized MFC flap as a treatment for CPC. We believe that this technique effectively ensures bone union during revision surgery for CPC. [ABSTRACT FROM AUTHOR]

Morel-Lavallée lesion (MLL) is a degloving injury in soft tissues caused by shear force accompanying trauma. Even if it is a small lacrimal wound at the initial visit, there is a range of skin necrosis which is not suitable for it. As a cause of the injury, a shearing force was applied over a wide range, and penetrating blood vessel damage to the skin occurred, resulting in skin necrosis. Attention is required. [ABSTRACT FROM AUTHOR]

The treatment methods used for Blauth type IIIB hypoplastic thumbs are controversial. We performed a nonvascularized, hemilongitudinal metatarsal bone transfer on a 5-year-old boy with a type IIIB hypoplastic thumb. Despite the child's age, the growth of the thumb was confirmed and the thumb had stabilized. Moreover, growth disorder of the donor toe was not observed. This method is relatively easy to perform. And donor toe deformation can be prevented, because of the preservation of more than half of the metatarsal bone. In our case, the patient was 5 years of age; nevertheless, the epiphyseal line was opened and the grafted metatarsal bone grew. This method is useful in terms of its simplicity and prevention of postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose. Elevation of the sural artery flap with the sural nerve is associated with donor-site morbidities, such as postoperative sensory disturbance of the lower extremity. We evaluated the sensory disturbance of the lower extremity after elevation of the sural artery flap. Methods. This study included 7 patients who underwent surgery using the sural artery flap. The sensory disturbances immediately after surgery and at present were evaluated on a 10-point scale. The influences of surgery on activities of daily living and patient satisfaction were also evaluated. Results. The sensory disturbance was 4.48 immediately after surgery and 2.24 presently, and the difference between the timepoints was not statistically significant. The influence of surgery on activities of daily living was 2.30, and the patient satisfaction was 7.90. Conclusion. It may be necessary to consider the sural artery flap, which does not include the sural nerve, to avoid unnecessary complications. When it is unavoidable to use the sural artery flap, including the sural nerve, it is important to thoroughly inform patients beforehand about the postsurgery sensory disturbance in the lower extremities. [ABSTRACT FROM AUTHOR]

Vasospasm is a phenomenon that can complicate microsurgery. We report a case in which vasospasm was quickly relieved by topical application of fasudil hydrochloride. A 36-year-old man underwent preoperative chemotherapy and wide excision for a malignant soft tissue tumor around the knee joint. We planned reconstruction using a free latissimus dorsi muscle flap for the resulting soft tissue defect and selected the peroneal vessels as the recipient vessels. However, there was no arterial blood flow from the peroneal vessels, which we diagnosed as vasospasm. Conventional treatment of the vasospasm was attempted, but blood flow was not achieved. Topical application of fasudil hydrochloride solution promptly relieved the vasospasm. To the best of our knowledge, this is the first clinical report of the use of fasudil hydrochloride for vasospasm during soft tissue reconstruction using a free flap. [ABSTRACT FROM AUTHOR]

• Outcomes of decellularized nerve grafts seem inconsistent when using long grafts. • We developed adipose-derive stem cell (ADSC) sheets. • Decellularized nerves wrapped with ADSC sheets were used for implantation. • Accelerated nerve regeneration was observed with ADSC sheets wrapping. • Humoral factors ADSCs secrete may have positive effects on nerve regeneration. We developed a sheet of stem cells derived from adipose tissue (ADSC sheet). To improve transplantation, we wrapped decellularized nerves with ADSC sheets and examined the efficacy of this recellularized nerves in nerve regeneration. Decellularized nerves were prepared from sciatic nerves of Sprague-Dawley rats. Wistar rats were subjected to sciatic nerve injury and then randomly assigned to three groups (n = 7 per group), which were transplanted with 15-mm bridge grafts; the first group received a decellularized allogenic nerve implant, the second an ADSC sheet-wrapped decellularized allogenic nerve implant, and the third an autogenous nerves were implant. No significant differences were found in S100-positive and neurofilament-positive areas, axon density, and sciatic functional index (SFI) score between rats transplanted with ADSC sheet-wrapped nerve grafts and those that received autografts. In contrast, these parameters except SFI and the amplitude ratio were significantly larger in rats grafted with ADSC sheet-wrapped nerve than with the decellularized nerve. These results suggest that the number of regenerating axons, as well as their regenerating velocity, and the number of migrating Schwann cells into the implant in rats transplanted with ADSC sheet-wrapped nerves matched those in rats transplanted with autografts. These positive effects are possibly attributable to secretion of growth factors of ADSCs. [ABSTRACT FROM AUTHOR]