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Soft tissue sarcomas about the patellar tendon necessitate wide resection and thus present a significant reconstructive challenge. This article describes the novel use of a synthetic mesh graft to reconstruct the knee extensor mechanism as a single stage procedure after wide en bloc resection of an extraskeletal myxoid chondrosarcoma (EMC) in a patient with an invasive mass that was intimately associated with her patellar tendon.

Extensor mechanism disruption after total knee arthroplasty is a relatively rare but potentially devastating complication. One technique to address this problem involves reconstruction with synthetic mesh. Although there are reports of successful clinical outcomes using this technique, we are not aware of any histological analyses of removed mesh grafts. This case report of a failed mesh reconstruction includes a retrieval analysis demonstrating robust host soft-tissue incorporation into the mesh graft and supports the rationale for continued use of this off-label technique. This case report also highlights the need for careful operative technique when performing these procedures to increase the chance of a successful outcome. Keywords: Extensor mechanism disruption, Total knee arthroplasty, Synthetic mesh

An abnormally mobile subclavian pacemaker pulse generator in a 49-year-old woman was stabilized by an absorbable mesh graft. This device was successfully replaced 2 years later without any problems. A 4-year follow-up evaluation was uneventful.

A simple and economical mesh graft expansion wheel is described. The instrument does not need any consumables--carriers for example--and is very low priced compared with other expanders. A small institution or a private practising surgeon in this country can afford it. It is possible to increase or reduce the number of wheels to individual surgeon's requirements. Different expansion ratios can be obtained by simple changes in design.

Lanz described mesh grafting in 1907. A similar device was used earlier by Paré and Heister for different applications. Historical analysis reveals a definite link between old scarificators and mesh graft machines.

Using the mesh graft II dermatome (Zimmer) for split skin graft expansion, the 3 to 1 and 1·5 to 1 expansion rates were evaluated for true clinical expansion. In one hundred and one 1·5 to 1 expanded grafts the actual expansion was 1·2 and in sixty 3 to 1 expanded grafts, it was 1·5.