Surgical Techniques Development

Background/Objectives: This article brings forward a novel methodology for the intra-op approach of forearm amputation stumps to facilitate their subsequent wireless connection to a neural prosthesis. A neural prosthesis offers the amputee more motor functions compared to myoelectric prostheses, but the neural prosthesis must be connected to the patient’s stump nerves. Methods: An experimental animal study was conducted on 15 Wistar rats. Under anesthesia, the sciatic nerve was carefully dissected and preserved using a folding technique to maintain maximum length without tension. Nerves were repositioned with consideration for future use with biocompatible conduits. Morphometric measurements (nerve length, external diameter, fascicle count) were performed, followed by statistical analysis of length–diameter correlations. Results: The techniques show that the length of the nerves in the amputation stump can be preserved and integrated into the muscle masses with appropriate methods and biomaterials, which ensures the transmission of motor impulses to control the movements of a prosthesis. Fibrosis and mechanical injury have a lower risk of occurring with the nerves protected in the muscle mass. Through statistical analysis we find that sciatic nerve length and diameter have a positive correlation (r = 0.71, p = 0.003), supporting anatomic plausibility for human extrapolation of results. Conclusions: The amputation technique preserves much of the nerve length and viability and is simple to perform. Neural electrode implantation can be facilitated by folding the nerve within a large muscle mass and using biomaterial conduits. Better rehabilitation of the patient may occur with the use of a prosthesis equipped with more functions and superior control.

Background: Achieving orthogonal coronal-plane alignment in total ankle arthroplasty (TAA) remains challenging in cases with severe varus deformity. We developed a novel tibial precutting technique for use in transfibular TAA to resolve intra-articular bony conflict and enable accurate implant placement without excessive medial soft tissue release. Methods: This technique involves a controlled resection of the lateral distal tibia to eliminate impingement between the tibial plafond and talar dome. From November 2019 to June 2022, 15 patients with coronal varus deformities >15° underwent transfibular TAA using this method. Twelve patients with ≥2 years of follow-up were retrospectively evaluated. Coronal alignment was assessed using the tibiotalar angle (TTA) on weight-bearing radiographs. Clinical outcomes were measured using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and ankle range of motion (ROM) before surgery and at final follow-up. Results: The median TTA significantly improved from 20.4° (IQR: 18.1–24.3) preoperatively to 1.8° (IQR: 0.9–3.6) at the latest follow-up (p < 0.01), indicating successful correction to neutral alignment. All SAFE-Q subscales showed statistically significant improvement (p < 0.05), and ankle ROM also increased significantly postoperatively (p < 0.05). No cases of talar subsidence, implant lucency, fibular non-union, or avascular necrosis were observed. Conclusions: These results indicate that the TIBIA #2 technique can broaden the indications for transfibular total ankle arthroplasty in severe varus deformity while delivering meaningful clinical benefit. Nevertheless, confirmation in larger, controlled, and multi-centre cohorts is required before widespread adoption.

Introduction: Hemifacial hypoplasia is the second most common congenital craniofacial anomaly after cleft lip and palate. Mandibular ramus deficiency represents a key component of this condition, and vertical augmentation is traditionally managed with distraction osteogenesis. However, technical challenges related to device positioning and vector control continue to limit its reproducibility. This study aims to describe and compare three surgical techniques for mandibular ramus augmentation in hemifacial microsomia and to develop a surgical treatment algorithm based on individual anatomical characteristics and clinical complexity. Materials and Methods: From 2010 to 2022, eighteen patients with Pruzansky–Kaban grade I–IIb hypoplasia underwent staged orthodontic–surgical treatment at our institutions. The standard protocol included initial ramus vertical augmentation followed by bimaxillary osteotomy for asymmetry correction. The patients were equally divided into three groups of six patients each, based on the surgical technique employed. Three representative cases were selected to illustrate the evolution of our approach: (1) bidirectional distraction following a full-thickness osteotomy above the lingula; (2) unidirectional distraction applied to a sagittal ramus osteotomy according to Obwegeser; and (3) direct vertical augmentation with rigid fixation after sagittal osteotomy, supported by virtual surgical planning. Results: Vertical ramus augmentation of 15–25 mm was achieved in all cases. The first technique proved effective but technically demanding. The second approach improved vector control and device stability. The third, involving direct vertical augmentation with rigid fixation, simplified the procedure, reduced costs, and maintained bony contact for stable healing. Conclusions: Sagittal ramus osteotomy with direct stabilization represents a promising alternative to traditional distraction in selected patients, combining historical surgical principles with computer-assisted planning to achieve reproducible outcomes.