Percutaneous repair is an attractive alternative to open and closed repair of the heel cord. 2 • 4 • 5 This report is intended to make orthopaedic operating surgeons aware of the potential for rerupture and injury to the sural nerve. MATERIALS AND METHODSThe six patients in this study were treated by one surgeon with the Ma and Griffith 5 original surgical technique and postoperative method. The operation was done on day 1 to four patients, and on days 7 and 20 to the remainder.The average postoperative immobilization period was 57.8 days (range 55-63 days). Two of the patients also wore limited ankle dorsiflexion shoes (of 0°) for 2 extra months. RESULTSThere was one immediate postoperative complication. The last patient showed a related pain and anesthesia in the sural nerve zone.Initially, he was treated conservatively, but his pain increased. Fourteen days later, the sural nerve was examined. It has been tied against the Achilles aponeurosis with a nylon suture at the central point of the three lateral incisions (Fig. 1). The suture was cut, the nerve was freed, and the suture was re-tied. Twelve months later, the patient was pain free and his calf was strong, but he did have some numbness in the zone.There were two cases of reruptures 92 and 102 days, respectively, after suturing had been completed.

Background: The purpose of this study was to determine whether the aesthetic results of subpectoral augmentation mammaplasty using anatomically shaped versus round prostheses are differentiable. Methods: Thirty observers (i.e., plastic surgeons and nurses) assessed preoperative and postoperative photographs (frontal and oblique views) of 30 patients who had undergone subpectoral augmentation mammaplasty with cohesive silicone gel implants, with an average implant volume of 295 cc (range, 220 to 340 cc). The observers classified each case as round or shaped on two different occasions with a 12-week time interval. A statistical concordance analysis was performed, calculating the overall concordance rate, the interobserver, the intraobserver, and the overall intraobserver kappa indexes, to evaluate the expert observers’ capacity to differentiate the implant type. Results: Among the total of 1800 observations (30 observers assessed 30 cases on two occasions), the overall concordance rate was 50.33 percent (95 percent CI, 47.99 to 52.67). The interobserver kappa value was 0.010 (95 percent CI, 0.0025 to 0.04). The overall intraobserver kappa value was 0.0602 (95 percent CI, 0.0025 to 0.123). The observers were unable to recognize the type of implant used, nor was interobserver concordance noted. An agreement was not reached before the different observers, nor was an intraobserver concordance seen between the first and second classifications of the same cases by each observer. Conclusion: The results obtained from subpectoral augmentation mammaplasty using anatomically shaped and round prostheses with a volume of 340 cc or less are indistinguishable, not justifying the systematic use of anatomically shaped implants in this patient. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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