Adequate Healing Research Articles

Tratamento de pigmentações melânicas com instrumentos rotatórios e lâmina de bisturi Treatment of melanic pigmentations with rotary instruments and scalpel blade

Introduction: Oral pigmentary lesions may have different clinical characteristics, ranging from physiological pigmentation, such as melanin spots, to something more serious, such as malignant melanoma. Due to the great variety of pigmented lesions, the treatments are varied and individualized. Objective: This clinical case reports a case of melanocytic removal through a surgical technique that associates rotary instruments and scalpel blade. Case report: A 45-year-old patient, melanoderma, sought care at the Positivo University, complaining about the dark spots visible on his gum, and the discomfort they caused him when smiling. After the clinical examination, the presence of melanocytic pigmentation was diagnosed and the proposed treatment was surgical removal of spots with a drill and scalpel blade. In the immediate postoperative period, the patient presented good healing and reported only mild burning in the first three days. After 60 days, the gingiva was healed, with no relapsing spots. Conclusion: The technique chosen was effective because it presented adequate healing and absence of relapse of the pigmentation in the postoperative follow-up

Intestinal resection of a porcine model under thermographic monitoring

Objective: Surgical resection of a part of the intestine is a standard procedure in gastrointestinal surgery and in order to perform this type of surgery successfully, tissue blood flow must be evaluated clearly. There exists a theoretical indication that it would be possible to use infrared thermography (IRT) for this purpose. Therefore, the main objective of the study is the qualitative evaluation of the infrared thermography method as an ancillary method for determining the resection lines and forming an optimal intestinal anastomosis on the porcine model. Approach: Blood circulation rate has a close relationship with temperature difference and is also very important for identifying the resection lines on the bowel, the formation of anastomoses, and, subsequently, their adequate healing. Therefore, IRT could be helpful in determining the nonvascular part of the intestine. In order to make a qualitative evaluation of this method, the study also focuses on a comparison of IRT with the contrasting indocyanine green (ICG) imaging method, which is commonly used. Main results: The comparison of two independent imaging methods (IRT and ICG) revealed similar, but not identical, results. Subjective evaluation of the anastomosis performed by the team of three surgeons was more in agreement with the area detected by contactless thermography imaging. Moreover, the proceeding ‘dynamic temperature return test’, when the particular intestinal part was cooled and its subsequent temperature return was measured, revealed significant results. The time taken to return to the original intestinal temperature was greater for the devascular part of the intestine. Significance: A thermographic examination could help to detect the correct location of the intestine resection line for further/continuing anastomosis creation.

An Objective and Subjective Evaluation of Dental Implant Impressions using Vinylsiloxanether and Polyether Impression Materials−An in Vivo Study

Purpose: This invivo study was planned to subjectively and objectively evaluate dental implant impressions using Vinyl Siloxanether& Polyether impression materials. Method: Two master impression were made for each of the 20 subject, with Vinyl Siloxanether ‘ID’ and Polyether ‘IM’ using the closed tray impression technique after adequate healing. These were subjectively and objectively evaluated using preset standardised criteria. The results were statistically analyzed for noninferiority of ‘IM’ and ‘ID’ by using the Chi – Sqaure test and Fisher’s exact test for the subjective evaluation and for objective evaluation Analysis of Variance (one way ANOVA) was used. Results: On the basis of the subjective assessment of the two impressions ID showed superior ratings in terms of taste (p=0.19) as evaluated by the patient, tear resistance upon removal from mouth (p=0.018) and tear resistance upon removal from stone cast (p=0.046) as evaluated by the operator. However , in terms of clinical handling, hydrophilic properties (p=0.376) and total setting time( 0.147) there was no statistical difference between ID and IM impression materials. On the basis of objective evaluation of the two impression materials, vinyl siloxaneether appears to be a good alternative to polyether in terms of transfer accuracy from oral to model situation with respect to dental implants as there was no statistical difference between the two groups. Conclusion: Vinylsiloxanether which is a chemical combination of polyether and vinylpolysiloxane has superior mechanical and hydrophilic properties while achieving its final hardness, thereby providing accurate implant impressions for the fabrication of successful implant prosthetic restorations

Case report: Unusual complications of severe hidradenitis suppurativa

Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic follicular occlusive disease that affects the folliculopilosebaceous unit, mainly, but not exclusively, in intertriginous axillary, groin, perianal, perineal, genital and inframammary skin. The clinical course is highly variable. The disease is difficult to treat, and has a severe impact on quality of life. An 18-year-old female was diagnosed with bilateral axillary HS/AI in 2014. She was a known smoker, with a body mass index of 21, no known comorbidities and retroviral-disease negative. She presented in 2017 with advanced Hurley stage III disease, with extensive painful open wounds and purulent material draining. The patient also had bilateral shoulder contractures with reduced abduction. She was clinically malnourished, anaemic and hypoalbuminaemic. Wound swabs showed a Pseudomonas infection. Wide local excision was performed of the diseased areas and skin grafted, and arm splints were designed to keep both arms in fixed abduction, to allow for adequate healing and wound care management. However, all grafts failed to take. We employed a multidisciplinary approach to manage this patient. Negative-pressure wound therapy was utilised to assist with wound management. The patient had developed a spontaneous pneumothorax owing to the severity of the disease, which eroded into the chest wall. This was managed conservatively with an intercostal drain. Despite all these efforts, the patient’s condition did not improve. She subsequently went into septic shock, and died in the intensive care unit. This case illustrates the fact that early diagnosis and management of HS/AI is essential. As the disease advances, it becomes increasingly difficult to manage, and requires a multidisciplinary treatment approach.

Polysaccharide-based film loaded with vitamin C and propolis: A promising device to accelerate diabetic wound healing

Wound healing can be a painful and time-consuming process in patients with diabetes mellitus. In light of this, the use of wound healing devices could help to accelerate this process. Here, cellulose-based films loaded with vitamin C (VitC) and/or propolis (Prop), two natural compounds with attractive properties were engineered. The starting materials and the cellulose-based films were characterized in detail. As assessed, vitamin C can be released from the Cel-PVA/VitC and Cel-PVA/VitC/Prop films in a controlled manner. In vitro antibacterial activity studies showed a reduction of bacteria counts (Escherichia coli and Staphylococcus aureus) after Cel-PVA/VitC, Cel-PVA/Prop, and Cel-PVA/VitC/Prop treatments. Moreover, we examined the antibacterial and wound healing properties of the cellulose-based films in a streptozotocin (STZ)-induced diabetic animal model. Diabetic mice exhibited impaired wound healing while the Cel-PVA/VitC/Prop treatment increased the wound closure. A marked reduction in bacterial counts present in the wound environment of diabetic mice was observed after Cel-PVA/VitC, Cel-PVA/Prop and Cel-PVA/VitC/Prop treatment. Histological analysis demonstrated that the non-treated diabetic mice group did not exhibit adequate wound healing while the treated group with Cel-PVA/VitC and Cel-PVA/VitC/Prop films presented good cicatricial response. Furthermore, these novel eco-friendly films may represent a new therapeutic approach to accelerate diabetic wound healing.

Healing capacity of bone marrow mesenchymal stem cells versus platelet-rich fibrin in tibial bone defects of albino rats: an in vivo study

Background: Various techniques for tissue engineering have been introduced to aid the regeneration of defective or lost bone tissue. The aim of this study was to compare the in vivo bone-forming potential of bone marrow mesenchymal stem cells (BM-MSCs) and platelet-rich fibrin (PRF) on induced bone defects in rats’ tibiae. Methods: In total, one defect of 3-mm diameter was created in each tibia of 36 Wistar male rats. There were two groups: group A, left tibia bone defects that received PRF; and group B, right tibia bone defects of the same animal that received BM-MSCs loaded on a chitosan scaffold. Subsequently, Scanning electron microscope/energy-dispersive X-ray (SEM/EDX) analyses was performed at 3 and 10 days, and 3 weeks post‑implantation and following euthanasia; (n=12). Results: The EDX analysis performed for each group and time point revealed a significant increase in the mean calcium and phosphorous weight percentage in the BM-MSC-treated group relative to the PRF-treated group at all-time intervals (P < 0.05). Moreover, the mean calcium and phosphorus weight percentage increased as time progressed since the surgical intervention in the PRF-treated and BM-MSCs groups (P < 0.05). Conclusions: In the present study, both BM-MSCs and PRF were capable of healing osseous defects induced in a rat tibial model. Yet, BM-MSCs promoted more adequate healing, with higher mean calcium and phosphorous weight percentages than PRF at all-time points, and showed greater integration into the surrounding tissues than PRF.

Abstract: Predictors of Adverse Outcomes in the Management of Mandibular Fractures: An Analysis of 953 Cases

PURPOSE: Mandibular fractures are the most common isolated facial fractures in the United States and often require surgical treatment with open reduction and internal fixation to prevent infection and promote adequate bone healing. Various clinical risk factors have been associated with increased rates of postoperative complications, including smoking, substance abuse, and surgical approach. However, national outcomes reports are limited, and data are conflicting. Using a national multi-institutional database, we sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation. METHODS: Retrospective review of the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015. Case distribution was based on available CPT codes and included open treatment of mandible fracture with external fixation (21454), open treatment of mandible fracture with and without interdental fixation (21462, 21461), and open treatment of complex fractures involving multiple approaches (21470). Preoperative demographic data and postoperative outcomes were analyzed. Primary outcomes included: wound complications (superficial surgical site infection (SSI), deep SSI, and wound dehiscence), overall complications (wound complications and/or medical complications), as well as 30-day readmission and reoperation rates. For risk factors significant on univariate analysis, multivariate analysis was performed to control for confounders. RESULTS: Review of the database identified 953 eligible patients who underwent surgical treatment of mandibular fractures. Mean age was 34.5 years and 84% of the cohort was male. Fifty percent of patients were active smokers. Wound complications occurred in 38 patients (4.0%) and the overall complication rate was 7.9%. The 30-day reoperation and readmission rates were 2.2% and 3.3%, respectively. Multivariate analysis demonstrated age to be a significant risk factor for 30-day readmission (OR = 1.06, p=0.01) and reoperation (OR = 1.05, p=0.01), as well as overall complications (OR = 1.03, p=0.02). Additionally, active smoking was a significant risk factor for 30-day reoperation (OR = 4.86, p=0.03). The odds of readmission for smokers was more than 3 times higher than non-smokers (OR=3.25; 95% CI 0.93–11.43); however, this approached but failed to reach our threshold for statistical significance (p=0.07). CONCLUSION: Our analysis demonstrates that surgical treatment of mandibular fractures can be performed safely and with low rates of wound and overall complications. However, increased age is an independent risk factor for readmission, reoperation, and overall complications. Active smoking was also found to be an independent risk factor for reoperation, with active smokers nearly five times as likely to undergo additional surgery. This is a particularly important finding given that over half of all mandibular fracture patients in our nationwide study were active tobacco users, highlighting the importance of patient education and smoking cessation in the perioperative period within this population.

Pierre Robin Sequence: Two Case Reports

Pierre Robin sequence was first described as a syndrome; however, it is currently recognized as a sequence that includes micrognathia, glossoptosis, and paroxysmal respiratory obstructions. Airway long-term treatment is necessary to avoid serious complications of this condition. Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in children with severe Pierre Robin sequence. The authors described 2 cases of new-born children diagnosed with severe Pierre Robin sequence, treated according to a fixed protocol, that is, following diagnosis, the children were taken to the surgical center for tracheofibroscopy and tracheostomy in cases of tongue impingement. Following general anesthesia, the patients were submitted to MDO using a 20 mm pediatric distractor, bilaterally. After 1 mm of distraction daily and adequate bone healing, distractors were removed and the airway evaluated. The patients showed an improvement of the airway, allowing tracheostomy removal. In conclusion, mandibular distraction is an effective procedure for Pierre Robin sequence.

Application of the "continuous suture dividing and equal suture tightening" method in video-assisted thoracoscopic surgery sleeve lobectomy.

The primary focus of video-assisted thoracoscopic surgery (VATS) sleeve lobectomy is bronchial anastomosis. Both interrupted suture and continuous suture cannot overcome entanglement of the suture threads. The present study used the "continuous suture dividing and equal suture tightening" method in VATS sleeve lobectomy for bronchial anastomosis and discussed the feasibility of this approach. A total of 17 patients underwent VATS sleeve lobectomy with bronchial anastomosis using the "continuous suture dividing and equal suture tightening" method. Four incisions were utilized in the operation as follows: (I) the pulmonary arteries and veins were cut-off using an endoscopic linear stapler. Systematic hilar and mediastinal lymph node dissection was performed; (II) the surgeon used a surgical knife for incision into the thoracic cavity and to cut the lung lobe and main bronchi. Intraoperative pathological analysis revealed negative bronchial margins; (III) the "continuous suture dividing and equal suture tightening" method was performed for anastomosis; (IV) the integrity of the anastomosis was assessed by intraoperative bronchoscopy. Computed tomography (CT), three-dimensional (3D) reconstruction and bronchoscopy assessed the anastomosis 1-week postoperatively. A follow-up was conducted using a 3-month bronchoscopy, and CT scans monitored the recurrence and stenosis of the anastomosis. The method was successfully completed for VATS sleeve lobectomy with bronchial anastomosis in 17 cases. Although various histological profiles were observed, the 1-week postoperative CT and bronchoscopy showed adequate healing of the anastomotic stoma as well as the absence of postoperative mortality and bronchial pleural fistula. All patients were alive and followed up for 31-49 months postoperatively; local recurrence and anastomotic stenosis were not detected. The continuous suture dividing and equal suture tightening method is convenient, feasible, and safe for bronchial anastomosis in VATS sleeve lobectomy. It can effectively avoid the entanglement of the suture threads, thereby enabling the widespread adoption of VATS sleeve lobectomy.

Type II Fractures in Older Adults: Can They Be Treated Conservatively?: A Single-Center Experience and Review of the Literature

Odontoid fractures are the most common acute cervical spinal fractures in the geriatric population. Their rate is increasing along with the rising age of the elderly population. Whereas conservative management with external immobilization is reported as the treatment of choice for type I and III odontoid fractures, there are no clear indications concerning the best treatment for type II fractures. In younger patients surgical management is considered the best choice, but in older adults the rate of good outcomes worsens and operative risk because of comorbidities increases. We report our retrospective single-center experience with conservative treatment of type II odontoid fractures in an elderly population, focusing on both radiologic and functional outcomes to compare our results with the recent literature. Among the 21 selected subjects with a minimum follow-up of 18 months, 19 (90.5%) showed a satisfactory clinical outcome, with an adequate bony healing in 10 cases and nonsymptomatic pseudarthrosis in 9 patients. All these patients were satisfied with the conservative results and could stop use of the collar. Two patients (9.5%) did not show any improvement and had to keep the collar indefinitely. Our study was limited because it was a retrospective review, with a limited number of patients. Nevertheless, the clinical and radiologic outcomes of our patients differ from the results of other studies, suggesting that conservative management of these fractures in this population does not necessarily lead to a bad clinical outcome or delayed surgery.

All Soft-suture Anchor versus Suture Bridge Construct for Insertional Achilles

Category: Ankle Introduction/Purpose: New techniques and anchors have been developed for the surgical treatment of insertional Achilles tendinopathy and rupture to allow for earlier return to postoperative weight bearing and accelerated rehabilitation. Two recently introduced soft tissue-to-bone anchor technology have purported advantages for insertional Achilles repairs. Knotless suture anchors allow suture tension to be precisely controlled with a ratcheting mechanism. The other is a suture bridge construct fastened with biotenodesis screws, increasing the soft tissue footprint and reducing the risk of suture pullout through the tendon. However, neither technology has been studied in a biomechanical model of Achilles tendon repair. We hypothesized that there would be no difference in the biomechanical characteristics of a single-row all-suture anchor repair to a double-row repair with knotless anchors and suture tape. Methods: Six matched-pairs of fresh-frozen lower leg cadaveric specimens (12 total) were obtained. All tendons were completely detached from their calcaneal insertions and tendon thickness was measured. Calcaneal exostectomies were performed (e.g., Haglunds removal) above the Achilles insertion. Group 1 was repaired with a single-row construct with two all-soft anchors. Group 2 was repaired with a double-row suture bridge construct with two knotless anchors distally and two suture tape anchors proximally. The repaired specimens were cyclically loaded from 10N to 100N at 1 Hz for 2,000 cycles then to failure at 1mm/sec. A motion capture system measured Achilles-calcaneal displacement at the medial and lateral anchors. Paired t-tests and linear mixed models (LMMs) were used to analyze the following outcomes: clinical failure load, ultimate failure load, Achilles-calcaneal medial and lateral displacement, distance at ultimate failure load, tendon thickness, footprint, and mode of failure. A p-value of &lt;0.05 was considered statistically significant. Results: Group 2 showed significantly less Achilles-calcaneal overall medial and lateral displacement, 19.5% and 36.9% respectively (Table 1). Group 2 showed a statistical trend toward greater clinical and ultimate failure load, 23.8% and 34.2%, respectively (Table1). LMM analyses showed that a suture bridge repair over all-soft anchor repair was independently associated with a 50.24N increase in the load to clinical failure (p=0.0011). Higher clinical failure loads were associated with higher BMI (p&lt;0.0001), thinner tendons (p&lt;0.0001), and smaller tendon footprints on the calcaneus (p=0.0013). Higher absolute failure loads were associated with older age (p&lt;0.0001), higher BMI (p&lt;0.0001), thinner tendons (p=0.0028), and larger footprints (p&lt;0.0001). Conclusion: These data suggest a trend toward higher clinical and ultimate failure loads in a suture bridge construct compared to all-soft suture anchors for insertional Achilles repair. Loads to failure in both groups were higher than previously reported pull-out strengths for most suture anchors (150-300 N), but are lower than typical loads at the Achilles insertion during walking activities. The use of the suture bridge repair method may result in superior loads to failure compared to all-soft anchors. Patient age, BMI and tendon thickness impact failure loads. Adequate healing should be allowed followed repair of complete Achilles detachment.

Efficacy of vancomycin impregnated deep freeze irradiated allogenic bone graft in osteoreconstructive surgery

Aim of study was to use the allogenic bone graft with or without vancimpregnation in osteoreconstrutive surgery and compare the results with respect to: • Efficacy and safety in prevention of graft related and surgical site infection. • Effect on bone healing and osteointegration. Materials & Methods: In our study a total of 30 patients who required allogenic bone grafting for varied indications and gave informed consent for participation in the study were included. Patients with active osteoarticular infection at the proposed surgical site and with any medical contraindication to the use of vancomycin were excluded from the study. Broadly three indications for which allogenic bone graft was used included fractures, benign osteolytic lesions and miscellaneous indications which included allograft use for lumbar spinal fusion and for augmenting acetabular reconstruction. Observation & Result Infection: An overall infection rate of 3.3% (1 out of 30 cases) was found in this study which is much lower than what is mentioned in the literature as infection rates ranging from 4-12% have been reported by different workers Osteointegration: The overall success rate in terms of adequate osteointegration in our study was 83.33% (5 failure cases out of 30) with 12 cases (80%) out of 15 in study group and 13 cases (86.7%) out of 15 achieving adequate osteointegration and there was no significant difference (p value=1) between the two groups. Bone Healing: Fractures: In cases of fractures a good overall union rate of 88.8% was obtained with 16 out of 18 patients achieving adequate union. The two failure cases brought down the union rate to about 77.7% in the study group as compared to 100% union rate in the control group but this difference was not statistically significant with p value of 0.384 Thus vancomycin impregnation was not found to affect fracture union in our study. Benign bone lesion: A total of eight patients (3 each of SBC and GCT and 2 of ABC) were included. After random allocation five patients (2 each of SBC and GCT and 1 of ABC) came under the study group and three patients (1 patient each of SBC, GCT and ABC) under control group. The mean age of patients in the study group and control groups was 25.2 years and 34.1 years respectively and thus were comparable. There was no significant difference in terms of lesion healing between the two groups (p value= 0.684) as all the eight patients (100%) showed adequate healing as defined by Neer’s classification [1].

Association of Rush Pin and Intramedular Pin Techniques for the Stabilization of Salter Harris Type I Fracture in Rabbit (Oryctolagus cuniculus)

Background: In domestic rabbits, fractures are usually the result of household accidents. Fractures of the distal femoral physis are frequently observed in animals with immature skeletons and may cause future orthopedic problems. With this type of fracture, early reduction and stabilization are necessary to prevent additional damage to the physis and to preserve the growth potential of the bone. This report aims to describe the clinical and radiographic findings, as well as the surgical method used that combined Rush pins with an intramedullary pin, associated with a Salter Harris type I fracture of the right distal femur in a rabbit.Case: A 4-month male domestic rabbit (Oryctolagus cuniculus) weighing 1.2 kg, was referred to the Veterinary Hospital with a right pelvic limb lameness after an episode of trauma. Orthopedic examination revealed swelling, instability, crepitation, and increased pain sensitivity in the distal aspect of the right femur. Following physical and radiographic examination,a Salter Harris type I fracture of the right distal femur was diagnosed. The patient was premedicated with a combination of xylazine (2 mg/kg IM) and ketamine (10 mg/kg IM), which allowed placement of an IV catheter for the administration of fluids and intubation using an endotracheal tube with an internal diameter of 2 mm. Anesthesia was maintained with isoflurane, and an epidural was performed with a combination of lidocaine (2 mg/kg) and bupivacaine (0.75 mg/kg). Osteosynthesis was performed with two Rush pins and an intramedullary pin. Radiographic examination 110 and 330 days after the surgical procedure showed good alignment of the bone and adequate healing of the fracture. The combination of techniques used in this case report proved to be effective, resulting in functional recovery of the limb and rapid bone healing.Discussion: Preoperative planning for orthopedic surgery in rabbits is different from that of dogs and cats, due to the particularities of the species. Familiarity with the regional anatomy, patient preparation, and appropriate instrumentation are necessary when contemplating osteosynthesis in a rabbit. Salter Harris fractures affect young animals, where the physis is considered an area of fragility in the bone. Surgical planning should take into account the function of the growth plates.It is recommended that implants passing through the physis do so perpendicularly, since angulation greater than 45° may predispose the bone to premature closure of the growth plate. Another important consideration involves the choice of implants, since the use of trocar-tipped pins facilitates their precise placement in the bone. The use of threaded pins should be avoided due to their weakness at the thread-shaft interface, and the risk of impaired longitudinal bone growth and thedifficulty of removal if necessary. Steinman pins and Kirschner wires can be used to stabilize a variety of different fractures. In Salter-Harris type I and II fractures, the use of pins neutralizes bending forces but not rotational or compressive forces. In contrast, Rush pinning and cross-pinning techniques are effective in neutralizing the forces acting on the physis, and are frequently used for the fixation of fractures in this region. Complications, often associated with poor reduction and alignment, can result in varus or valgus deviation and are associated with a high risk of implant failure or migration, malunion, and patellar luxation. It was concluded that the combination of Rush pins and an intramedullary pin resulted in adequate stabilization of the Salter Harris type I fracture of the distal femur in this rabbit.Keywords: Orthopedic implants, osteosynthesis, trauma, bone repairing, lagomorph.

Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft.

Background Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity. Purpose The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm. Patients and Methods Patients with proximal pole scaphoid fragments comprising less than 20% of the entire scaphoid were included. Fixation was accomplished from a dorsal approach with a micro headless compression screw and distal radius bone graft. Six patients were included. Average follow-up was 44 months (range, 11-92). Results Mean proximal pole fragment size was 14% (range, 9-18%) of the entire scaphoid. The mean immobilization time was 6 weeks, time-to-union of 6 weeks, and final flexion/extension arc of 88°/87°. All patients had a successful union, and no patient had deterioration in range of motion, avascular necrosis, or fragmentation of the proximal pole. Conclusion Small diameter screws with a maximal thread diameter of ≤ 2.8 mm can be used to fix the union of proximal pole acute scaphoid fractures comprising less than 20% of the total area with good success. Level of Evidence Therapeutic case series, Level IV.

Systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing.

Adipose-derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects due to the pro-angiogenic and anti-inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm2 . Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.

Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle.

Background:Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb.Patients and Methods:After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up.Results:There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient.Conclusions:Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

Ultrasound-Mediated Gene Delivery Enhances Tendon Allograft Integration in Mini-Pig Ligament Reconstruction.

Ligament injuries occur frequently, substantially hindering routine daily activities and sports participation in patients. Surgical reconstruction using autogenous or allogeneic tissues is the gold standard treatment for ligament injuries. Although surgeons routinely perform ligament reconstructions, the integrity of these reconstructions largely depends on adequate biological healing of the interface between theligament graft and the bone. We hypothesized that localized ultrasound-mediated, microbubble-enhanced therapeutic gene delivery to endogenous stem cells would lead to significantly improved ligament graft integration. To test this hypothesis, an anterior cruciate ligament reconstruction procedure was performed in Yucatan mini-pigs. A collagen scaffold was implanted in the reconstruction sites to facilitate recruitment of endogenous mesenchymal stem cells. Ultrasound-mediated reporter gene delivery successfully transfected 40% of cells recruited to the reconstruction sites. When BMP-6 encoding DNA was delivered, BMP-6 expression in the reconstruction sites was significantly enhanced. Micro-computed tomography and biomechanical analyses showed that ultrasound-mediated BMP-6 gene delivery led to significantly enhanced osteointegration in all animals 8weeks after surgery. Collectively, these findings demonstrate that ultrasound-mediated gene delivery to endogenous mesenchymal progenitor cells can effectively improve ligament reconstruction in large animals, thereby addressing a major unmet orthopedic need and offering new possibilities for translation to the clinical setting.

Evaluating strategies and outcomes following rotator cuff tears.

Rotator cuff tear surgical repair techniques have significantly progressed. However, tendon retear following primary repair persistently occurs at high rates. Rehabilitation protocols, surgical fixation techniques, biologic therapy with scaffolds, platelet-rich plasma, and even stem cell applications are under study to promote adequate tendon healing. A nonsystematic query of the PubMed database was conducted in July 2016 utilizing the search terms "rotator cuff repair," "tear," "rehabilitation," "scaffold," "platelet-rich plasma," and "stem cell" to identify, analyze, and summarize relevant studies. Individualized rehabilitation protocols may be the best approach for small to medium sized tears. Surgical fixation will continue to be debated as modifications to single-row technique and increases in suture number have improved tensile strength. Double-row repairs have been associated with higher costs. Transosseous equivalent technique exhibits comparable subjective and objective outcomes to single- and double-row repair at two-year follow-up. Biocompatible scaffold augmentation has showed inconsistent short-term results. Platelet-rich plasma has lacked uniformity in treatment preparation, administration, and outcome measurement with mixed results. Few human studies have suggested decreased retear rates and improved repair maintenance following bone marrow-derived mesenchymal stem cell augmentation. This review reiterated the necessity of additional high-quality, large-sample studies to develop any final verdict regarding efficacy.

Calcium silicate-poly(n-butyl-2-cyanoacrylate) nanocomposite for bone tissue adhesion

Abstract Calcium silicate–poly(n-butyl-2-cyanoacrylate) nanocomposite has been studied as a promising biomaterial to immobilize small bone fragments in order to achieve adequate fracture healing. The aim of this work was to investigate the in-vitro and in-vivo biocompatibility of the synthetic nanocomposite produced. The samples were characterized by means of infrared spectroscopy, thermogravimetric analysis, scanning and transmission electron microscopy. Bioactivity, degradability, cytotoxicity and implantation tests were performed. Experimental results showed the degradability of the nanocomposite, no cytotoxicity and a significant apatite nucleation and growth on the material surfaces after seven days of immersion in simulated body fluid. The new bone formation observed on the surface of the nanocomposite implanted in vivo is an indicator of its biocompatibility.

A study of efficacy of locking versus dynamic compression plates for diaphyseal forearm fractures

Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs 1, 4. Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation. 2, 3 various treatment modalities were introduced from time to time and each of them had some edge over the previous one. The forearm represents the critical anatomic unit of upper limb, permitting the effector organ of the upper limb, the hand, to perform multiaxial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional outcome, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. 3, 5, 7 The number of forearm fractures is increasing faster than the predicted rate due to increasing number of road traffic accidents, increased incidence of violence, rapid industrialization, and various sports activities. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome 4, 6, 7. compression techniques have a lower incidence of non-union and are found to hasten rehabilitation, with less joint stiffness.the various modalities of plating have developed each has edge over the other. there are very less studies on indian population this study has taken up to analyse the outcome between two most commonly used plates in forearm shaft fracture treatment i.e DCP (dynamic compression plate) and LCP (locking compression plate). Aims and Objectives of The Study: 1) To study and compare the functional and radiological outcome after surgical intervention by using and open reduction and internal fixation with dynamic compression plating vs locking compression plate in the treatment of closed diaphyseal fractures of forearm. 2) To study and compare the complications associated with these two modalities of the treatment. Materials And Methods: About 60 patients with both bone forearm fractures treated with LCP or DCP in RLJ hospital attached to Sri Devaraj Urs Medical College between maech 2013 to june 2017, will be taken up for the study after obtaining the informed consent. This is a retrospective study with follow up period of 6 months minimum. The functional outcome was assesed according to Anderson scoring system which included evaluation of the movements and the radiological union. Conclusions: Statistically, both LCP and DCP have similar outcomes in the treatment of diaphyseal fractures of both bones forearm. Whereas, LCP group had a faster recovery as compared to DCP group. Thus, we conclude that both LCP and DCP have similar results for the diaphyseal fractures.