Advancement Flap Research Articles

Role of Laser Ablation of Fistula Tract in High Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Aim of the Work To assess and evaluate the efficacy and safety of LASER ablation of high perianal fistula. Patients and Methods This study is a randomized prospective study which will be conducted at Ain Shams University hospitals recruiting (20) patients and will be operated upon between January 2021 and July 2021 with minimal follow up to 3 months postoperatively. Results From these studies, it emerges that this procedure has some advantages. It doesn’t affect continence, administers controlled hyperthermic effect to the tissues, has a short learning-curve and reduces postoperative hospital stay as compared to endorectal advancement flap or LIFT. However, it has also some drawbacks. It is a blind procedure, as it’s not possible a direct visualization of the fistula tract or any secondary tracts and this may lead to recurrence. It requires expensive equipment, particularly if compared to other sphincter-saving techniques. Conclusion LASER ablation is a technique that has a promising results regarding complex perianal fistula preserving anal continence and short healing period and low recurrence rate as regarding classic and other techniques.

Compartive Study between Conventional Laying-Open Technique with Sphincter Repair and Ligation of Intersphincteric Fistula Tract (LIFT) in Treatment of High Trans-Sphincteric Perianal Fistula

Abstract Background Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. A fistulotomy lays open the fistulous tract, thus leaving smaller unepithelized wounds, which hastens the wound healing. Until now, fistulotomy is still the most widely used. But, the high cure rate is limited by the fact that laying open a transsphincteric fistula tract and cutting both the internal and the external sphincter has the risk of fecal incontinence ranging up to 40%. Objective To retrospectively evaluate the success rate, the recurrence and incontinence when using the Conventional laying-open and sphincter Repair technique in comparison to Ligation of Intersphincteric Fistula Tract (LIFT) for treating high trans-shpincteric perianal fistula. Patients and Methods This was a cohort retrospective, comparative study that was conducted on cases of fistula in the anus, who were subjected to surgery in Ain Shams University Hospitals and Ain shams specialized hospitals in the period from October 2021 to March 2022 (at least 30 cases) to evaluate the success rate, the recurrence rate, and incontinence rate when using the conventional laying open with sphincter repair technique compared to ligation of inter-sphincteric fistula tract (LIFT) For High trans-sphincteric perianal fistula. Results Regarding Relation of recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation and complications. that there was no statistically significant relation found recurrence with demographic data of the studied patients, de novo/recurrent, Wexner score before and after operation while there was statistically significant relation found with complications. Conclusion LIFT procedure is an effective and preferred sphincter-saving technique for fistula-inano with shorter healing time and lower incidence of postoperative anal incontinence, but have higher incidence of recurrence as compared to conventional layopen with sphincter repair which have a lower incidence of recurrence but have a relatively longer Healing time and higher incidence of postoperative anal incontinence. Both techniques are effective, have post operative good results and safe in treatment of high transsphincteric perianal fistula but Further research work is still warranted to confirm the long term outcome of these 2 techniques with a larger sample size and a longer follow up period. To know which technique is superior over the other.

Rhinoplasty with Concurrent Repair of Septal Perforation.

Concurrently performing septal perforation repair and rhinoplasty is challenging. Successful management of patients who require or desire these procedures performed simultaneously can be achieved with appropriate preoperative workup and optimization, thoughtful surgical planning, masterful execution, and diligent postoperative care. Consideration of perforation etiology and status of the perforation along with overall nasal health are the foundation upon which surgery may be planned. Preoperative evaluation to determine locations of obstruction, aesthetic goals, and feasibility of procedure is required. Rhinoplasty techniques and perforation closure techniques may share common maneuvers making concurrent surgery possible. Surgical techniques to achieve perforation closure often influence rhinoplasty considerations, and vice versa. Care must be taken to account and possibly even to capitalize on these influences. Perforation closure techniques that may be readily combined with rhinoplasty include interposition grafting and intranasal mucosal rotational advancement flaps, which may exert forces upon the nose with aesthetic or functional consequences. Rhinoplasty techniques targeting any third of the nose also can impact tension or available mucosa for perforation closure techniques. Combining these procedures can be very rewarding for the patient and provider but should be considered responsibly and thoughtfully.

The Superficial Circumflex Iliac Artery Perforator Flap for Devastating Hand Injuries in the Obese.

Blast injuries to the hand, such as those from fireworks, are debilitating and life altering. Often, because of the nature of the injury, there is a need for soft tissue and skin coverage. However, in the increasingly obese American population, free flaps often are too bulky for functional hand coverage. In this study, we present a series of 7 patients who underwent the superficial circumflex iliac artery perforator (SCIP) flap for upper extremity reconstruction with improvement in cosmesis, including a primarily repaired donor site, as well as an overwhelmingly high return to work with minimal revision surgery necessary. All patients who underwent a SCIP for hand injuries from a blast were included. Flaps were harvested based on previously described methods. A single attending surgeon performed all surgeries. All patients were followed for at least 6 months. Preoperative and postoperative characteristics were described. A total of 7 patients were included in this study. Ages ranged from 16 to 58 years and body mass index from 19 to 48 kg/m2. More than half of the patients had a body mass index greater than 30 kg/m2. All donor sites were primarily closed. Five patients returned to their preinjury work. Three patients had neurotized flaps with return of protective sensation. Three patients required revision surgery; all 3 had liposuction, and 1 had additional flap advancement surgery. The SCIP flap is a versatile flap that can be used in hand reconstruction in blast injuries with good functional outcome and improved cosmesis compared with other perforator flaps for the upper extremity.

Simplifying Forehead and Temple Reconstruction: A Narrative Review.

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal-temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow's triangle is also an excellent option for reconstructing tumors in the temporal area.

Aesthetic outcome comparison between Millard and Fisher technique for cleft lip surgery: a literature review

Background: Cleft lip is the most common congenital defect found in children, with a prevalence of 0.5 to 1.6 per 1000 live births. Besides causing functional problems, a cleft lip greatly affects the patient's aesthetic appearance. Therefore, several surgical techniques have been developed to produce a good clinical appearance to support the patient's social functioning. The Millard and Fisher technique is the most widely used cleft lip surgery (cheiloplasty) technique. This literature review aims to compare the aesthetic outcomes between the Millard and Fisher techniques in cleft lip surgery. Methods: This literature review was carried out by searching studies in online databases in the form of PubMed, the Cochrane Library, and Google Scholar using the keywords "cleft lip surgery," "Millard," "Fisher," "aesthetic outcome," and "comparison." Appropriate studies were then carried out through a narrative synthesis analysis. Discussion: The Millard technique uses the principle of rotational and advancement flaps, performed by making incisions and flaps on two sides, namely a rotational flap on the medial lip and an advancement flap on the lateral lip. Meanwhile, the Fisher technique uses the principle of anatomical subunit approximation, in which the measurement of the boundaries and extent of the surgical procedure is very accurate, resulting in a more anatomical position of the scar tissue. Regarding surgical scars, nose symmetry, vermillion, Cupid's bow and nasal, and Steffensen grading, better aesthetic results were found in Fisher's technique compared to Millard's. Conclusion: Fisher's technique provides superior aesthetic results compared to Millard's technique in cleft lip surgery.

Favorable Safety Outcomes of Delayed Primary Closure of Large Fournier’s Gangrene Skin Defects

To assess the feasibility and safety of delayed primary closure (DPC) in Fournier's gangrene (FG) patients with large genital defects. A single institution retrospective review was performed from October 2020 to December 2022 of adult males that underwent DPC for FG. All patients underwent standard medical management and were assessed for DPC eligibility by the urology service. Clinical data on patient factors and outcomes were collected, and descriptive statistics were assessed. Of 16 patients that underwent DPC, the average age was 61.1years and body mass index was 34.6kg/m2. Median Charlson Comorbidity Index was 3.5 (IQR 2-5.3) and Fournier's Gangrene Severity Index was 6.5 (IQR 4.8-8). Median number of debridements was 2.5 (IQR 2-3), with a time to closure of 6.5days (IQR 3-11) and length of stay of 13days (IQR 9-16.3). Mean genital defect size was 119cm2 (range 44-346cm2). Eight patients (50%) were closed using scrotal flaps alone while other patients had advancement flaps using the inner thigh, lower abdomen, and perineum. The majority of patients were discharged home directly (63%). There were four Clavien-Dindo III complications: two partial flap necrosis, one wound dehiscence, and one instance of bleeding. Of patients with follow-up, 6/15 (40.0%) had no known complications. DPC is safe and effective for a range of patients presenting with FG. Patients with large defects may benefit from less complex wound management and direct discharge home.

Commentary on: "Septal Advancement Flap" by Ferriera: Caudal Septal Extension Graft, Columellar Strut, or the New Septal Advancement Flap.

The septal advancement flap is introduced as a new technique to support the nasal base in preservation rhinoplasty. The SAF is a septal flap composed of the caudal septum in continuity with the high strip incision used in dorsal preservation. The technique is supported with a strut of cartilage between the medial crura. The SAF has been evaluated using mathematical models and a finite element mesh to verify the stability of the graft. The SAF is compared with the caudal septal extension graft and columellar strut and discussed in the context of all three options for stabilizing the base of the nose in rhinoplasty. The pros and cons of each as well as details about refinements of the caudal septal extension graft are discussed.

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis.

This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group's secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group's [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

Application of a jigsaw puzzle flap based on free-style perforator to repair large scalp defects after tumor resection: A case series

BackgroundReconstruction of large scalp defects after tumor resection is common and challenging. Free skin grafting or free flap transfer is always performed. However, these techniques can result in poor functional and cosmetic outcomes. MethodsIn the Second Affiliated Hospital of Soochow University and the Second Affiliated Hospital of Chengdu Medical College, 35 patients underwent jigsaw puzzle flap procedures based on a free-style perforator to repair large scalp defects after tumor resection from May 2013 to November 2022. The key to this procedure was to divide a large defect into several smaller parts that correspond to adjacent free-style perforators around the scalp defect. The free-style perforator flaps were designed in different ways, such as propeller flaps, rotation flaps, and V-Y advancement flaps, which were pedicled with free-style perforators. All of the small flaps were then mobilized to the defect and sutured to each other to create a new, large jigsaw puzzle-like flap to cover the large scalp defect. Finally, all the donor sites were closed directly. ResultsOverall, 35 patients were treated. The average defect size was 72 ​cm2 (range, 25–91 ​cm2). All flaps had a satisfactory appearance after follow-up periods of 6 months–10 years. Local tumor recurrence occurred in one case. ConclusionThe application of a jigsaw puzzle flap based on a free-style perforator is a suitable option for the reconstruction of large scalp defects after resection, yielding satisfactory functional and cosmetic results.

Fingertip coverage with uni-pedicled volar rotational advancement flap with large Z-plasty: a report on 112 cases

BackgroundSimple and safe fingertip reconstruction methods involve the use of local neurovascular islands flaps that can preserve functional length and sensitivity, and reconstruction with skin of the same texture. However, techniques involving flaps have numerous drawbacks and do not satisfy all the requirements for fingertip reconstruction. A particular problem is the persistence of contracture deformity due to lack of full flap advancement. We present a new technique using uni-pedicled volar rotational advancement flap with large Z-plasty, and describe the results of long-term follow-up.MethodsFrom October 1993 to December 2009, 112 fingers of 98 patients were covered with uni-pedicled volar rotational advancement flap with large Z-plasty after sustaining various types of injuries or finger pulp avulsion. A longitudinal incision was made along the lateral border of the digit and a large neurovascular volar flap was elevated just above the pulleys and flexor tendon sheath. To release tension, a large Z-plasty was applied at the metacarpophalangeal joint or interphalangeal joint crease. The final patient outcomes were reviewed retrospectively.ResultsAll fingertip injuries were treated without flap necrosis. Partial wound dehiscence was observed in two patients and average static two-point discrimination was 5.2 mm. There were no postoperative contracture deformities, joint stiffness, paresthesia, or hypersensitivity. Most patients were left with acceptable scarring and were free of postoperative pain and cold intolerance during the long-term follow-up.ConclusionsOur novel technique provides durable, completely sensate, and well-vascularized coverage of the fingertip with minimal discomfort to patients.

How the Lifting Amount of Endoscopic Brow Lifts Is Influenced by Supraorbital Nerve Tension and Brow Gliding-Layer Mobility.

Sensory nerve tension and gliding-layer mobility in the brow may be significant factors affecting postoperative brow level in an endoscopic brow lift, yet they have rarely been studied. To investigate the effects of sensory nerve tension and gliding-layer mobility, the following measurements were performed alongside the endoscopic brow lift in 50 fresh cadaveric hemifaces: amount of brow elevation, critical lifting amount (as sensory nerves became tense), laxity of sensory nerve courses, and mobility of brow-gliding layers. The sensory nerve situations in the subperiosteal and subgaleal dissections were also observed. Supraorbital nerve tension limited the cephalic advancement of the forehead flap. The mean elevation of the brow was 5.8 ± 1 mm (range, 3.5 to 8.6 mm). The mean critical lifting amount was 5.3 ± 1.1 mm (range, 4.0 to 7.3 mm). The mean amount of laxity in the supraorbital nerve (the permissible amount of lift) was 4.1 ± 0.9 mm (range, 2.5 to 5.5 mm). The galeal fat pad was responsible for 60% of brow mobility. The sensory nerve was more protected by a subgaleal dissection in the brow and inferior forehead and by a subperiosteal dissection in the middle and upper forehead. Cephalic movement of the forehead flap is limited by supraorbital nerve tension. The permitted lifting amount varies from 2.5 to 5.5 mm. Gliding-layer mobility in the brow offsets the postoperative amount of cephalic advancement of the forehead flap. Consideration of supraorbital nerve tension and gliding-layer mobility is recommended to obtain an optimal brow level in endoscopic brow lifts.

The effect of smoking on clinical and biochemical early healing outcomes of coronally advanced flap with connective tissue graft: Prospective cohort study.

This study aimed to determine the effects of smoking on early (≤3 months) clinical outcomes and relevant molecular biomarkers following root coverage surgery. Eighteen smokers and 18 nonsmokers, status biochemically verified, with RT1 gingival recession defects were recruited and completed study procedures. All patients received coronally advanced flap plus connective tissue graft. Baseline and 3 month recession depth (RD), recession width (RW), keratinized tissue width (KTW), clinical attachment level (CAL), and gingival phenotype (GP) were recorded. Root coverage (RC) percentage and complete root coverage (CRC) were calculated. Recipient (gingival crevicular fluid) and donor (wound fluid) site VEGF-A, HIF-1α, 8-OHdG, and ANG levels were determined. There were no significant intergroup differences for any baseline or postoperative clinical parameters (P>0.05), except for whole mouth gingival index (increased in nonsmokers at 3 months; P<0.05). Compared to baseline, RD, RW, CAL, KTW, and GP significantly improved postoperatively, without significant intergroup differences. There were no significant intergroup differences for RC (smokers=83%, nonsmokers=91%, P=0.069), CRC (smokers=50%, nonsmokers=72%, P=0.177), and CAL gain (P=0.193). The four biomarker levels significantly increased postoperatively (day 7; P≤0.042) in both groups and returned to baseline (day 28) without significant intergroup differences (P>0.05). Similarly, donor site parameters were not different between groups. Strong correlations, consistent over time, were found between biomarkers implicated in angiogenesis (VEGF-A, HIF-1α, and ANG). The early (3 month) clinical and molecular changes after root coverage surgery utilizing a coronally advanced flap plus connective tissue graft are similar between smokers and nonsmokers.

Advancing Surgical Education: A Comprehensive Systematic Review with Meta-Analysis and Novel Approach to Training Models for Local Skin Advancement Flaps.

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouragedto further improvement of surgical education and enhance the trainees' surgical skills.

Autologous Lipo-Dermal Advancement Flap for Inframammary Fold Reconstruction: A Technical Note for Prevention and Management of Caudal Breast Implant Migration

Inferior breast implant displacement, also known as caudal migration, or bottoming-out, is a known complication of breast augmentation. This leads to a loss of upper pole fullness, a more superiorly located nipple-areolar complex, and an unnatural appearance. Avoiding these complaints has been a longstanding challenge in the field of aesthetics and this technical note suggests a novel solution. This technical note describes the process of preoperative assessment, careful markings, and the use of an autologous lipo-dermal advancement flap that has been designed, mobilized, and rotated to be internally fixated to costal margins and the relevant deep fascial structures at the proposed inframammary fold level. This technique creates a robust partitioning hammock-like structure that stabilizes the breast implant and prevents future caudal displacement. The described technique may be implemented as an independent solution, or as an adjunct to other modalities like biological meshes in revision breast surgery.

What are the outcomes in patients referred to a tertiary referral centre for Crohn's rectovaginal fistula surgery?

Rectovaginal fistulas in patients with Crohn's disease are challenging to manage, and surgical treatment remains the best option for achieving permanent closure of the fistula. Biologicals are now used routinely for patients with Crohn's disease. The aim of this study was to investigate the surgical procedures used by us to treat rectovaginal fistula in patients with Crohn's disease in the era of biologicals. Patients with Crohn's disease who underwent surgery for a rectovaginal fistula between 2010 and 2020 were included in this retrospective study and were identified from a prospectively maintained institutional database. Collected variables included demographics, perioperative and operative variables and data regarding medications used. Success of the procedure was defined as no symptoms at least 6 months after definitive repair and/or stoma closure. Twenty patients (out of 80 referred for evaluation) underwent surgery with intent to close the fistula and had at least 6 months of follow-up. Mean age was 44 ± 12 years with a median follow-up duration of 33 months (range 6-130 months). Forty per cent of the patients had a history of at least two surgeries to close the fistula. The overall healing rate was 70% (14/20). The most performed procedure was a transanal rectal advancement flap (7/20), with a success rate of 85%. Rectovaginal fistula in Crohn's disease is difficult to cure; according to our results almost half of these patients have multiple surgeries due to recurrence. Multiple procedures may be offered for this challenging problem in motivated patients. Perioperative diversion should be strongly considered.

Effectiveness of Adjunctive Hyaluronic Acid Application in Surgical Treatment of Gingival Recession Sites

The aim of this systematic scoping review was to provide scientific evidence on the efficacy and methods of application of hyaluronic acid (HA) in the coverage of gingival recessions in terms of recession depth (RD) reduction, clinical attachment level (CAL) gain and probing depth (PD). An electronic search of the literature on the main databases was conducted. Initially, 405 articles were identified. Finally, four studies were included after the review process. It was not possible to perform a meta-analysis of the articles selected because of the differences among the surgical treatments and commercial formulations and compositions of HA. Both randomized controlled trials in this research examined type 1 gingival recessions treated with a coronally advanced flap. In the selected case series, recessions were treated with either a modified coronally advanced tunnel or laterally closed tunnel combined with a subepithelial connective tissue graft and HA. No significant variation was found in terms of PD. Modifications of CAL are connected to variations of RD; however, RD reduction is similar to the control group. HA seems to improve the clinical outcomes of gingival recession coverage in the short term, but the magnitude is limited. Formulations, surgical techniques and application methods are heterogeneous.

Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin.

To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38mm ± 0.36mm vs. 3.48mm ± 1.13mm). Bone formation measured 2.15mm ± 0.8mm in the test group and 2.24mm ± 1.23mm in the control group, respectively, without a statistically significant difference (p = 0.94). The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.

Patient-reported outcomes following guided bone regeneration: Correlation with clinical parameters

ObjectivesPostoperative oral health-related quality of life is procedure-dependent and may vary during early healing. There is scarce evidence on patient-reported outcome measures (PROMs) after extraction and guided bone regeneration (GBR) or on the clinical parameters influencing PROMs. This prospective observational study aimed to evaluate PROMs during the first 2 weeks following extraction and GBR and correlate them with clinical parameters. MethodsPatients undergoing extraction and GBR (bone graft and resorbable membrane) at a single tooth-bound site were recruited. PROMs (pain, swelling, difficulty of mouth opening, and OHIP-14) were recorded immediately preoperatively, and at 2, 7, and 14 days postoperatively. Flap advancement, gingival and mucosal thickness, duration of surgery, and wound opening were the clinical parameters assessed. ResultsTwenty-seven patients were included. All PROMs peaked on postoperative day 2, decreased subsequently and were significantly correlated with each other. Although 41–56% of patients reported moderate to severe pain, swelling, or mouth opening difficulty on day 2, most patients experienced mild or no symptoms throughout the postoperative period. Pain, swelling and difficulty of mouth opening were determinants of OHIP-14 and were correlated with all OHIP-14 domains during different time points. Wound opening peaked on day 7. Flap advancement, soft tissue thickness, wound opening, duration of surgery and preoperative PROMs affected postoperative PROMs. ConclusionsWithin the limitations of the present study, postoperative symptoms after guided bone regeneration are worst on day 2 and oral health-related quality of life is significantly impacted by pain, swelling, difficulty of mouth opening, surgery duration and flap advancement. Clinical significanceThis is the first study to report PROMs following extraction and GBR with particulate bone graft and resorbable membrane in preparation for implant placement. It will help guide both practitioners and patients on what should be the anticipated experiences following such a routinely performed surgery.

Island Pedicle Flap Pada Dinding Hidung Dengan Karsinoma Sel Basal

A flap is a tissue unit that is transferred from one area (donor site) to another area (recipient site) while still maintaining its blood circulatory system. The island pedicle flap, also known as the V-Y flap, is a modified advancement flap. This flap is a very useful reconstruction option for small to intermediate-sized defects. A 69-year-old Acehnese woman with a history of working as a farmer came with complaints of a non-painful nodule on the wall of her left nose for the last 6 months. Based on the history and physical examination, the patient was provisionally diagnosed with nodular type Basal Cell Carcinoma. An excisional surgical was performed, then a pedicle island flap was performed to close the defect. Anatomical pathology examination results concluded basal cell carcinoma. The island pedicle flap technique is one of the surgical techniques that can be an option to close tumor excision defects. This technique offers a one-stage reconstruction with excellent cosmetic results for defects in the nasal wall. The color and texture of the skin after surgery are almost perfect because the flap originates from the skin immediately adjacent to the defect.