Transplantation Of Fascia Research Articles

60例鼓膜修补术临床分析

目的：探讨鼓膜修补术的适应证和手术方法，以提高手术效果。材料和方法：回顾分析2012年6月至2013年2月本人所做60例鼓膜修补术的临床资料，介绍2种手术方法、移植材料，并评价其优、缺点。60耳中，鼓膜大穿孔32耳，中等大小穿孔26耳，小穿孔2耳；中耳腔干燥者48耳，潮湿者12耳；咽鼓管功能良好者50耳，差者8耳，不通者2耳。修补材料均采用自体颞肌筋膜。内植法55耳(其中全翻内衬法2耳，余均采用外耳道半环带蒂皮圈法)，夹层法5耳。结果：术后穿孔封闭49耳；移植膜脱落1耳；大穿孔修补术后，移植膜未愈合完全而变成小穿孔2耳；失访8耳。听力提高耳；术后鼓膜穿孔闭合者49/60耳，占81.66%，术后小穿孔者2/60耳，占3.33%。移植膜脱落1耳，占1.66%。术后听力提高10 dB以上者40/60耳，占66.67%。结论：术前干耳2个月以上，良好的咽鼓管功能是耳膜修补术的重要条件。有边缘的中等大小穿孔，夹层法较好，但操作难度较大。对于大穿孔，外耳道带蒂皮瓣内衬法是一种可取的方法。常规的方法移植膜内衬于锤骨柄之下，本人采取游离锤骨柄上上皮及粘膜，将移植膜前端内衬于鼓膜穿孔残缘之下，然后将移植膜铺于鼓室及锤骨柄之上，移植膜后部以鼓耳道瓣和带蒂外耳道皮瓣压迫的方法，术后随访，此种方法移植膜成活率较高。术后随访换药十分重要。 Objective: To discuss the indications and surgical methods of myringoplasty in order to advance the therapeutic effect. Methods: The clinical data of 60 cases undergoing myringoplasty between 2012 and 2013 were retrospectively analyzed. Their surgical methods and replant materials were introduced and evaluated. Results in 60 ears included: 32 ears of preoperative tympanic membrane perforation, 26 ears of medium perforation and 2 ears of small perforation; 48 ears of dry middle ear cavity, 12 ears of wet middle ear cavity; 50 ears of good function of eustachian tube, 8 ears of not good function of eustachian tube, 2 ears of closed eustachian tube. Repair materials adopt autologous temporalis fascia. In 55 ears using plant method (2 ears of all double lined method, rest ears of half ring pedicle skin ring method of external auditory canal), 5 ears use sandwich method. Result: 49 ears of postoperative perforation closed, 1 ear of membrane transplantation falling off, 2 ears of small perforation due to fascia transplantation not healed completely after repair surgery of large perforation, and 8 ears lost to follow-up. Hearing improved ear; Tympanic membrane perforation of 49/60 ears closed later, accounting for 81.66%; postoperative perforation of 2/60 ears was discovered, accounting for 3.33%. 1 ear of membrane transplantation falling off accounts for 1.66%. Postoperative hearing of 40/60 ears increased more than 10 dB, accounting for 66.67%. Conclusion: The middle ear drying over two months and the good function of pharyngotympanic tube are two essential conditions. For small perforation of eardrum, the underlay technique may be adopted, and for large perforation of the eardrum, the inlay technique or underlay technique may be adopted. Careful examination and treatment are important postoperatively.

Involvement of Adhesive Puncta Adherentia Type Junctions in the Formation of Synaptic Connections between Dentate Fascia Transplants and the Recipient Brain

The dentate fascia of 20-day Wistar rat fetuses were transplanted heterotopically into the somatosensory area of the neocortex of adult rats. Granule cells in grafts projected their axons (mossy fibers) into recipient brains and established synaptic contacts with inappropriate targets. Electron microscopy was used to study the characteristics of the organization of ectopic mossy fiber synapses. These studies showed that ectopic synapses reproduced the determinant structural features of giant hippocampal synapses and induced subcellular reorganization of postsynaptic dendrites in the neocortex. Morphometric analysis showed significant increases in the number and extents of adhesive junctions, puncta adherentia, in ectopic synapses as compared with controls. These data indicate the involvement of adhesive mechanisms in the structural-chemical adaptation of target neurons to foreign axons growing from transplants.

声帯内側頭筋筋膜自家移植

声帯内側頭筋筋膜自家移植

Artificial vocal folds adjustments to a patient’s voice as easily as changing hearing aids or eyeglasses

For anti-ageing, devices and procedures to improve hearing (hearing aids, cochlear implants, etc.) and vision (eyeglass, intra ocular lens, etc.) are well established as communication support tools for the "speech chain". They can be fit to a person's individual needs, and adjusted as these needs change. However effective tools to improve voice problems associated with physiological aging are not so well established. Review previous phono surgical techniques with my experience, I propose a complete different approach for glottal incompetence. I suggest a new adjustable surgical technique as a replacement for previous injection techniques used to treat glottal incompetence. My proposed solution is to implant an inflatable bag, or balloon, on the lateral side of the vocal fold. Unlike Autologous transplantation of fascia into the vocal folds procedures, where the implanted material appears to become vocal-fold tissue, the new implant would function as an artificial vocal fold. Using the proposed technique, the degree of augmentation can be adjusted to meet changing physical conditions.

Involvement of neuropeptide mechanisms in the process of integration of heterotopic dental fascia transplants with recipient brains

Embryonic dentate fascia was transplanted into the somatosensory area of the neocortex of adult rats. Ultrastructural and morphometric analyses of giant synapses formed by the granule neurons of transplants with inappropriate neuronal targets in the recipient brains were performed after nine months. As compared with intact synaptic terminals in the control hippocampus, there were differences in the quantity and distribution of large synaptic vesicles with electron-dense centers storing neuropeptide cotransmitters. The proportion of peptidergic vesicles (of the total number of vesicles) in ectopic giant synapses was 5.8 +/- 0.6%, compared with 3.3 +/- 0.6% in controls. Accumulations of large, dense vesicles close to the active zones of aberrant connections were seen almost 7.9 times more often than in controls. These results show that neuropeptide transmitters are critical for maintaining synaptic connections between heterotopic dentate fascia transplants and recipient brains.

Autologous Transplantation of Fascia into the Vocal Fold: Long-Term Result of Type-1 Transplantation and the Future

Autologous Transplantation of Fascia into the Vocal Fold: Long-Term Result of Type-1 Transplantation and the Future

Vocal Fold Medialization by Autologous Fascia Transplantation

The LaryngoscopeVolume 116, Issue 9 p. 1723-1724 Article Vocal Fold Medialization by Autologous Fascia Transplantation Mehmet Guven MD, Mehmet Guven MD Gaziosmanpa&OV0612;a University Medical Faculty, Department of Otorhinolaryngology, Tokat, TurkeySearch for more papers by this authorKursat Yelken MD, Kursat Yelken MD Gaziosmanpa&OV0612;a University Medical Faculty, Department of Otorhinolaryngology, Tokat, TurkeySearch for more papers by this author Mehmet Guven MD, Mehmet Guven MD Gaziosmanpa&OV0612;a University Medical Faculty, Department of Otorhinolaryngology, Tokat, TurkeySearch for more papers by this authorKursat Yelken MD, Kursat Yelken MD Gaziosmanpa&OV0612;a University Medical Faculty, Department of Otorhinolaryngology, Tokat, TurkeySearch for more papers by this author First published: 02 January 2009 https://doi.org/10.1097/01.mlg.0000231287.54685.9aCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume116, Issue9September 2006Pages 1723-1724 RelatedInformation

Vocal Fold Medialization by Autologous Fascia Transplantation

Vocal Fold Medialization by Autologous Fascia Transplantation

Long‐Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy

The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap. In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold. This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery. This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.

Autogenous fat injection for glottic insufficiency: Analysis of 101 cases and correlation with patients' self-assessment

Conclusions. Our data confirm that fat injection (FI) is a safe, useful, thorough and experience-dependent procedure. It should be considered as a potential treatment protocol for patients with vocal fold atrophy (VFA) and sulcus vergeture (SVER). To increase the chances of excellent phonatory results for sulcus vocalis (SV) patients, our recommended surgical option is FI with fascia transplantation. Objective. To investigate prognostic factors in patients with glottic insufficiency following FI. Material and methods. The study sample comprised 101 patients treated for VFA (n=31), SVER (n=41) and SV (n=29). A retrospective analysis was performed by means of patient self-assessments, employing multiple logistic regressions for the four independent factors of age, gender, diagnosis and time-frame of surgery. Results. The mean follow-up time was 16.8 months (range 5–38 months). Immediate complications included hematoma of the donor site in two patients and fat extrusion at the injection site in three. The results of treatment were “excellent” in 48.4% (15/31) of VFA cases, 43.9% (18/41) of SVER cases and 20.7% (6/29) of SV cases, with 19.4% (6/31), 24.4% (10/41) and 55.2% (16/29), respectively reporting improvement and 32.3% (10/31), 31.7% (13/41) and 24.1% (7/29), respectively reporting no improvement. Disease type was determined to have a significant bearing (p=0.025) on treatment effectiveness and patients operated on most recently were shown to have a 4.3-times greater chance of achieving successful results (p<0.01). Multiple logistic regression analysis indicated that VFA and SVER sufferers (as compared to those with SV) and men (as opposed to women) were more likely to achieve an “excellent” result: 3.4, 3.3 and 3.6 times, respectively.

Autologous Transplantation of Fascia into the Vocal Fold: Long‐Term Result of Type‐1 Transplantation and the Future

Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long-term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future. Prospective study. We were able to obtain long-term results from 10 volunteer cases (2 female and 8 male, age: 15-71, mean 46.5 years old) who could be followed up for at least 3 years after transplantation. All were cases of pathologic sulcus vocalis.We measured maximum phonation time (MPT) and carried out pre- and postsurgical clinical observation and laryngeal stroboscopy in all cases. These measurements and observations were made before the ATFV and at 6 months, 1 year, 2 years, and 3 years after surgery. In stroboscopic observation 1 year after the ATFV, satisfactory glottal closure and excellent mucosal wave were observed for all cases, and there was no case with hyperadduction of the false vocal folds. MPT measures remained at an improved level 2 years and 3 years after the transplantations. Paired-sample t tests showed that the improvement relative to preATFV levels was significant for all postsurgical measurements up to 3 years. We conclude that ATFV is a successful surgical procedure for sulcus vocalis and scarred vocal folds. Other phonosurgical clinical applications may also be envisioned.

Autologous transplantation of fascia into the vocal fold as a treatment for recurrent nerve paralysis.

To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure. Technical modifications were made in transplantation of the temporal fascia into the paralyzed vocal fold. Eight patients underwent the surgery, and their phonatory function was examined preoperatively and postoperatively. The following surgical techniques were applied to prevent the falling-off of the graft: 1) a roll-shaped fascia graft was prepared before the transplantation and 2) a pocket was made within the lamina propria mucosa using a newly devised special elevator. The maximum phonation time and airflow rate during sustained phonation (in four cases) were measured, and perceptual evaluation of voice quality was made using the GRBAS scale by speech pathologists before and after the surgery. All the cases showed no evidence of falling-off of the graft. Elongation of the maximum phonation time and improvement in voice quality were obtained in all cases postoperatively. The method proved to be useful for the treatment of glottal insufficiency due to recurrent nerve paralysis.

Autologous transplantation of fascia into the vocal fold: long-term results of a new phonosurgical technique for glottal incompetence.

To study the long-term results of autologous transplantation of fascia into the vocal fold, and to evaluate our use of autologous transplantation instead of bovine collagen injection in cases of glottal incompetence. Retrospective study of the patients who have undergone autologous fascia transplantation using our new technique. Follow-up studies were performed for at least 1 year (up to 3 y) on 9 autologous fascia transplant patients (6 cases with type 1 procedures and 3 cases with type 2 procedures). Clinical observations, including laryngeal stroboscopy, and measurement of maximum phonation time (MPT) were carried out. During 3 months after autologous fascia transplantation, MPT gradually increased and stroboscopy showed improved glottal closure. These improvements continued beyond 1 year in all cases of type 1 surgery and 2 of 3 cases of type 2 surgery. Autologous transplantation of fascia into the vocal folds as a phonosurgical treatment for glottal incompetence yields excellent long-term results. Temporal fascia appears to be a highly suitable tissue for transplantation in Reinke's space. However, the fascia is less suitable for transplantation in the muscle. We speculate that transplantation of temporal fascia leads to regeneration of vocal fold tissue, perhaps using a mechanism similar to stem cell transplantation in other organs.

声帯内自家側頭筋膜移植術施行後の移植部に発生した肉芽腫の1例

声帯内自家側頭筋膜移植術施行後の移植部に発生した肉芽腫の1例

声帯内自家側頭筋膜移植術の手術手技に関する検討

Two technical modifications were attempted for the transplantation of fascia into the vocal folds. First, a roll-shaped fascia graft was inserted into a pocket prepared within the lamina propria mucosa of a vocal fold in order to prevent fall-off of the graft. In addition, a new suturing technique was devised to save the time required for the surgical procedure. Successful results were obtained when the new techniques were applied.

Experimental Evaluation of Free Versus Pedicled Fascial Flaps for Sling Surgery of Urinary Stress Incontinence

Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate and physical properties of autologous fascial sling yet remain to be determined. Our study was designed to evaluate in an animal model of twenty rabbits fascial slings from free and pedicled fascial flaps of two different widths (7 mm and 15 mm.) and uniform length (60 mm.) in respect to changes of length, width, tensile strength and histological criteria of vitality and integrity 3 months after surgery. The results 3 months after surgery revealed shrinkage in length by 37% (31%-46%) of the original length, shrinkage in width by 63% (60%-69%) of the original width and reduction of tensile strength of 53% (51%-55%) without consistent differences between free and pedicled flaps or 7 mm. and 15 mm. wide flaps. In the groups with 7 mm. wide flaps a total of two dystrophic slings (1 pedicled, 1 free) were seen; however, no dystrophies were seen in 15 mm. wide flaps. On microscopy, all slings were vital regardless of their surgical configuration. In summary, on macroscopic, microscopic and physical examination no gross differences between free and pedicled slings could be detected, so that preferences for use of free or pedicled fascial flaps could not be established for clinical applications in sling surgery. However, 15 mm. wide flaps had a lower incidence of dystrophy and retained greater absolute tensile strength than 7 mm. wide flaps.

Comparative Cost Analysis of Collagen Injection and Fascia Lata Sling Cystourethropexy for the Treatment of Type III Incontinence in Women

We examined the cost of 2 common forms of surgical treatment of genuine stress urinary incontinence due to intrinsic sphincter deficiency, that is sling cystourethropexy and periurethral collagen injection. Between May 1994 and July 1995, 14 women with intrinsic sphincter deficiency underwent sling cystourethropexies. A total of 14 matched patients with intrinsic sphincter deficiency underwent endoscopic collagen injection during the same period. The total cost per treatment of fascia lata sling cystourethropexy ($10,382) was 2.1 times greater than that for collagen injection ($4,996, p < 0.001). At an average followup of 14.9 months for fascia lata cystourethropexy and 21.3 months for collagen injection, 71.4% of patients in the former and 26.7% in the latter groups were completely continent (p = 0.05). One or no pads were used daily by 85 and 40% of the patients, respectively. Fascia lata sling cystourethropexy may be a more cost-effective surgical treatment than periurethral endoscopic collagen injection for treating genuine stress urinary incontinence in women with intrinsic sphincter deficiency when the greater success rate of the former procedure is considered.

Favorable Outcome of Pubovaginal Slings for Geriatric Women With Stress Incontinence

Traditionally pubovaginal slings have been associated with a greater risk of immediate morbidity and prolonged voiding dysfunction compared to other stress incontinence repairs. Because elderly patients already have inherently greater perioperative risk and prevalence of innate voiding dysfunction, there is some reluctance to construct slings in this age group. We examined the outcome of pubovaginal sling in elderly women versus younger controls to determine whether this concern is justified. We retrospectively analyzed the outcome of 19 geriatric women older than 70 years who underwent a pubovaginal sling procedure between 1992 and 1995, and compared the findings to those of 77 younger control women with a mean followup of 22 months. All women had video urodynamically proved stress incontinence due to intrinsic sphincter deficiency and many had coexistent bladder instability symptoms. Women with neurogenic causes for incontinence were excluded from the study. Stress incontinence resolved in 100% of geriatric and 97% of control women. Preoperative instability symptoms, including urge incontinence, improved in more than 50% of patients in both groups. De novo instability symptoms arose in 10% of women in each group but were generally controlled with anticholinergics. Efficient voiding resumed within a mean of 16 days in both groups. The morbidity and success rates of pubovaginal sling surgery in the elderly compare favorably to those in younger women. Advanced age alone would not dissuade us from constructing a pubovaginal sling when indicated.

The Use Of Autogenous Fat, Fascia, And Nonvascularized Muscle Grafts In The Head And Neck

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

History of Soft-Tissue Allografts in Orthopedics

Experimentation with soft-tissue allografts has been reported for over 100 years. Gluck described the successful transplantation of an Achilles tendon in a chicken in 1881. Subsequent animal work with tendon and fascia transplantation continued in the early 1900s. The first attempt at preservation prior to implantation was reported in 1918. A case of human tendon allografting was reported in 1923 involving the use of an entire patella with its attached tendons. Successful fascial allograft use in humans was noted in 1927. A large amount of experimental and clinical work in flexor tendon replacement of the hand was performed in the 1960s and 1970s. However, such application was curtailed in the 1980s. Allograft tissue for anterior cruciate ligament reconstruction has seen an enormous amount of use in the last 10 years. Numerous reports of ACL allograft selection, processing and preservation, mechanical properties, rejection phenomenon, and clinical results are in the literature. Early use has been encouraging, although a possible trend toward late failure is noted. Meniscal allografts have also been used and have shown limited clinical success. The use of allograft tissue in other joints has also been reported. The concomitant rise in allograft bone and cartilage transplantation is noted, along with the development of tissue banks. Although many questions remain unanswered with respect to soft-tissue allografts, there is clearly a role for their continued use in orthopedic surgery.