Full-thickness Flap Research Articles

Myeloid sarcoma of the Gingiva with myelodysplastic syndrome

The purpose of this report is to present a case of myeloid sarcoma of the gingiva with myelodysplastic syndrome.A 52-year-old male diagnosed with myelodysplastic syndrome with skin lesions presented with gingival swelling and gingival redness involving the maxillary left second premolar and the maxillary left first molar. The patient was referred from the Department of Hematology for a biopsy of the lesion. Full-thickness flaps were elevated and inflamed, and neoplastic soft tissue was removed from a lesion and the samples sent for histopathologic analysis.Histopathologic results showed leukemic cell infiltration beneath the oral epithelium, and the specimen was positive for the leukocyte marker. The diagnosis was myeloid sarcoma. Uneventful healing was observed at 2-week follow-up, but relapse of the lesions with the hyperplastic and neoplastic tissue was noted at 4-week follow-up. Further follow-up or treatment could not be performed because the patient did not visit at the next follow-up.In conclusion, myeloid sarcoma should be a diagnosis option for gingival growth because it can involve intraoral lesion. In this report, a biopsy was performed due to referral considering the patient's medical history. Although myeloid sarcoma in the oral cavity is extremely rare, a small biopsy and consultation with a hematologist may be beneficial for patients and may provide a differential diagnosis.

Enamel Matrix Derivative Promotes Healing of a Surgical Wound in the Rat Oral Mucosa.

Enamel matrix proteins (EMPs) play a role in enamel formation and the development of the periodontium. Sporadic clinical observations of periodontal regeneration treatments with enamel matrix derivative (EMD), a commercial formulation of EMPs, suggest that it also promotes post-surgical healing of soft tissues. In vitro studies showed that EMD stimulates various cellular effects, which could potentially enhance wound healing. This study examines the in vivo effects of EMD on healing of an oral mucosa surgical wound in rats. A bilateral oral mucosa wound was created via a crestal incision in the anterior edentulous maxilla of Sprague-Dawley rats. Full-thickness flaps were raised, and, after suturing, EMD was injected underneath the soft tissues on one side, whereas the EMD vehicle was injected in the contralateral side. Animals were sacrificed after 5 or 9 days, and the wound area was subjected to histologic and immunohistochemical analysis of the epithelial gap, number of macrophages, blood vessels, proliferating cells, and collagen content in the connective tissue (CT). Gene expression analysis was also conducted 2 days post-surgery. EMD had no effect on the epithelial gap of the wound. On both days 5 and 9, EMD treatment increased significantly the number of blood vessels and the collagen content. EMD also enhanced (by 20% to 40%) the expression of transforming growth factors β1 and β2, vascular endothelial growth factor, interleukin-1β, matrix metalloproteinase-1, versican, and fibronectin. EMD improves oral mucosa incisional wound healing by promoting formation of blood vessels and collagen fibers in CT.

Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique.

To delineate the distribution and course layer of the perforator vessels using a modified technique. Twelve perforator flaps were obtained from the crura of six fresh adult cadavers. The flaps were randomized into three groups (n=4 per group): the full-thickness flap group; the deep fascia-free flap group, and the subcutaneous adipose layer-free group. The flaps were smoothened on a silk screen on a batten frame and the isolated flaps were perfused at a perfusion pressure of 140mmHg for 10min via the trunk of the posterior tibial artery. Perforator flaps were photographed using a digital camera and radiographed using a mammography device. The imaging data were processed by digital software system. The mean number of the posterior tibial artery perforator was 4.17±0.94. The three relatively constant perforators varied in the projection points as well as the diameter and the length. The vascular branches and courses of the perforators were clearly visible on the mammograms. Elimination of all the deep fascia or the subcutaneous adipose tissues in the distal portion had no significant impact on the blood supply of posterior tibial artery perforator flaps while the vascular areas of the artery perforators were significantly reduced after the subcutaneous adipose tissue was eliminated in the proximal portion. We developed an effective modified technique for delineating the vascular territory on perforator flaps of different thicknesses. Our results provide significant guidance for clinical surgeons by providing them with more detailed anatomical knowledge of perforator flaps.

Eyelid Reconstruction with Full Thickness Skin Grafts After Carcinoma Excision

Various techniques have been proposed for reconstruction of the eyelid anterior lamella after carcinoma excision: among these are the transposition of skin flaps, and full-thickness skin grafts or combination of these two. To present our experience in eyelid reconstruction with full-thickness skin grafts and to assess the aesthetic and functional outcomes. The present retrospective study included 39 patients (20 males, 19 females, mean age 71 yrs) with surgically excised eyelid carcinoma, followed by reconstruction using full-thickness skin grafts. The patients were treated between 2005 and 2014. Parameters recorded were patient demographics, histological classification of malignancy, tumor localization and size, postoperative defect size. In cases of large full-thickness lower lid defect Hughes tarsoconjunctival flap was used for reconstruction of posterior lamella. Full-thickness skin grafts donor sites included upper eyelid, preauricular area and inner brachial area. We appraised the grafts viability one week after surgery and the aesthetic results - 6 months after surgery by the graft colour and lid position. In 95% of the cases the skin grafts were viable. The full-thickness skin graft (FTSG) failed in two patients because of subcutaneous haematoma. There were a few early postoperative complications including graft hypertrophy, graft contraction, and partial graft failure, which were managed without additional surgery. All 39 patients had normal postoperative lid function. All 39 had either good (14) or excellent (25) cosmetic results. Our findings suggest that full-thickness skin graft is a good choice in periocular reconstructive surgery after carcinoma excision. The surgical technique is easy to perform producing proper functional and aesthetic results.

Closure of chronic oroantral fistula with repair of the Schneiderian membrane : Report of three cases

An oro-antral fistula(OAF) is one of the most common complications after procedures at the maxillary posterior area. The purpose of this study was to introduce the closure of OAF with repair of the Schneiderian membrane. This case report includes three patients with OAF arising after dental surgery on molar region of maxilla. Under general anesthesia, fistulectomy was achieved in all three patients and the full thickness flap around OAF was raised. After removal of inflammatory tissue, the Schneiderian membrane was repaired with suture or application of fibrin sealant. Additional closures were then performed with a buccal fat pad flap and a buccal mucoperiosteal flap. All OAF in three patients enrolled in this study were closed successively without recurrence of fistula. Treatment of oroantral fistula using repair of the Schneiderian membrane is a good alternative option for patients with OAF accompanied by chronic maxillary sinusitis.

Guided Bone Regeneration Using Biphasic Calcium Phosphate With Adjunct Recombinant Human Bone Morphogenetic Protein-2 With and Without Collagen Membrane in Standardized Calvarial Defects in Rats: A Histologic and Biomechanical Analysis.

This study aimed to assess the efficacy of biphasic calcium phosphate (BCP) with adjunct recombinant human bone morphogenetic protein-2 (rhBMP-2), with and without collagen membrane (CM), in regeneration of standardized rat calvarial defects. Thirty female Wistar albino rats with a mean age of 12 weeks and mean weight of 300 g were used. The skin over the calvaria was exposed using a full-thickness flap. A standardized defect measuring 4.6 mm in diameter was created in the parietal bone. The defects were randomly divided into the following groups: (1) no treatment (control group); (2) BCP soaked in rhBMP-2 and then covered with a resorbable CM; and (3) BCP soaked in rhBMP-2. Following euthanasia, histologic, histomorphometric, and biomechanical assessments of the calvarial specimens were performed to assess bone regeneration. The results showed islands of newly formed bone (NFB) between the defect edges in the control group. NFB was observed bridging the defect edges and around the remnants of BCP in the rhBMP-2 + BCP + CM group and only around the BCP remnants in the rhBMP-2 + BCP group. Histomorphometric analysis revealed a significantly higher mean ± standard deviation (SD) percentage of NFB per defect in the rhBMP-2 + BCP + CM group (46.12 ± 2.56) compared with the control (11.79 ± 0.75) and rhBMP-2 + BCP (26.65 ± 1.48) groups. Although no differences were found in the hardness and elastic modulus (EM) of NFB between the rhBMP-2 + BCP + CM (hardness: 687.78 ± 4.74 MPa; EM: 27.71 ± 0.063 GPa) and the rhBMP-2 + BCP (hardness: 637.65 ± 6.32 MPa; EM: 21.49 ± 0.095 GPa) groups, the biomechanical parameters of NFB in the control group (hardness: 286.17 ± 9.49 MPa; EM: 12.62 ± 0.048 GPa) were significantly less. The experiment demonstrated the efficiency of rhBMP-2 + BCP in GBR, wherein the presence of CM leads to a greater percentage of new bone formation within standardized calvarial defects.

Efficacy of Mucograft vs Conventional Resorbable Collagen Membranes in Guided Bone Regeneration Around Standardized Calvarial Defects in Rats: An In Vivo Microcomputed Tomographic Analysis.

The aim of this in vivo microcomputed tomographic (μCT) study was to compare the efficacy of Mucograft (MG) vs resorbable collagen membranes (RCMs) in facilitating guided bone regeneration (GBR) around standardized calvarial defects in rats. Forty female Wistar albino rats with a mean age and weight of 6 to 9 weeks and 250 to 300 g, respectively, were used. With the rats under general anesthesia, the skin over the calvaria was exposed using a full-thickness flap. A standardized calvarial defect with a 4.6-mm diameter was created in the left parietal bone. For treatment, the rats were randomly divided into four groups (n = 10 per group): (1) defects covered with MG (MG group); (2) defects covered with an RCM (RCM group); (3) defects filled with xenograft bone particles and covered by MG (MG + bone group); and (4) defects filled with xenograft bone particles and covered by an RCM (RCM + bone group). Primary closure was achieved using interrupted resorbable sutures. The animals underwent high-resolution, three-dimensional μCT scans at baseline and at 2, 4, 6, and 8 weeks after the surgical procedures. Data regarding volume and bone mineral density (BMD) of newly formed bone (NFB) and bone particles revealed an increase in the volume of NFB in all the groups from baseline to 8 weeks. The MG group had the lowest volume of NFB (mean ± standard deviation [SD], 1.32 ± 0.22 mm(3)). No significant differences in mean ± SD values for volume of NFB were observed between the RCM (3.50 ± 0.24 mm(3)) and MG + bone (3.87 ± 0.36 mm(3)) groups, but their values were significantly lower than that of the RCM + bone group (2.95 ± 0.15 mm(3), F = 131.91, dfN = 2, dfD = 27, P < .001). Significant differences in BMD of NFB between the groups (F = 332.46, dfN = 3, dfD = 36, P < .001) and during different data collection periods (F = 97.04, dfN = 3, dfD = 36, P < .01) were observed, with the RCM group having the highest mean ± SD BMD of NFB (0.42 ± 0.05 g/mm(3)). Significant differences in the bone particle volume between the RCM + bone and MG + bone groups (F = 91.04, dfN = 1, dfD = 18, P < .05) and at different data collection periods (F = 314.12, P < .01) were observed, with the RCM + bone group displaying greater reduction in both volume (36.8%) and BMD (19.7%) of bone particles. The present in vivo μCT study demonstrated that RCM is better than MG in enhancing new bone formation in rat calvarial standardized defects when used in combination with mineralized particulate graft material.

Efficacy of Mucograft vs Conventional Resorbable Collagen Membranes in Guided Bone Regeneration Around Standardized Calvarial Defects in Rats: A Histologic and Biomechanical Assessment.

Guided bone regeneration (GBR) using a porcine-derived collagen matrix (Mucograft [MG], Geistlich) has not yet been reported. The aim of this histologic and biomechanical study was to compare the efficacy of MG versus resorbable collagen membranes (RCMs) in facilitating GBR around standardized rat calvarial defects. Forty female Wistar albino rats with a mean age and weight of 6 to 9 weeks and 250 to 300 g, respectively, were used. With the rats under general anesthesia, the skin over the calvaria was exposed using a full-thickness flap. A 4.6-mm-diameter standardized calvarial defect was created in the left parietal bone. For treatment, the rats were randomly divided into four groups (n = 10 per group): (1) MG group: the defect was covered with MG; (2) RCM group: the defect was covered with an RCM; (3) MG + bone group: the defect was filled with bone graft particles and covered by MG; and (4) RCM + bone group: the defect was filled with bone graft particles and covered by an RCM. Primary closure was achieved using interrupted resorbable sutures. The animals were sacrificed at 8 weeks after the surgical procedures. Qualitative histologic analysis and biomechanical assessment to identify hardness and elastic modulus of newly formed bone (NFB) were performed. Collected data were statistically analyzed using one-way analysis of variance. Histologic findings revealed NFB with fibrous connective tissue in all groups. The quantity of NFB was highest in the RCM + bone group. Statistically significant differences in the hardness (F = 567.69, dfN = 3, dfD = 36, P < .001) and elastic modulus (F = 294.19, dfN = 3, dfD = 36, P < .001) of NFB were found between the groups. Although the RCM + bone group had the highest mean ± standard deviation (SD) hardness of NFB (531.4 ± 24.9 MPa), the RCM group had the highest mean ± SD elastic modulus of NFB (18.63 ± 1.89 GPa). The present study demonstrated that RCMs are better than MG at enhancing new bone formation in standardized rat calvarial defects when used along with mineralized particulate graft material.

The use of a modified abbé island flap to reconstruct primary lip defects of over 80.

BackgroundLip reconstruction for defects greater than 80 % present a challenge in maintaining acceptable oral function and good aesthetic results. Abbé flaps offer an excellent reconstructive option but are limited to defects under 65 %.MethodsWe describe a two-stage “modified Abbé island flap” technique whereby a full-thickness myocutaneous flap is combined with a modified Karapandzic flap, allowing for reconstruction of total and near total lip defects.ResultsSix patients underwent successful two-stage lower and upper lip reconstruction with this technique. Oral competence and satisfactory aesthetic outcomes were achieved in all six cases. There were no complications. Although microstomia was noted to a certain extent, we argue this impact to be less than the morbidity of a free flap that lacks sphincteric function.ConclusionThe “Modified Abbé Island Flap” can be used to reconstruct near-total lip defects using locally innervated, well-vascularized tissues that recreate the oral sphincter and restore oral competence. The combination of the conventional Abbé flap with a modified Karapandzic flap provides reliable results and significantly reduces operating time.

Bone Regeneration Using Bone Morphogenetic Protein-2 and Biphasic Calcium Phosphate With and Without Collagen Membrane in Calvarial Standardized Defects: An In Vivo Microcomputed Tomographic Experiment in Rats.

The aim of this in vivo microcomputed tomographic (μCT) experiment was to assess in real time the efficacy of a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and biphasic calcium phosphate (BCP), with and without resorbable collagen membrane (CM), in regeneration of standardized calvarial defects (SCDs) in rats. A total of 30 female Wistar albino rats (n = 10/group) with a mean age and weight of 7.5 months and 275 g, respectively, were used. With the rats under general anesthesia, the calvaria were exposed using full-thickness periosteal flaps and unilateral SCDs of 4.6 mm diameter were created on the left parietal bone. Defects were left untreated (control group) or randomly filled with either BCP soaked in rhBMP-2 and then covered with CM (BMP + BCP + CM group) or BCP soaked in rhBMP-2 alone (BMP + BCP group). In vivo μCT scans were done at baseline and 2, 4, 6, and 8 weeks. Newly formed bone (NFB) and remaining BCP particles were assessed for their volumes (NFBV, BCPV, respectively) and mineral densities (NFBMD, BCPMD, respectively). In vivo μCT results showed scanty amounts of new bone at the peripheries of the defect in the control group. In the other two groups, near complete defect closure was evident at 8 weeks. The mean NFBV after 8 weeks was 4.63 ± 0.96 mm(3), 11.82 ± 1.17 mm(3), and 13.85 ± 1.89 mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean NFBMD was 0.38 ± 0.03 g/mm(3), 0.24 ± 0.07 g/mm(3), and 0.35 ± 0.03 g/mm(3) for the control, BMP + BCP + CM, and BMP + BCP groups, respectively. After 8 weeks, the mean BCPV and BCPMD values for the BMP + BCP + CM and BMP + BCP groups were 2.73 ± 0.65 mm(3), 0.33 ± 0.08 g/mm(3), 2.49 ± 0.71 mm(3), and 0.28 ± 0.03 g/mm(3), respectively. The present real-time in vivo μCT experiment demonstrated that BMP + BCP, either with or without CM, was effective in promoting bone regeneration within rat SCDs and enabled new bone formation starting as early as 2 weeks.

Total Upper Eyelid Reconstruction with Modified Cutler-Beard Procedure Using Autogenous Auricular Cartilage.

Malignant tumour in upper lid is a surgical challenge to oculoplastic surgeon. Full thickness defect created after removal of large tumour promptly treated with modified cutler beard procedure using autogenous auricular cartilage. Surgical procedure is two staged: In first stage, removal of the tumour followed by full thickness flap repaired; In second stage, opening the closed lid with lid margin repair. Post-operatively, there is good anatomical, functional and cosmetic restoration of the eyelid similar to the other eye. To evaluate the efficacy of the modified Cutler-Beard procedure using autogenous ear cartilage for tarsal plate reconstruction in the repair of 70-100% upper eyelid defects. This is a prospective, interventional case series of 16 patients over a period of three years. Patients with upper eyelid defects, secondary to removal of tumour, greater than or equal to 70% were included. Of these patients, those with lymph node involvement, distant metastasis, lower eyelid involvement, corneal infiltration or intra-orbital extension were excluded. FNAC was done in all the cases. Created defect was measured in mm (length and width) and later expressed in percentage. Pre and Post-operative measurement of Levator Palpebrae Superioris (LPS) was done. Pre and Post-operative measurement of Margin to Reflex Distance (MRD1) were also noted. Upper eyelid recreation was successful in all patients without complications. Pre-operative LPS action ranged from 0-4 mm, while post-operative LPS action was 12-14 mm. Pre-operative MRD1 ranged from -4 millimeters to -1 mm, while post-operative MRD1 was +3 to +4 millimeters. The follow-up period ranged from six months to two years. Every patient had a successful upper eyelid reconstruction. The modified Cutler-Beard procedure using an autogenous auricular cartilage graft is an effective procedure for repair of large upper eyelid defects, with acceptable functional and cosmetic results. Furthermore, it is particularly useful in resource-poor areas, due to lower cost than other available options.

Sub-epithelial connective tissue graft and enamel matrix derivative in the management of a localized gingival recession defect: A case report

Within the past 20 years, clinicians have successfully performed mucogingival surgeries to restore periodontal defects. This article describes the application of enamel matrix derivative (EMD) in combination with connective tissue graft (CTG) for the repair of localized mucogingival defect. The procedure was performed to observe the clinical success of autogenous CTG in the treatment of moderate facial recession defect combined with the usage of an EMD. The management involved scaling and root planning, root surface conditioning, elevation of full-thickness flap, application of EMD, shaping and application of CTG at the recession site. Eight-month observations showed root coverage of 3 mm (>75%) with attachment level gain of 4 mm and a gingival margin that was harmonious with adjacent teeth. From a clinical observation, it emerges that root coverage and soft tissue attachment is possible with the use of autogenous CTG in combination with EMD in the management of moderate gingival recession defects.

Proline-Rich Peptide Mimics Effects of Enamel Matrix Derivative on Rat Oral Mucosa Incisional Wound Healing.

Proline-rich peptides have been shown to promote periodontal regeneration. However, their effect on soft tissue wound healing has not yet been investigated. The aim of this study is to evaluate the effect of enamel matrix derivative (EMD), tyrosine-rich amelogenin peptide (TRAP), and a synthetic proline-rich peptide (P2) on acute wound healing after a full-thickness flap procedure in an incisional rat model. This experimental study has a split-mouth, randomized, placebo-controlled design. Test and control wounds were created on the palatal mucosa of 54 Sprague-Dawley rats. Wounds were histologically processed, and reepithelialization, leukocyte infiltration, and angiogenesis were assessed at days 1, 3, and 7 post-surgery. EMD and P2 significantly promoted early wound closure at day 1 (P <0.001 and P = 0.004, respectively). EMD maintained a significant acceleration of reepithelialization at day 3 (P = 0.004). Wounds treated by EMD and P2 showed increased angiogenesis during the first 3 days of healing (P = 0.03 and 0.001, respectively). Leukocyte infiltration was decreased in EMD-treated wounds at day 1 (P = 0.03), and P2 and TRAP induced a similar effect at days 3 (P = 0.002 and P <0.0001, respectively) and 7 (P = 0.005 and P <0.001). EMD and P2 promoted reepithelialization and neovascularization in full-thickness surgical wounds on rat oral mucosa.

Improving outcomes in pilonidal sinus disease

BackgroundOptimal surgical treatment for pilonidal sinus disease remains controversial. Studies in children are uncommon with overall high postoperative recurrence and infection rates (20%). Our unit adopted a technique for excision of the pilonidal sinus with primary midline closure using a full-thickness flap. We present our results of this technique in the pediatric age group. MethodsSingle-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care. Results19 children were identified. Median age was 15years, and 47% were male. All had previously infected sinuses, with 5 requiring abscess drainage. Median follow-up was 13months (3.5–67months). Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis). Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8–36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases. Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence. ConclusionThis is the first report of this technique in children which showed a higher incidence of complications than a comparable adult study. Our study underlines the importance of accurate long-term outcomes when introducing new techniques to evaluate operation-associated morbidity. Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study.

The Vasodilator Effect of a Cream Containing 10% Menthol and 15% Methyl Salicylate on Random-Pattern Skin Flaps in Rats

BackgroundIt is still difficult to prevent partial or full-thickness flap necrosis. In this study, the effects of a cream containing menthol and methyl salicylate on the viability of randompattern skin flaps were studied.MethodsForty female Sprague-Dawley rats were divided into two equal groups. Caudally based dorsal random-pattern skin flaps were elevated, including the panniculus carnosus. In the study group, 1.5 mL of a cream containing menthol and methyl salicylate was applied to the skin of the flap, and saline solution (0.9%) was used in the control group. Upon completion of the experiment, flap necrosis was analyzed with imaging software and radionuclide scintigraphy. Histopathological measurements were made of the percentage of viable flaps, the number of vessels, and the width of the panniculus carnosus muscle.ResultsAccording to the photographic analysis, the mean viable flap surface area in the study group was larger than that in the control group (P=0.004). According to the scintigrams, no change in radioactivity uptake was seen in the study group (P>0.05). However, a significant decrease was observed in the control group (P=0.006). No statistically significant differences were observed between the groups in terms of the percentage of viable flaps, the number of vessels, or the width of the panniculus carnosus muscle (P>0.05).ConclusionsBased on these results, it is certain that the cream did not reduce the viability of the flaps. Due to its vasodilatory effect, it can be used as a component of the dressing in reconstructive operations where skin perfusion is compromised.

Full-thickness endoanal advancement flap repair (EAFR) in patients with IBD and fistulas-in-ano

Purpose: The purpose of this study was to assess primary healing, recurrence and continence after endoanal advancement flap repair in patients with IBD compared to those with cryptoglandular disorders. Patients and Methods: 71 patients with fistulas-in-ano received endoanal advancement flap repair between 1997 and 2009. This is a prospective, non-randomized, single-centre study. Results: Follow up data was available for 63 patients. In 46% the fistulas were due to chronic inflammatory bowel disease. 54 % had cryptoglandular fistulas. Primary healing was observed in 37 cases (58.7 %). The median time to recurrence was 27 months (mean: 45 ± 50.31) and differed significantly across the patient groups: Inflammatory bowel disease 11 months (mean: 23.65 ± 32.47), cryptoglandular origin 51 months (mean: 63.20 ± 55.84) (P < 0.01). Preoperatively, 31 (49.2 %) of the patients had impaired continence versus 30 (47.6%) postoperatively. In IBD there was no significant difference between pre- and postoperative CCIS values (pre 4.05 ± 4.12 vs 3.61 ± 4.78, P = 0.4) Conclusions: Full-thickness endoanal advancement flap repair is a successful treatment option for IBD patients with transsphincteric fistulas. Fistulas associated with chronic inflammatory bowel disease were found to have a significantly higher rate of recurrence and a shorter time to recurrence at long-term follow-up. Repeat interventions do not negatively impact postoperative continence.

Peri‐implant tissues morphometry at SLActive surfaces. An experimental study in the dog

The objective was to study tissue components around implants with highly hydrophilic surfaces during early healing. In 12 Labrador dogs, the second and third mandibular premolars were extracted bilaterally. After 3months of healing, full-thickness flaps were elevated in the edentulous region of one side of the mandible. An implant was installed, and the flaps were sutured to allow a non-submerged healing. The timing of the implant installations in the other side of the mandible until sacrifices were performed in such a way to collect biopsies representing healing after 4, 7, 15, and 60days. An n=6 was achieved for each healing period. Paraffin sections were obtained for morphometric analyses. Provisional matrix with a percentage of 32.9±16.7% was found already after 4days. This percentage became 37.3±8.5%, 24.3±9.1%, and 1.6±1.7 after 7, 15, and 60days, respectively. New bone was found after 7days of healing, at a percentage of 26.2±3.2%. This proportion increased to 36.0±9.6% and 50.4±8.3% after 15 and 60days, respectively. Marrow spaces free from a blood clot, inflammatory cells, and provisional matrix represented a low proportion of the tissues after 4days (1.6±2.4%). This proportion increased over time to 9.2±6.4%, 20.3±12.9%, and 37.9±9.6%, respectively. The percentage of old bone was noted in a similar percentage (~8%) up to 15days. The percentage decreased to ~5% at 60-day of observation. The tissue changes observed during the healing were similar to those from historic controls studying healing in a chamber adjacent to implants. Hence, the characteristics of the implant surfaces may not be reflected in the tissue composition adjacent to the implant but rather affect the adhesion of tissue onto the implant surfaces.

Locked Plate Fixation of Proximal Humeral Fractures Through an Extended Deltoid Split Approach with Use of a Shoulder Strap Incision.

The shoulder strap approach involves an anterolateral deltoid split with use of an inverted U incision, providing excellent lateral exposure for locked plate fixation of complex proximal humeral fractures. Proper positioning of the image intensifier is important for uninterrupted fluoroscopy. The tip of the acromion is a useful landmark and serves as the proximal extent of the incision. Raise a broad-based full-thickness fasciocutaneous flap. Split the deltoid anteriorly to minimize the chances of denervation. Leave a cuff of deltoid muscle to protect the axillary nerve. The cuff sutures are helpful in reduction of the proximal fracture segments and improve stability of three and four-part fractures. Avoid varus reduction and reestablish the relationship between the humeral head and the greater tuberosity. Proper plate positioning is important to maximize the possibility of using all proximal screw options and to minimize chances of impingement. As is necessary with all locked internal fixators, reduce the fracture before fixing the plate; the order of fixation may vary with the type of fracture. In our study of fifty patients with a displaced three or four-part fracture treated with this approach, all flaps healed well without any necrosis and no infections were seen.IndicationsContraindicationsPitfalls & Challenges.

Sequential Healing at Implants with Different Configuration and Modified Surfaces: An Experimental Study in the Dog.

To evaluate the peri-implant soft and hard tissue adaptation at implants with different modified surfaces and configurations. Six Beagle dogs were used. Mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness flaps were elevated, and two different types of trans-mucosal implants (ICX-Gold®, Medentis Medical GmbH, Dernau, Germany and SLActive®, Institute Straumann, Bern, Switzerland) and two different surfaces were randomly installed in the distal regions of one side of the mandible. Abutments were applied, and a nonsubmerged healing was allowed. After 1 month, the procedures were performed in the other side of the mandible, and after a further month, the animals were sacrificed, biopsies were collected, and ground sections prepared for histological examination. Similar results in marginal bone and soft tissues dimensions were observed after 1 month of healing at the two implant systems used, and no major changes could be observed after 2 months of healing. After 1 month, the percentage of new bone was 69.0% and 68.8% at ICX-Gold and SLActive surfaces, respectively. After 2 months, the percentage of new bone was 67.8% and 71.9% at ICX-Gold Medentis and SLActive surfaces, respectively. No statistically significant differences in osseointegration were found. The two implant systems used resulted in similar osseointegration after 1 and 2 months of healing.

The Effect of Flapless and Full-thickness Flap Techniques on Implant Stability During the Healing Period.

Purpose : When soft tissue flaps are reflected for implant placement, the blood supply from the periosteum to the bone is disrupted. The aim of this study was to compare the effects of the flapless (FL) and full-thickness flap (FT) techniques on implant stability. Methods : Nine patients received 22 implants. The implants were placed using the FL technique on the contralateral side of the jaw; the FT technique was used as the control technique. Resonance frequency analysis (RFA) was performed at the time of implant placement and at 6 and 12 weeks after implant placement. RFA values were compared between the FL and FT groups and between time intervals in the same group. Results : The median (interquartile range [IQR]) RFA values at the time of implant placement were 75.00 (15.00) for the FL technique and 75.00 (9.00) for the FT technique. At 6 weeks, the median (IQR) values were 79 (3.30) for the FL technique and 80 (12.70) for the FT technique. At 12 weeks, the median (IQR) values were 82.3 (3.30) for the FL technique and 82.6 (8.00) for the FT technique. There were no significant differences between the 2 techniques at the time of implant placement, after 6 weeks or after 12 weeks, with p values of 0.994, 0.789, and 0.959, respectively. There were significant differences between the RFA values at the time of implant placement and after 6 weeks for the FL technique (p=0.028) but not for the FT technique (p=0.091). There were also significant differences between the RFA values at 6 weeks and the RFA values at 12 weeks for the FL technique (p=0.007) and for the FT technique (p=0.003). Conclusion : Periosteum preservation during the FL procedure will speed up bone remodeling and result in early secondary implant stability as well as early loading.