Graft For Closure Research Articles

Buccal fat pad with sandwich graft versus buccal fat pad with block graft in closure of oroantral communication: prospective clinical study

Objective: The present study was performed to evaluate the efficacy of buccal fat pad with sandwich graft versus buccal fat pad with bone block graft in closure of oroantral communication. Subjects and methods: Patients of the present study were selected from those attending the outpatient clinic of Oral and Maxillofacial Department at Faculty of Dental Medicine, Al Azhar University (Assiut Branch). Fourteen patients with oroantral communications were divided in two groups: (group I) treated with sandwich graft covered by buccal fat pad, and (group II) treated by bone block covered by buccal fat pad. Results: Closure of oroantral communication was successful in both groups. No patient had any infection, graft exposure and /or loss, soft tissue dehiscence. Radiographic analysis revealed significant increase in bone density fo both groups, (from 693.5 ± 28.61 immediately postoperative to 805.2 ± 28.06 after 9 months) for G (I) And (from 590.0 ± 30.24 immediately postoperative To 683.3 ± 16.59 after 9 months) for G (II). Also, there was significant decrease in bone height in bone height in both groups at 6 and 9 months. Conclusion: Closure of OAC with buccal fat pad and bone graft not only gives excellent soft tissue healing, but also compensate the underlying bone defect.

Evaluation of Platelet Rich Fibrin Sandwiching technique with mixture of alloplastic bone graft and Hyaluronic Acid in repair of Recurrent Oronasal Fistula

Aim: is to evaluate efficacy of platelet rich fibrin (PRF) sandwiching technique associated with hyaluronic acid (HyA) mixed with alloplastic bone graft in closure of recurrent oronasal fistula after previously alveolar cleft grafting. Subjects and Methods: Our study conducted on 24 patients with recurrent unilateral oronasal fistula complaining of oronasal leakage. They were divided into two random equal groups. Group I, alveolar cleft defect was packed with alloplastic bone graft ( osteon II collagen) between two layers of PRF gel. While, in group II, alveolar cleft defect was packed with a mixture of alloplastic bone graft (osteon II collagen) and HyA between the two layers of PRF gel. All patients were observed clinically and radiographically (CBCT) for evaluation after three and six months postoperatively. Results: Our clinical results revealed that, all patients had uneventful wound healing except 4 cases in group I and one case in group II which had wound dehiscence and graft exposure at 1-week postoperatively. The radiographic results by CBCT scans showed a better new bone formation and good osseous union obliterating the oronasal defect.in group II than group I. There was a significant difference between bone density and bone resorption values in both groups at all intervals. Conclusion : Our results demonstrated that PRF sandwiching technique combined with a mixture of alloplastic bone graft and HyA could provide a favorable bony and soft tissue barriers for closure of recurrent oronasal fistula in alveolar cleft patients.

Clinical and radiographic evaluation of buccal pad of fat versus sandwiched Bio-Oss® bone graft in closure of oroantral communication

Aim: Evaluation of buccal fat pad versus sandwiched Bio-Ossbone graft in the management of oroantral communication.Materials and Methods: This study was carried out on 12 patients with oroantral communication. They were divided into 2 groups, 6 patients in each. In Group A, the patients were managed with sandwiched Bio-Oss bone graft technique,while in group B, the patients were treated with buccal fat pad technique.Results: There was no significant difference between the two groups regarding pain, swelling and infection during different follow up periods. No recurrence for the oroantral communication was observed in all patients of both groups after one month postoperatively. Panoramic radiographs showed an evidence of bone formation in all the patients of Group A and in zero patients in Group B after 3 months postoperatively.Conclusion: No recurrence for the oroantral communication was observed in all patients of both groups at the end of the clinical follow up period after 1 month. In group A, new bone formation was evident in the panoramic x-rays after 3 months postoperatively where this can allow implant placement at the site of closure. On the other hand, patients in group B didn't show any evidence of new bone formation and no implants can be placed unless further surgical procedures are carried out.

Evaluation of Graft Uptake and Hearing Assessment after Palisade Myringoplasty

Cartilage as a graft for closure of tympanic membrane has got superior benefits than other usual grafts (temporalis fascia and perichondrium). Cartilage supported myringoplasty with palisade technique has good result of graft uptake rate, even under difficult conditions. This technique brings very good functional and better long-term results. This study is done to assess graft uptake rate and hearing improvement after myringoplasty with cartilage palisade technique. It is a descriptive, hospital based observational study done at Manipal Teaching Hospital, Pokhara between 2014-2017. A total of 45 patients aged between 13 years and 44 years diagnosed with chronic otitis media-mucosal were taken. Pure tone audiometry was done before and six months after surgery. Graft uptake and Post-operative hearing gain was evaluated after six months. Statistical analysis was done by Statistical Package for Social Sciences version 16.0. Statistical significance was set at P<0.05. Graft uptake rate was 41 (91.1%). The mean pre-and post-operative pure tone average were 26.88dB and 8.44dB respectively. The post-operative hearing gain was 18.36dB. Hearing improvement after surgery was found to be statistically highly significant with P<0.001. Cartilage supported myringoplasty using palisade technique is preferred for chronic otitis media-mucosal with large and sub-total tympanic membrane perforation.

The use of buccal fat pad free graft in closure of soft-tissue defects and dehiscence in the hard palate

Introduction:The integrity of the palatal mucosa can be lost due to congenital, pathological, and iatrogenic conditions. Various surgical techniques have been suggested for the closure of palatal defects. The aim of the current study is to present the free buccal fat pad graft as a novel technique to repair the soft-tissue defects at the palate.Patients and Methods:During a 2-year period, the free fat tissue graft harvested from the buccal fat pad (BFP) (FBFG) and used to reconstruct five soft-tissue defects of the palate in five patients (2 women, 3 men; mean age, 34 years; range, 22–58 years). In two patients, the palatal defect size was 2–3 cm and resulted from the resection of pleomorphic adenoma. In two other patients, the defect was due to odontogenic lesion, and in the last patient, the etiology was an iatrogenic dehiscence during maxillary segmentation surgery. Patients were examined every 2 weeks in the first 3 months and thereafter every 3 months.Results:Five patients were treated with FBFG to reconstruct palatal defects and were followed up for 6–24 months. The healing process of the BFP and the recipient sites were uneventful, with minimal morbidity. At 3 months after the surgery, there was complete epithelialization of the graft at the recipient sites.Conclusions:Harvesting of FBFG is a simple procedure with minor complications; manipulation and handling the graft are easy. The use of FBFG in reconstruction of small and medium palatal defects is encouraging with excellent clinical outcomes.

Simple Underlay Myringoplasty: A Prospective Study

Background: Chronic otitis media (COM) is highly prevalent disease encountered by an otologist world wide and also in Nepal. Myringoplasty is the treatment of choice in many cases. There are various techniques of performing myringoplasty with various types of grafts. We propose Simple Underlay Myringoplasty (SUM) using fat graft. Objective: The objective of this study was to evaluate the role of fat graft in closure of small dry central perforations by simple underlay myringoplasty (SUM) with aim to introduce SUM technique in this part of Nepal (Mid Western and Far Western Region).Methods: Young patients above 15 years of age with diagnosis of chronic otitis media, mucosal type with perforations smaller than 50% of tympanic membrane were included for fat graft myringoplasty. There were total 25 cases included for the study. All the cases were done under local anesthesia. A large single piece of fat, approximately double the size of perforation was harvested from the posterior side of ear lobule. The margin of perforation was freshened. The fat was placed like a dumbbell, equal portion lies medial and lateral to the perforation. Graft uptake results were evaluated after 4 weeks.Results: Graft uptake was successful in 23 patients (92%).Conclusion: The technique avoids extensive middle ear manipulation and it is safe, simpler procedure for the closure of a dry small central perforation. Its success rate is as good as myringoplasty using temporalis fascia in small central perforations.Journal of Nepalgunj Medical College Vol.12(1) 2014: 19-21

Application of Skin Stretching Technique for Closure of Large Surface Skin Defects

Closure of large defects skin surface after extensive burns remains an important issue in plastic and reconstructive surgery. Deficit of intact skin dictates a careful and creative approach to surfaces of normal skin. Skin stretching technique using tissue expansion device is a promising approach to treat the little patients with large skin defects. The goal of this approach is to form a full-thickness skin flap of a desired size in cases where skin surfaces, typical for taking a graft, are limited in area or damaged. The resulting skin graft, obtained by our method, could be used on various body parts. We have treated 25 patients with large defects of skin surface using skin stretching technique. 24 patients had burn trauma and one child had a trauma related to a car accident. All patients had cicatricial deformations and various degrees of contractures, which were associated with significant limitations in their everyday life. Using skin stretching devices we were able to get full-thickness skin grafts ranging to 300 sq cm. Scar deformations and contractures were corrected in all patients. Skin stretching technique has been proven to be a useful method in treating large surface skin defects in pediatric patients with various burns, cicatricial contractures, other traumatic causes of skin defects. Skin stretching technique allows receiving a full-thickness skin graft of a desired size similar to normal skin. This method solves a problem of lack of skin graft for closure of large wound areas.

Divided full-thickness skin graft for closure of circular and oval scalp defects

Divided full-thickness skin graft for closure of circular and oval scalp defects

Rathke Cleft Cysts

Object. Microscopic Rathke cleft cysts are a common incidental autopsy finding, but some Rathke cleft cysts can become sufficiently large to cause visual impairment, hypothalamic-pituitary dysfunction, and headaches. In this study patients were evaluated preand postoperatively to ascertain the clinical significance of surgical intervention on endocrine and visual improvement. Factors correlated with cyst recurrence were also evaluated. Methods. A retrospective analysis was conducted in 160 patients with Rathke cleft cysts who were treated between 1984 and 1995 and completed at least a 5-year follow-up period. Of these 160 patients, 118 initially exhibited symptoms of visual impairment or endocrine dysfunction, became symptomatic during the follow-up period, or were found to have cyst enlargement. These 118 patients underwent transsphenoidal surgery. Forty-two patients with incidental lesions that demonstrated no growth on magnetic resonance (MR) images were followed up without an operation. Complete resection, as observed on MR images 3 months postoperatively, was obtained in 114 (97%) of 118 patients. Vision improved postoperatively in 57 (98%) of 58 patients. Hypogonadism improved in 11 (18%) of 62 patients, growth hormone deficiency resolved in 14 (18%) of 78 patients, and hypocortisolemia resolved in one (14%) of seven patients. Twenty-two patients (19%) began to exhibit symptoms of diabetes insipidus, which had not been present preoperatively. The total 5-year recurrence rate was 18% (21 of 118 patients), with 12 patients requiring a repeated operation. Surgical and pathological factors that were found to be statistically associated with recurrence were the use of a fat and/or fascial graft for closure (p < 0.01) and the presence of squamous metaplasia in the cyst wall (p < 0.01). The extent of resection of the cyst wall was not associated with an increased rate of recurrence. In 42 (69%) of 61 patients the incidental cysts did not progress on imaging studies or clinically. Conclusions. This is the largest series of patients with symptomatic Rathke cleft cysts who received operative intervention and participated in the longest postoperative follow up reported in the literature. The high recurrence rate (18%) supports the theory that a relationship exists between a symptomatic Rathke cleft cyst and craniopharyngioma. Improvements in visual and endocrine dysfunction can be expected after surgical decompression of the optic apparatus and the hypothalamic-pituitary axis.

Comparative study of the ipsilateral full thickness forearm skin graft in closure of radial forearm flap donor site defects

The early experience of our unit with the technique of ipsilateral full thickness forearm skin grafting of the radial forearm flap donor site defect is described. The technique provides the advantages of a full thickness skin graft whilst avoiding the need to harvest skin from a remote area. We have compared the results with that of split skin grafts used contemporaneously for the same purpose in our unit; the advantages and disadvantages are outlined. Continued success has encouraged us to utilize this technique routinely with certain modifications which we describe.

Bilobed Latissimus Dorsi Flap for a Decubitus Ulcer

A case is presented of a bilobed latissimus dorsi flap. The advantage of this flap is to close a large defect without having to resort to a skin graft for closure of the donor-site defect. The advantages of this procedure are as follows: Well-vascularized, stable coverage for decubitus ulcers. Acceptable cosmetic deformity. Avoidance of a skin graft. Decreasing the length of hospitalization.

FULL-THICKNESS SKIN GRAFT FOR CLOSURE OF TYMPANIC MEMBRANE PERFORATIONS. FOLLOW-UP INVESTIGATION OF 140 CASES.

During the years 1959–1960, 156 patients have undergone tympanoplastic operation type I using retroauricular skin. 140 of these cases have been followed up with an observation time of between 23/4 and 43/4 years.In 60 per cent there has been a primary healing. A control examination about 4 years later showed the healing to be 33 per cent. This figure will probably be still lower as many transplants have, more or less, dermatitic changes.

Experimental use of nylon mesh-supported pericardial grafts for closure of full-thickness esophageal defects

Experimental use of nylon mesh-supported pericardial grafts for closure of full-thickness esophageal defects