Kind Of Reconstruction Research Articles

Fully automatic CAD design of the occlusal morphology of partial crowns compared to dental technicians' design

The aim of this study was to compare the occlusal morphology of partial crown reconstructions made by dental technicians with reconstructions made by a fully automatic software process (biogeneric tooth model) in relation to the original natural tooth shape. Stone replicas of natural teeth were measured three-dimensionally before preparing inlay and onlay cavities for ceramic restorations (n = 5). For each preparation, five reconstructions (in total n = 25) were made by five dental technicians. Additionally, reconstructions were calculated automatically by a software based on the biogeneric tooth model (Cerec 3D). In order to compare the two different kinds of reconstruction, an objective metrical similarity measure (shape similarity value, SSV) based on calculated volumes between compared datasets was used. In 22 of 25 cases, the reconstructions made by the CAD software were closer to the original situation than the reconstructions made by the technicians. Mean average SSV of reconstructions made by the technicians (310.2 ± 78.8 μm) was significantly higher (p < 0.05) than mean SSV of CAD reconstructions (biogeneric model) (222.0 ± 47.7 μm). In the design of naturally shaped occlusal inlay/onlay surfaces, a fully automatic CAD system can be at least as good as conventional wax-ups by dental technicians. The adjustment of a dental restoration to fit the morphology of surrounding tooth structures, still presents challenges for the dentist.

Reconstruction par lambeau perforant de l’artère intercostale latérale (LICAP) d’une séquelle sévère de traitement conservateur du cancer du sein

Lateral breast defect after partial mastectomy is a difficult challenge. Pedicled perforator flap is a new indication for breast surgery. Perforator flaps and fat tissue transplant are new concepts in this kind of reconstruction. Lateral intercostal artery perforator (LICAP) flap has been used for a lot of indications. It can be used for lateral breast defect reconstruction. This flap provides several advantages: minimal donor site morbidity, advantages in flap shaping, better aesthetic results and higher patient satisfaction. The aim of this paper is to present indications of LICAP flap. We discuss its advantages and its limits in lateral breast reconstruction after partial mastectomy. LICAP flap provides a new solution instead of conventional flaps.

Couverture d’une escarre trochantérienne par lambeau pédiculé fasciocutané antéro-latéral de cuisse

The anterolateral thigh flap is usually used as a free flap for various kinds of reconstruction and resurfacing of distant areas. Cover of a deep trochanteric pressure sore is commonly made by muscular or musculocutaneous flaps such as tensor of fascia lata or vastus lateralis. We report the case of a trochanteric pressure sore covered by a fasciocutaneous pedicled anterolateral thigh flap after negative pressure therapy in a 58-year-old paraplegic patient. After 6 months, a good quality of coverage was obtained with minimal morbidity of donor site. The pedicled fasciocutaneous anterolateral flap appears as a reliable option for the treatment of trochanteric pressure sore.

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

Postmastectomy Radiation Therapy and Breast Reconstruction: An Analysis of Complications and Patient Satisfaction.

Abstract Introduction: The indications for postmastectomy radiation therapy (PMRT) have expanded over the past decade. Plastic surgeons are reluctant to perform an immediate reconstruction followed by radiation because of their perception this sequence results in worse results. This study examines the relationship between the use and sequencing of radiation therapy on complication rates and patient satisfaction following reconstrucion.Methods: A retrospective chart review was performed of all women at an academic institution who underwent mastectomy and reconstruction from 1999-2006. The 769 reconstructed breasts were separated into 4 groups: PMRT prior to delayed reconstruction (n = 60); immediate reconstruction then PMRT (n = 56); reconstruction without PMRT (n = 540); and reconstruction after breast-conserving therapy with RT (BCT-RT, n = 113). The median length of follow-up was 44 months. All operative complications were categorized into early (≤90 days) or late. A questionnaire based on the Michigan Breast Reconstruction Outcomes Study assessed general and aesthetic satisfaction (response rate, 73.2%). Dichotomous variables were evaluated using the Fisher's exact or chi-squared test; statistical significance was set at p &amp;lt;0.05.Results: The overall complication rate for patients having PMRT (given before or after reconstruction) was higher than for patients with reconstruction only (36% vs. 27%, p = 0.048). The overall complication rate for women receiving PMRT then reconstruction was lower than for reconstruction then PMRT, although this was not statistically significant (28% vs. 45%, p = 0.068). Patients having reconstruction then PMRT had increased overall and late complication rates compared to patients having reconstruction only (45% vs.27.%, p = 0.006; 34% vs. 21%, p = 0.023, respectively). Results were similar when subdivided by the kind of reconstruction, except for increased late complications for patients having implant/expanders who had reconstruction then PMRT (62%, 8/13) compared to reconstruction alone (20%, 26/129) (p=0.003). General satisfaction was similar among all four groups. Aesthetic satisfaction was significantly lower in the PMRT then reconstruction group, compared to reconstruction only (48% vs. 65%, p = 0.029). Patients who underwent reconstruction then PMRT had similar aesthetic satisfaction compared to patients having reconstruction only (62% vs. 65%).Conclusions: Patients who have reconstruction prior to PMRT have increased overall and late complication rates compared to patients having reconstruction without radiation, but they have similar rates of general and aesthetic satisfaction. In contrast, patients who receive PMRT prior to delayed reconstruction have similar complication rates and general satisfaction levels to patients undergoing reconstruction only; however, the former patients report decreased aesthetic satisfaction. Patients requiring PMRT should consider both the risk of complications and likelihood of satisfaction in their decision-making process. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4102.

Biodegradacja węglowego implantu tchawicy w eksperymencie zwierzęcym

The radical treatment of tracheal stenosis comprises segmental resection and its reconstruction. The most successful type of reconstruction is the "end to end" technique. In cases with large tracheal defects (over 6 cm) this kind of reconstruction is impossible. From many years the adequate biomaterial is searched for the tracheal reconstruction. Most of the implanted biomaterials undergo biodegradation process. The aim of the study was to analyze the biodegradation process in carbon fibers of prosthesis implanted in tracheal defects in animal experiment. We studied the prosthesis implanted in tracheal defects in sheep. The prosthesis were built with composite biomaterial composed of carbon fibers and polisulfone. The observation period was 1, 2, 3, 4, 6, 8, 24 and 38 weeks. In the morphometric evaluations the breadth, curve width, fullness factor and mean grey level of carbon fibers were assessed. The results showed that carbon fibers undergo progressively degradation in animal environment. The width gradually decreased. The mean grey level in the first three weeks decreased, but in the next period it increased. Conclusion. The carbon fibers of segmental tracheal prosthesis undergo gradually degradation process in biological environment expressed by decreasing of their dimensions connected with the lost of irregularities and changes of structure density.

Brustrekonstruktion mit Becker-Expandern allein und in Kombination mit Latissimuslappen

BACKGROUND: The Becker permanent tissue expander for breast reconstruction was designed in order to achieve a more natural form of the breast by overexpansion followed by controlled deflation especially if combined with a latissimus flap. The present study was done in order to confirm this in our cases of breast reconstruction. METHODS: Between July 2003 and May 2007 in 43 breasts in 34 women an expander prosthesis was implanted, in 19 breasts in combination with a latissimus dorsi flap. In the same period the latissimus dorsi flap was used to cover a prosthesis of fixed volume in 9 cases. The anatomically shaped Becker 35 expander was implanted in 10 breasts in 6 women. Patients were examined physically after a median follow-up of 30 months. RESULTS: A generally low complication rate was seen after all kinds of reconstruction with Becker expanders. The breasts which were reconstructed by latissimus flaps and expanders exhibited larger breast volumes but only a slight increase in ptosis than the breasts after reconstruction by a latissimus and a prosthesis of fixed volume. CONCLUSIONS: The use of prostheses for breast reconstruction, alone or in combination with a latissimus flap is still a valuable method. According to our findings, a Becker expander should be suggested to be implanted under the latissimus flap, if the final volume of the prosthesis will be more than 300 cm3.

Simulations of the consequences of tongue surgery on tongue mobility: implications for speech production in post‐surgery conditions

We studied the ability of a three-dimensional (3D) biomechanical model of the oral cavity to predict the consequences of tongue surgery on tongue movements, according to the size and location of the tissue loss and the nature of the flap used by the surgeon. The core of our model consists of a 3D biomechanical model representing the tongue as a finite element structure with hexahedral elements and hyperelastic properties, in which muscles are represented by specific subsets of elements. This model is inserted in the oral cavity including jaw, palate and pharyngeal walls. Hemiglossectomy and large resection of the mouth floor are simulated by removing the elements corresponding to the tissue losses. Three kinds of reconstruction are modelled, assuming flaps with low, medium or high stiffness. The consequences of these different surgical treatments during the activation of some of the main tongue muscles are shown. Differences in global 3D tongue shape and in velocity patterns are evaluated and interpreted in terms of their potential impact on speech articulation. These simulations have been shown to be efficient in accounting for some of the clinically observed consequences of tongue surgery. Further improvements still need to be done before being able to generate patient-specific models easily and to decrease the computation time significantly. However, this approach should represent a significant improvement in planning tongue surgery systems and should be a very useful means of improving the understanding of muscle behaviour after partial resection.

Femoral tunnel placement in anterior cruciate ligament reconstruction: rationale of the two incision technique

Endoscopic anterior cruciate ligament (ACL) reconstruction can be performed through one-incision or two-incision technique. The current one-incision endoscopic ACL single bundle reconstruction techniques attempt to perform an isometric repair placing the graft along the roof of the intercondylar notch, anterior and superior to the native ACL insertion. However the ACL isometry is a theoretical condition, and has not stood up to detailed testing and investigation. Moreover this type of reconstruction results in a vertically oriented non-anatomic graft, which is able to control anterior tibial translation but not the rotational component of the instability. Femoral tunnel obliquity has a great effect on rotational stability. To improve the obliquity of graft, an anatomical ACL reconstruction should be attempt. Anatomical insertion of ACL on the femur lies very low in the notch, spreading between 11 and 9–8 o'clock position and the center lies lower than at 11 o'clock position. Femoral aiming devices through the tibial tunnel aim at an isometric placement, and they do not aim at an anatomic position of the graft. Also, a placement of tunnel in a position of 11 o'clock is unable to restore rotational stability. The two-incision technique, with the possibility to position femoral tunnel independently by tibial tunnel, allows us to place femoral tunnel entrance in a position of 10 'clock that can most accurately reproduce the anatomic behaviour of the ACL and can potentially improve the response of the graft to rotatory loads. This positioning results in a more oblique graft placement, avoiding problem related to PCL impingement during knee flexion. Further studies are required to understand if this kind of reconstruction can ameliorate proprioception as well as clinical outcome at a long-term follow-up.

Role of Poly(ADP-Ribose) Polymerase during Vascular Reconstruction

Open vascular repair of ischemic myocardium and aortic aneurysms results in a systemic inflammatory response that influences the mortality and morbidity of these procedures. Recent studies in animal models of complex vascular reconstruction indicate that the activity of poly(ADP-ribose) polymerase (PARP) may influence the mortality and morbidity of these kinds of reconstructions. PARP's activity, localized to nuclei and mitochondria, is stimulated by deoxyribonucleic acid (DNA) strand breaks. Activation of PARP results in synthesis of poly(ADP-ribose) sugar moieties, whose primary role is to protect DNA from degradation during cytotoxic stress. Paradoxically, when stressful conditions similar to those experienced during vascular reconstructions result in overactivation of PARP, depletion of cellular levels of adenosine triphosphate and nicotinamide adenine dinucleotide can result in exacerbation of tissue injury. Herein we review the role of PARP in inflammation and its relevance to cardiovascular reconstructions.

Effects of different operative procedures on the digestive and nutritional status of patients treated with a gastrectomy for gastric cancer

Postgastrectomy syndromes evoked by the loss of several gastric functions after total or subtotal gastrectomy are very common. Different kinds of reconstruction have been developed to overcome the problem. Patients with preservation of a duodenal passage and jejunal interposition with or without a pouch show a better quality of life and minimal symptoms postoperatively. A jejunal interposition with or without a pouch after proximal or distal subtotal gastrictomy seems to improve the nutritional condition and quality of life. The prognostic nutritional index (PNI), Visick score, Spitzer index and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire (QLQ-C30) are available to evaluate the quality of life and nutritional status after gastrectomy.

Bladder, Bowel and Bugs—Bacteriuria in Patients with Intestinal Urinary Diversion

The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of “antibacterial defenses”, and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.

Hand Reconstruction Using the Thin Anterolateral Thigh Flap

Perforator flaps have been introduced for various kinds of reconstruction and resurfacing; in particular, the free thin anterolateral thigh flap is becoming one of the most preferred options for reconstruction of soft-tissue defects. Between 1999 and 2002, the authors used this flap as a free flap for nine cases for covering hand defects after burn, crushing injuries, or severe scar contracture release. There were eight men and one woman, the mean age of the patients was 31 years, and the size of the flaps ranged from 7 x 3.5 cm to 15 x 9 cm; thinning was performed in all flaps. All flaps survived completely, and the donor site was closed directly in seven cases; in two cases, the exposed muscle was covered with split-thickness skin graft. The anterolateral thigh flap was thin enough for defects on the dorsum and/or palm of the hand and for first web reconstruction after scar contracture release. It has many advantages in free flap surgery including a long pedicle with a suitable vessel diameter, and the donor-site morbidity is acceptable. The thin anterolateral thigh flap is a versatile soft-tissue flap that achieves good hand contour with low donor-site morbidity.

What is reconstruction for ordered sets?

Reconstruction questions arise when studying interactions between the isomorphic type of a structure and the isomorphic types of its substructures. In this survey paper we are interested in binary relations and particularly we focus on partially ordered binary relations. We present most of the known results on partially ordered sets and that for different kinds of reconstruction: among them we have the Fraı¨ssé-reconstruction, the Ulam-reconstruction, the max-reconstruction and the set-reconstruction.

Source-group method to speed up the reconstruction of objects from radar data by using the FBTS method

We have proposed a time-domain forward-backward time-stepping (FBTS) method for reconstructing 3D structures in highly absorptive media. The reconstruction speed is greatly dependent on the number of transmitters. In this paper, we propose a source-group method to speed up the reconstruction. In the source-group method, multiple transmitters arranged at different positions are excited simultaneously, and receivers collect the wave fields. To compare the reconstruction results, three kinds of reconstructions from 16 conventional single transmitter-multiple receiver data sets, four source-group multiple-receiver data sets, and four conventional single-transmitter multiple-receiver data sets are carried out. Reconstruction by the source-group method is several times faster than (and the reconstructed results are almost the same as) those of the first kind of reconstruction, and they are much better than those of the third kind. © Wiley Periodicals, Inc. Microwave Opt Technol Lett 48: 67–71, 2006; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.21263

Bladder, bowel and bugs--bacteriuria in patients with intestinal urinary diversion.

The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of "antibacterial defenses", and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.

Effects of patient motion during myocardial perfusion SPECT on linogram and sinogram by two iterative and FBP reconstruction methods

Patient motion during myocardial perfusion SPECT (MPS) produces images with artifactual defects. We studied the pattern and extent induced by simulated motion using different kinds of reconstruction methods. Methods: Movements were applied to raw projections with control images and were assessed by a panel of consultants. The motions were applied in 1–3 pixels, in X and Y planes, plus and minus directions in early, middle and late phases of imaging, in non-returning and returning patterns. The simulated images were reconstructed using OSEM and FBP methods. Myoquant Software interpreted all images visually and quantitatively. Using simulated motions, 288 different states were studied plus 2 original images. From 144 images in each method of reconstruction, 64 and 32 images were categorized as definitely abnormal (P<0.001). These were 51 and 45 images in±direction of motion (P=0.602) and 54 and 45 images in X and Y directions (P=0.340). The summed stress score (SSS) was 5.25 and 8.25 using FBP and OSEM (P=0.001), 6.90 and 6.60 in the±direction (P=0.727), and 5.98 and 7.52 in the X and Y directions of motion (P=0.07). OSEM has more profound effect on motion artifacts and this kind of reconstruction should not be used when patient motion is suspected.

3D Surface and Body Documentation in Forensic Medicine: 3-D/CAD Photogrammetry Merged with 3D Radiological Scanning

A main goal of forensic medicine is to document and to translate medical findings to a language and/or visualization that is readable and understandable for judicial persons and for medical laymen. Therefore, in addition to classical methods, scientific cutting-edge technologies can and should be used. Through the use of the Forensic, 3-D/CAD-supported Photogrammetric method the documentation of so-called "morphologic fingerprints" has been realized. Forensic, 3-D/CAD-supported Photogrammetry creates morphologic data models of the injury and of the suspected injury-causing instrument allowing the evaluation of a match between the injury and the instrument. In addition to the photogrammetric body surface registration, the radiological documentation provided by a volume scan (i.e., spiral, multi-detector CT, or MRI) registers the sub-surface injury, which is not visible to Photogrammetry. The new, combined method of merging Photogrammetry and Radiology data sets creates the potential to perform many kinds of reconstructions and postprocessing of (patterned) injuries in the realm of forensic medical case work. Using this merging method of colored photogrammetric surface and gray-scale radiological internal documentation, a great step towards a new kind of reality-based, high-tech wound documentation and visualization in forensic medicine is made. The combination of the methods of 3D/CAD Photogrammetry and Radiology has the advantage of being observer-independent, non-subjective, non-invasive, digitally storable over years or decades and even transferable over the web for second opinion.

Full thickness chest wall reconstruction after tumor resection by myocutaneous flap

Full thickness chest wall defects result when a chest wall tumor resection is necessary. The feasibility of a reconstruction is sometimes unfamiliar to the oncologist or thoracic surgeon; this can be the reason for refusing the possibility of surgical resection or inappropriate coverage of the defect. Our experiences over the last 7 years in collaboration between plastic the thoracic surgical services, shows that it is generally possible to utilize a myocutaneous flap for reconstruction of even extensive full thickness chest wall defects. The reconstruction of any full thickness chest wall defect after tumor resection by myocutaneous flaps is almost always possible with low mortality, acceptable morbidity and good results, mechanically and aesthetically. The experience with the different reconstruction techniques clearly shows the preference for the latissimus dorsi myocutaneous flap, but also emphazises that the other kinds of reconstruction must be kept in mind for special indications.

Jejunum free flap in hypopharynx reconstruction: case series.

BackgroundSurgical treatment of hypopharyngeal cancers with extension to the retrocricoid region generally requires a circumferential pharyngolaryngectomy followed by a reconstruction of the removed segment of the upper digestive tract. Historically, many techniques have been used in order to achieve a safe and functional reconstruction. Jejunum interposition is generally considered the best reconstructive technique.MethodsThis study examines the details of the surgical technique, the complications, the oncological and the functional results in a series of 29 consecutive patients submitted to circumferential pharyngoesophageal resection for advanced hypopharyngeal cancer followed by reconstruction with a free flap of jejunum.ResultsThree of the transplants failed because of venous thrombosis. The overall success rate was 90%. There were no general complications. A good swallowing has been preserved in all our patients. All our patients where a phonatory prosthesis was positioned (20/29) were able to achieve speech following speech therapy and all were satisfied with their own capacity to communicate.ConclusionsThe prognosis of hypopharyngeal tumours (18–40% at 5 years) remains poor, but jejunum autografts are being shown to be an excellent choice for the reconstruction of the cervical hypopharyngo-oesophagus offering the patient fast rehabilitation and a reasonable quality of survival. Our experience confirm that this kind of reconstruction is safe with a good results in improving oncologic controls and restoring a good quality of life.