Labial Graft Research Articles

Surgery for female urethral stricture.

Female urethral stricture (FUS) is a rare entity that causes great morbidity and suffering in those affected. As the available scientific data is sparce, there are no formal guidelines or standard of care for this disease. This is a narrative review of the surgical management for female urethral stricture. The literature review was performed on PubMed. Articles were limited to English, but there was no limitation in terms of date. Management of FUS is divided between endoscopic and open surgical repair. Urethral dilation with or without urethrectomy can be offered as a first-line treatment. However, the rate of success of this procedure remains inferior to open surgical repair, and its efficacy decreases with the number of previous dilations. For distal urethral strictures, distal urethrectomy and advancement meatoplasty may be considered. Vaginal flaps are readily available, easy to harvest, well-vascularized, and allow for a dorsal or ventral orientation urethroplasty. The results of this procedure are promising, but most studies are small and retrospective. Labia flaps are easily accessible, wet, hairless, and elastic. The main limitations with the use of vaginal or labial tissues are co-existing conditions such as lichen sclerosis or vaginal atrophy, which may affect future results. Vaginal and labial graft urethroplasty can be used when it is not possible to mobilize an adequate flap. Stricture-free rates of this technique are variable. In cases of more severe stricture, an augmentation urethroplasty using buccal mucosa graft may be necessary. The techniques used in FUS replicate those for male urethral strictures, where both ventral and dorsal approaches can be utilized. Although there is growing interest in the field, the optimal management of FUS remains to be determined.

Reconstruction of Interdental papilla through connective tissue graft with orthodontic treatment: A Clinical Case Report

Regeneration of interdental papilla damaged by periodontal disease has been a very challenging task. Up until now, many dentists have devised and introduced great surgical methods. When I compared the pros. and cons. of these many methods, I came up with the best way to regenerate interdental papilla. Temporarily creating space between narrow interdental papilla, which could not be solved by periodontal surgery alone, was a great help for connective tissue graft (CTG). The CTG was performed using a microblade, and only one vertical incision was required from the gingival margin. The graft was then performed by inserting the grafts through this incision. Along with the orthodontic treatment, the area between the narrow interdental papilla was widened, which made it easier to carry out the CTG. After a period of maintenance, I was able to bring the teeth together again using orthodontic force and regenerate the interdental papilla. I named this method the ELSA (Enlargement of space - Labial graft - Squeezing - for Augmentation of papilla) technique.

The Influence of Different Guided Bone Regeneration Procedures on the Contour of Bone Graft after Wound Closure: A Retrospective Cohort Study.

The aim of this study was to evaluate the impact of different guided bone regeneration (GBR) procedures on bone graft contour after wound closure in lateral ridge augmentation. A total of 48 patients with 63 augmented sites were included in this study. Participants were divided into 4 groups (n = 12 in each group) based on different surgical procedures: group 1: particulate bone substitute + collagen membrane; group 2: particulate bone substitute + collagen membrane + healing cap, group 3: particulate bone substitute + injectable platelet-rich fibrin (i-PRF) + collagen membrane; group 4: particulate bone substitute + i-PRF + surgical template + collagen membrane. After wound closure, the thickness of labial graft was measured at 0–5 mm apical to the implant shoulder (T0–T5). At T0–T2, the thickness of labial graft in group 4 was significantly higher than the other three groups (p < 0.05). And group 4 showed significantly more labial graft thickness than group 1 and group 2 at T3–T5 (p < 0.05). Within the limitations of this study, the use of i-PRF in combination with the surgical template in GBR may contribute to achieving an appropriate bone graft contour after wound closure.

Deciphering the enigma of female urethral strictures: A systematic review and meta-analysis of management modalities.

To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was usedto assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome"of repair. The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean follow-up of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with95% (95% CI 0.86-1) for the ventral approach. FUS is a rare conditionrequiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.

Erectile dysfunction after urethroplasty.

IntroductionThe aim of this study was to analyze the influence of urethroplasty on sexual function.Material and methodsWe analyzed 75 operations: 41 anastomotic, 13 labial graft, 6 thigh skin mesh graft, and 15 penile skin flap urethroplasties. The severity of erectile dysfunction was assessed in the International Index of Erectile Function (IIEF5) questionnaire, preoperatively and at least 3 months after the surgery. The appearance of possible penile deformities was also evaluated postoperatively.ResultsThe etiology and location of the stricture had no impact on the erectile dysfunction in men with untreated urethral stricture. The difference in mean IIEF5 score before and after the first urethroplasty was not statistically significant (12.58 ±9.01 and 10.88 ±9.28; t(42) = 1.25, p = 0.220). The length of the stricture had no impact on the preoperative and postoperative IIEF5 score. Stricture in penile urethra caused a risk of postoperative penile curvature (p = 0.023).ConclusionsPatients with urethral stricture have a higher rate of erectile dysfunction than healthy men. Proper therapy should not negatively affect erectile function in a significant way, regardless of the length or location of the stricture, though it may have some influence on the penile anatomy.

Contemporary surgical management of female urethral stricture disease.

Female urethral stricture disease is increasingly recognized as an uncommon but important cause of lower urinary tract symptoms in women, which is amenable to surgical treatment. Several new reconstructive techniques have recently been described. The purpose of this review is to summarize the past literature with a focus on more recent contributions. Several new studies have recently been published investigating previously described reconstructive techniques including vaginal flap urethroplasty using the ventral approach, ventral labial graft, dorsal vaginal graft and dorsal buccal mucosal graft urethroplasty. Success rates, variably defined, ranged from 57.1 to 100% in these new contributions. No incidences of stress urinary incontinence were described. There continues to be lack of robust evidence to advocate one technique of urethroplasty for female urethral stricture disease over another, surgeon experience is likely to be an important factor. Urethroplasty using a flap or graft augmentation is a feasible treatment for female urethral strictures with good reported success rates and a minimal risk of stress of incontinence. Further studies are required to define the optimal technique and approach.

Vaginal and Labial Grafting to the Oral Cavity: A Review of 7 Cases

In Brief Objective: Grafting materials for the repairs of oral mucosal and urethral defects have been the subjects of extensive research. Methods: A series of 7 patients is presented in which oral mucosal defects were corrected using grafts from vaginal and labia minora epithelium. Six patients had undergone previous grafting procedures. The details of the donor site retrieval are described. Patients were evaluated postoperatively for donor site morbidity and success of the grafting procedure. Results: In this series of patients, epithelium from the vagina and the labia minora proved to be excellent tissue for grafting of oral mucosal defects. All patients had greater than 85% take of their grafts. Conclusions: According to the findings in this series, vaginal epithelium appears to offer an ideal grafting material to repair mucosal defects in the oral cavity. These findings coincide with reports of successful grafting of buccal mucosa to urogenital epithelium. Vaginal epithelium is hypothesized to be a suitable graft tissue for buccal defects.

Referral patterns in implant dentistry

omy to more predictably correct these defects. Five consecutive cases of maxillary alveolar distraction (AD) were compared to 5 consecutive osteotomy cases (SO). Parameters studied were the total distraction length desired and achieved, reconstitution of tissue height, favorable vector control, need for additional bone grafting, need for soft tissue grafting, total treatment time. Results: The sandwich alveolar bone graft technique was developed and applied in 5 sites, 5 patients. The surgical technique involves an alveolar osteotomy, for vertical displacement of the inferior fragment and placement of an interpositional autologous mandibular graft. A primary cortical mandibular ramus graft served as the donor site. Key surgical features included elevation of bone to the bone level of adjacent teeth, mobilization of the alveolar segment and retention of the adhering overlying gingival. Mobilization of the distal segment and malleting the graft into place were important for stability. From 5 to 8 mm of desired bony height for SO and 10 to 14 mm for AD were measured using periapical radiographs. Prolonged total treatment time, greater distraction lengths, reduced maintenance of tissue height, and increased need for additional bone grafting as a labial onlay were noted for AD, for equivalent intervals of 6-8 months later. The loss of tissue height could be accommodated for by modification of incision design for implant placement. The disparate distracted lengths may have accounted for the need for additional bone grafting and unfavorable vector control for AD. The recuperation following SO was similar requiring a 2to 5-day postoperative disability period, but there were fewer postoperative visits. AD required a procedure to eliminate the distraction device. Dehiscence over the distraction device could lead to unfavorable esthetic scarring. In contrast, to AD, there was no incidence of dehiscence or delayed labial grafting with SO Conclusion: Advantages of the technique noted include: accurate reliable reconstruction of the alveolus, elimination of additional bony reconstructive procedures, no relapse in the short term, and safer use of an acrylic interim denture for esthetic purposes. On the basis of this pilot study it appears that for vertical lengths of 5-8 mm, SO seems a more predictable procedure simply based on the number of postoperative visits and reduced total treatment time.