Soft Tissue Loss Research Articles

Traumatic Complete Loss of Knee Extensor Mechanism and Its Reconstruction With a Fresh-frozen Patellar Allograft With Patellar and Quadriceps Tendon.

We report on an 18-year-old female who sustained complete loss of her knee extensor mechanism (patella, quadriceps and patellar tendon) due to a motorbike injury with severe soft tissue loss of the ventral aspect of the knee and subsequent infection. After infection control and successful latissimus dorsi free flap surgery, reconstruction of the knee extensor mechanism was performed using a fresh frozen extensor mechanism allograft with patella, quadriceps- and patellar tendon and integrated tibia tuberosity fragment. After a follow-up of 18 months, there was infection free integration of the allograft with a range of motion 0-0-90° (extension/flexion) and pain free gait.

The Papilla Base CTG: A Novel Approach for Interdental Soft Tissue Reconstruction.

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article presents a novel surgical approach that applies the principles of the Connective Tissue Graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the aesthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal incisions, application of amelogenins, and a trapezoidal shape CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials.

The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, 'In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?' The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Motorcycle Wheel Spoke Injury to the Ankle and Foot in Children: A Cross-sectional Observational Study.

In developing countries, motorcycles are a widespread transportation method, leading to a notable increase in road traffic injuries, particularly those involving the ankle and foot caused by motorcycle wheel spokes. Our study sought to understand the epidemiological features and characteristics of motorcycle-induced wheel spoke injuries to the ankle and foot in children. The objectives were to comprehend injury patterns, evaluate their severity and pinpoint clinical indicators predicting injury nature and extent, aiming to guide prevention strategies. We conducted a cross-sectional observational study with a retrospective data collection focused on children under the age of 16 years who sustained injuries from motorcycle rear wheel spokes while riding as pillion passengers and were admitted to our department over 11 years, from 1 January 2010 to 31 December 2020, with a minimum follow-up of 2 years. Soft tissue wounds were classified using the Oestern-Tscherne classification. Thirty patients were enrolled in this study. Before 2015, cases ranged from none to one annually, increasing to 2-7 cases per year after 2015. The average age was 6.7 ± 2.1 years. Significantly, more patients were older than 6 years (P < 0.001), injured on the right side (P < 0.001) and suffered the injuries in the afternoon (P < 0.001). All patients were pillion and were injured by the motorcycle's rear wheel. Twenty-five patients (83%) had a Grade 3 injury. There was a tendon rupture in 22 (73%) and a bone fracture in 15 (50%) patients. Loss of soft tissue (P = 0.036) and reduced ankle mobility (P = 0.046) were linked to tendon ruptures. Lengths of wound exceeding 6 cm (P = 0.025) and loss of soft tissue (P = 0.025) were associated with a bone fracture. Children's motorcycle wheel spoke injuries have increased in recent years. Loss of soft tissue and ankle mobility deficit proved to be reliable clinical signs of a tendon rupture. A wound length exceeding 6 cm and a loss of soft tissue were indicative of a related bone fracture.

STAGED URETHROPLASTY FOLLOWING SEVERE ELECTRIC BURNS TO PERINEUM AND GENITALIA: A CASE REPORT

Objective: This study aims to know the surgical treatment of electrical injuries, perineum, and scrotum. Case(s) Presentation: A 55-year-old male sustained electric burns to the back, perineum and scrotum. The patient failed to void following removal of the catheter 6 weeks later, hence the patient was referred to the urology department for further management. was counselled for a two-phase urethral surgery. Discussion: In our case, the patient had sustained perineal and scrotal burns when he sat over a live wire. This led to the loss of skin and soft tissues, needing massive musculoskeletal and skin grafts. Our patient underwent a number of revision surgeries leading to repeated scarring of the perineal tissues and skin. Conclusion: Electrical injuries to the perinium and genitalia are rare. Hence the surgical strategy of electrical injuries requires a step-wise approach. Initially, conservative debridement needs to performed so as to preserve any tissue of questionable viability and ensure subsequent adequate soft-tissue coverage. The reconstructive surgical procedures bring about satisfactory outcomes. Keywords: Electrical injury, perineum, scrotum, surgical strategy.

A Randomized Controlled Trial on the Timing of Soft-Tissue Augmentation in Immediate Implant Placement: Hard-Tissue Changes and Clinical Outcome.

To assess the impact of the timing of soft-tissue augmentation (STA) on mean buccal bone changes following immediate implant placement (IPP) in the anterior maxilla. Patients with a failing tooth and intact buccal bone wall in the anterior maxilla (15-25) were enrolled in this randomized controlled trial. Following single IIP and socket grafting, they were randomly allocated to the control group (immediate STA performed during the same surgical procedure) or the test group (delayed STA performed 3 months later). Implants were placed with a surgical guide and immediately restored with an implant-supported provisional crown. Changes in bone dimensions were assessed using superimposed CBCT images taken prior to surgery and at 1-year follow-up. Clinical outcomes were registered at 1-year follow-up. Twenty patients were randomized to each group (control: 16 females, 4 males, mean age 57.6; test: 9 females, 11 males, mean age 54.2). Ten patients in the control group and 13 patients in the test group had a thick bone wall phenotype. Estimated marginal mean horizontal buccal bone loss at 1 mm below the implant shoulder was -0.553 and -0.898 mm for the control and test group, respectively. The estimated mean difference of 0.344 mm in favour of the control group was not significant (95% CI: -0.415 to 1.104; p = 0.363). Also at all other horizontal and vertical levels, no significant differences could be observed between the groups. The combination of socket grafting and STA enabled counteraction of any buccal soft-tissue loss (≥ 0 mm) at 1 mm below the implant shoulder in 82% of the patients in the control group and in 75% of the patients in the test group (p = 1.000). The clinical outcome was favourable in both groups, yet implants in the control group demonstrated slightly less marginal bone loss (median difference 0.20 mm; 95% CI: 0.00-0.44; p = 0.028). In patients with an intact and mainly thick buccal bone wall in the anterior maxilla, the timing of STA following IIP had no significant impact on mean buccal bone loss. ClinicalTrials.gov identifier: NCT05537545.

Biomaterial Scaffolds for Periodontal Tissue Engineering.

Advanced periodontitis poses a significant threat to oral health, causing extensive damage and loss of both hard and soft periodontal tissues. While traditional therapies such as scaling and root planing can effectively halt the disease's progression, they often fail to fully restore the original architecture and function of periodontal tissues due to the limited capacity for spontaneous regeneration. To address this challenge, periodontal tissue engineering has emerged as a promising approach. This technology centers on the utilization of biomaterial scaffolds, which function as three-dimensional (3D) templates or frameworks, supporting and guiding the regeneration of periodontal tissues, including the periodontal ligament, cementum, alveolar bone, and gingival tissue. These scaffolds mimic the extracellular matrix (ECM) of native periodontal tissues, aiming to foster cell attachment, proliferation, differentiation, and, ultimately, the formation of new, functional periodontal structures. Despite the inherent challenges associated with preclinical testing, the intensification of research on biomaterial scaffolds, coupled with the continuous advancement of fabrication technology, leads us to anticipate a significant expansion in their application for periodontal tissue regeneration. This review comprehensively covers the recent advancements in biomaterial scaffolds engineered specifically for periodontal tissue regeneration, aiming to provide insights into the current state of the field and potential directions for future research.

Concurrent plate fixation and pedicled flap coverage for open fractures complicated by soft tissue loss of the tibia in pediatric cohort: a clinical series.

The optimal treatment of open fractures complicated by soft tissue loss of pediatric tibial fractures remains inconclusive. The author described a protocol of concurrent plate fixation and pedicled flap coverage and retrospectively reviewed the outcomes of such injuries. A total of 25 pediatric cases with Gustilo lllB open tibial fracture were treated by single-stage plate fixation and pedicled flap reconstruction. The reviewed information consisted of time to fix and flap, type of plate, type of pedicled flap, fracture union time, postoperative complication and the clinical outcomes by objective scoring system. Fix and flap was undergone between 7 and 12days after injury with the average time of 8.2days. Regarding the type of plate, narrow LCP was applied in 8, 3.5mm precontoured LCP in 10, 5.0mm precontoured in 2 and double LCP in 5. According to soft tissue reconstruction, the medial gastrocnemius flap was selected in 6 cases, myocutaneous medial gastrocnemius flap in 2, soleus flap in 3, hemisoleus flap in 5, reverse sural flap in 6 and combined medial gastrocnemius and hemisoleus flaps in 3. No flap-related complication was demonstrated. All cases established fracture union in between 12 and 24weeks with an average time to union of 17.7weeks. According to postoperative complications, infected plate occurred in 2 cases and implant irritation in 5. According to Puno functional score, excellent results were presented in 7 cases and good results in 18 cases. Single-stage plate fixation and pedicled flap coverage are a reliable regimen for pediatric open fractures complicated by soft tissue loss of the tibia.

The Different Surgical Approaches to Maxillofacial Reconstruction after Ballistic Trauma.

Ballistic trauma to the face is a challenge, combining complex bone injury with severe soft tissue loss. The various surgical methods available are influenced by the extent of injuries. This study compares different operative modalities and their outcomes with different variables, aiming to define the ideal therapeutic approach. We retrospectively compared reconstructive modalities used to treat facial ballistic trauma cases at Hôtel-Dieu de France Hospital, Beirut, Lebanon, for a 12-year span. Statistical analysis was used to determine correlation between several factors and satisfactory results. Eighteen patients were included, with varying degrees of bone and soft tissue loss. After conservative debridement, fractures were treated by different modalities: open reduction and internal fixation, maxillomandibular fixation, and osteosynthesis with a reconstruction plate. Although primary closure was sufficient in 10 cases, severe loss of tissues was reconstructed with a fibular free flap in five cases, radial free forearm flap in two cases, and free parascapular flap in one case. Two others received an iliac bone graft as secondary reconstruction. The average follow-up was 2.45 years. Most cases achieved good aesthetic and functional results after several secondary operations, with few late complications. Early reconstruction and younger patients were associated with better outcomes. We favor early debridement and reconstruction. Free flaps were ideal for extensive tissue loss. Bone grafting was needed secondarily. A single surgical procedure seldom led to satisfactory functional and aesthetic outcomes, and secondary operations were inevitable.

Perforator-based local flaps for cutaneous facial reconstruction

BackgroundDespite the advancement of reconstructive surgical techniques, facial defect reconstruction has been always very challenging, aesthetic satisfaction has often been difficult to achieve due to the unique characteristics and complexity of the facial tissue. There have been various options regarding reconstruction and compensation of soft tissue loss all over the body rather than the face. Regardless of whether skin grafts, local flaps, and free flaps were used in the reconstruction process, each of them has its limitations. Beginning with skin grafts results could not always be satisfactory due to contracture, color, and lack of texture Additionally, local flaps have limitations due to mobility and the availability of overlapping skin and tissue, as well as the bulkiness of the pedicle which may need a second staged surgery and lately the difficulty of the free flaps and being a major surgery.ResultsPatients ages ranged between 23 and 77 years old, with a mean age of 58.33 ± 12.47. As regards the patients’ sex, 63.3% of our patients were males and 36.7% were females. Co-morbidities were found in 60% of cases (DM 23.3%, HTN 20%, HCV 3.3%, cardiac 3.3%).Most flaps were facial artery perforator flaps 53.3%, then transverse facial artery 26.7%, superficial temporal artery 10%, angular artery 6.7%, and supra-trochlear artery 3.3%.Twenty-ix cases representing 86.7% of cases went uneventful, while complications showed in 4 cases representing 13.3% of cases, 1 case (3.3%) showed venous congestion that was relieved within 24 h after 2 suture releases, another case (3.3%) showed wound dehiscence that was improved after 2 days with regular dressings, the third patient (3.3%) had recurrence after 4 months that was treated by excision and grafting, while last patient (3.3%) had inadequate excision that was treated by radiotherapy. No bleeding or infection occurred. Also, we observed no correlation between flap length and complications. As regards the functional point of view, all patients showed no functional impairment at the donor site, and only one case showed functional impairment at the recipient site.As regards patient satisfaction, all 30 patients achieved positive satisfaction scores using the Likert scale, 18 cases were satisfied, and 12 cases were very satisfied.ConclusionThe use of perforator-based flaps can provide a more effective and aesthetically pleasing solution for the reconstruction of small to moderate facial defects, provided that a reliable Perforator is accurately identified and executed by an experienced surgeon.

A comparison of dislocation risk between dual mobility and traditional constructs used in proximal femoral replacement

BackgroundProximal femoral replacement (PFR) is a reconstruction technique after tumor resection or for revision of failed total hip arthroplasty (THA). However, despite acceptable long-term oncologic and functional outcomes, extensive soft tissue or bone loss increases the risk for prosthetic instability. Instability may depend on the construct chosen for reconstruction, with current options including bipolar, constrained, or dual mobility implants. Clinical studies comparing patient outcomes after PFR with these three different constructs are limited. MethodsThis study retrospectively examined a single tertiary academic institution's experience with PFR over a fifteen-year period. The medical records of patients who underwent PFR for indications such as tumor and failed THA with bone loss were reviewed. Patients were stratified into cohorts based on use of bipolar, constrained, or dual mobility implants. Patient demographics, disease characteristics, perioperative data, and data on prosthetic dislocations were recorded. ANOVA and chi-square testing was performed for continuous and categorical variables, respectively. The threshold for statistical significance was set to p < 0.05. Results106 patients were identified who underwent PFR. 46 underwent PFR with bipolar prosthesis (follow-up: 20 ± 24.57 months), 42 with constrained liner (follow-up: 30.45 ± 35.32 months), and 18 with dual mobility (follow-up: 15.38 ± 15.67 months). Only BMI (p = 0.036) and smoking history (P = 0.002) differed between groups. Dislocations occurred in 4 (8.7 %) patients who underwent reconstruction with bipolar prosthesis, compared to 8 (19.0 %) with constrained liner, and 3 (16.7 %) patients with dual mobility. Mean time to dislocation was significantly longer in dual mobility patients (P = 0.009). There were no differences in instances of early dislocation between groups (P = 00.238). ConclusionWhile study numbers are low, mean time to dislocation was significantly longer with dual mobility. Additional large-scale longitudinal studies are needed to fully elucidate the differences in outcomes amongst these three treatments.

Surgical treatment of a teenager with an extensive wound defect of soft tissues against the background of severe combined injury

Extensive posttraumatic wounds, affecting functionally active areas and complicated by a purulent–necrotic process, are a serious problem in the acute period of injury due to a critical condition and in reconstructive surgical treatment. This study presents the case of a 16-year-old victim of a transport accident on a ferry who underwent a surgical treatment. Due to a truck collision, the girl was crushed against the metal structure of the ship and received a severe combined injury: closed craniocerebral injury, moderate brain contusion, linear fracture of the occipital bone on the right, closed chest injury, fracture of 9–11 ribs on the right, closed abdominal injury, rupture of the right kidney, damage to the bladder, retroperitoneal hematoma on the right, closed spinal injury, fracture of the spinous processes of the L4–L5 vertebrae, open fractures of the pelvic bones, and extensive posttraumatic wounds of the right half of the pelvic girdle and hip joints. During the initial hospitalization, the following were performed within 2 days: laparotomy, nephrectomy of a crushed kidney on the right, suturing of the bladder, primary surgical treatment of the wound in the sacrogluteofemoral region on the right and the wound of the left thigh with their primary suturing, and external osteosynthesis of the pelvic bones with a rod-based external fixation device. The early postoperative period was complicated by necrosis of injured soft tissues and a new surgical infection (polyantibiotic-resistant strains of microorganisms), which led to an increase in the size of the wound defect and loss of soft tissues due to their purulent melting. Complex surgical treatment aimed at eliminating surgical infection and transferring the wound process to the regeneration phase included repeated surgical treatments and the use of modern dressings and negative pressure therapy. An extensive wound defect of soft tissues caused by and injury or surgical treatment for purulent–necrotic complication was found in the functionally active zone of the hip joint and in the sacral region, which required the restoration of the skin of these areas. A strategy for surgical repair of a soft tissue wound defect is presented. Nonfree (rotated) blood-supply flaps were used: fasciocutaneous muscle flap based on the musculus tensor fascia lata from the right thigh and gluteal fasciocutaneous flap from the left gluteal region. After multistage surgical treatment, it was possible to replace an extensive wound defect of soft tissues and restore full skin in the hip joint and sacrogluteal region, which enabled avoiding trophic disorders and joint contractures and ensured a satisfactory cosmetic and functional result during 5-year followup.

“Comparison of activated Platelet Rich Fibrin and Platelet Rich Fibrin in osseous regeneration of freshly extracted socket- A double blinded randomized clinical study”

IntroductionDental extraction is a common oral surgery procedure, but it can lead to unpredictable changes in alveolar bone structure, which can complicate future rehabilitation with prostheses. Socket preservation aims to reduce bone and soft tissue loss after extraction and involves various techniques using different materials. Autogenous bone is considered the gold standard for grafts, while autologous platelet concentrates like platelet-rich fibrin (PRF) have been used for tissue healing. This study aims to radiographically assess the bone remodeling of freshly extracted socket filled with Activated Platelet Rich Fibrin (APRF) and PRF. Materials and methodsA randomized controlled study was conducted on 60 patients undergoing tooth extraction as atraumatic as possible. Patients were divided into two groups: one receiving APRF with 10% Calcium Chloride as activating agent and the other PRF. Radiographic assessments were done using Kelley et al. scoring criteria at various time intervals, and statistical analyses were performed to evaluate the results. ResultsIn this study we found increased bone density in extracted socket filled with APRF at any given time interval compared to PRF which is statistically significant. The maxilla demonstrated better bone formation compared to the mandible. Gender, age, and site also influenced bone formation, with females showing differences in lamina dura and overall density. DiscussionPRF is rich in growth factors, promoting osteoblast formation and angiogenesis. Activation with calcium chloride accelerates clot formation and the release of growth factors. This study's radiographic data suggests that APRF may be more effective than PRF in promoting socket preservation and bone formation.

Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region

BackgroundComplex defects involving the extensor tendon on the dorsal pedis have been reconstructed using multiple procedures. Skin coverage and tendon transfers have also been performed. This study aimed to present our experience using a chimeric skin-aponeurosis flap for one-stage reconstruction of composite soft-tissue defects on the dorsal pedis. MethodsBetween May 2017 and September 2020, 12 patients with these defects received total treatment using a chimeric groin flap. Based on the superficial circumflex iliac vessels, the skin paddle resurfaced the cutaneous defect, and the vascularised external oblique aponeurosis was rolled to form a tendon-like structure to simultaneously replace the absent segment of the extensor tendons. A suitable “Y” bifurcation was dissected to enlarge the vessel diameter. Single-stage reconstruction was performed using a set of vascular anastomoses at the recipient site. ResultsFlap survival was achieved without significant complications. The hammertoe deformity was completely removed. The average dimension of the skin paddle was 8.0 × 13.0 cm (range, 6.5 × 11.0–10.0 × 14.0 cm), and the mean size of the aponeurosis was 8.0 × 4.0 cm (range, 6.0 × 3.0–10.0 × 5.0 cm). At the last follow-up visit, no morbidity was observed at the donor site. Natural shapes and walking functions were successfully achieved with a protective sensation. ConclusionThe chimeric groin flap with sheets of external oblique aponeurosis is a great candidate for one-stage reconstruction of composite soft tissue loss on the dorsal pedis. This approach provides cosmetic coverage, allowing faster wound healing and reduced tendon adhesions.

Rehabilitative treatment of lower leg injury was studied by using anterolateral free thigh flap with CT scan

ObjectiveIn cases of severe soft tissue loss and deep tissue exposure in the lower part of the leg, microsurgical skin flap transplantation is the primary treatment method. MethodsBased on the anatomy of the descending branch of the lateral circumflex femoral artery and its musculocutaneous perforators, a free, ultra-thin anterolateral thigh perforator flap is designed for the repair of soft tissue defects in hands and feet. This method has been successfully used at our hospital to treat three patients. Postoperative recovery was favorable, with no vascular crises, and all skin flaps survived. ResultsThe aesthetic appearance of the repaired area was approved by patients, and there were no severe complications post-surgery. Patients were followed up for a period ranging from 6 to 24 months, averaging 14 months. The skin flaps were soft and elastic, without swelling, and the color matched that of normal skin, with good sensory function recovery. ConclusionIn surgical treatment of lower leg wounds, prioritizing using a free anterolateral thigh flap can enhance the repair of the wound and expedite functional recovery postoperatively.

Reconstruction of gap non-union tibia with composite use of extramedullary fixation and bone transport by monorail fixator: a prospective case series.

Non-union is a complex, multifactorial orthopaedic problem that requires multiple treatment modalities for its management. It can result from infection, segmental bone loss, soft-tissue loss, and associated host factors. External fixators as management of gap non-union are bulky and give rise to a number of complications In our study, we have described a technique where we have used extramedullary fixation in the form of a tibial locking plate and transportation of part of the tibial bone after corticotomy by a monorail fixator. The procedure was done in two stages where internal and external fixation was done after creating a gap at the non-union site. The bone was transported after corticotomy and fixed to the internal fixation device in the second stage. The external fixator was removed in the second stage and the patient was then followed up till the bony union. The evaluation was done by functional and radiological assessment along with the complications noted with the described procedure. Ten patients were enrolled in the study with a mean age of 33 years. The mean age of the patients was 33.7 ± 11.32 years with a mean size of the defect was 4.8 ± 1.7 cm. At 30 weeks out of nine patients, three patients had excellent and six had good functional results on the Association of Surgeons for Application and Methodology of Ilizarov (ASAMI) scale. The composite Musculoskeletal Tumor Society (MSTS) score was 76.66 % at the end of 30 weeks of follow-up. The mean time of consolidation was 134.4 days, whereas the mean union time was 145 days from index surgery. Ankle stiffness was the most common complication affecting 50% of the patients. Following closely was pin tract infection, which was present in 40% of the patients. According to Paley's classification, there were 11 obstacles, two problems and none were true complications. The integrated fixation is both safe and effective and has the advantage of early removal of the external fixator and a low complication rate as compared to use of a bulky conventional fixator alone. Moreover, it gives protection to the regenerated bone for a long period. So, this technique can be recommended for the management of segmental tibial defects.

ROLE OF BONE KNITTING HERBS IN THE MANAGEMENT OF PERIODONTITIS

Periodontitis is a chronic inflammatory disease affecting supporting structures of teeth leading to bleeding gums, soft tissue loss, mobility of teeth, and loss of a tooth. Periodontal disease is multifactorial in nature, the conventional therapies such as plaque control methods, the use of antimicrobial agents, and various surgical approaches demonstrated limited effectiveness in its management. Hence, the search for alternative therapies has been focused, among which herbal products have gained importance owing to their inherent properties of antioxidant, anti-inflammatory, anti-collagenase, stimulation of osteoblasts, and inhibition of osteoclasts, therefore, helping in the formation of bone. The present review focuses on various types of herbs which are used in treating periodontal disease.

Custom Bi-flanged Constrained Total Shoulder Revision Implants: A Novel Design and Report of Two Cases

Case Custom revision total shoulder replacements are one option for salvage of failed shoulder arthroplasty, but reports are scarce. We report two cases of revision shoulder arthroplasty using a custom constrained total shoulder (CCTS) endoprosthesis with a bi-flanged scapular (BFS) component in the setting of soft tissue, humeral, and glenoid bone loss. Conclusion The CCTS with BFS is a viable salvage implant for failed reverse total shoulder arthroplasty to achieve pain reduction, but long-term follow up is needed.

Anatomic study of flexor carpi ulnaris and brachioradialis muscles and their implication in reconstructive surgeries

Management of soft tissue loss around the posterior aspect of the elbow region is most challenging for clinicians, as it may require reconstructive methods for the better healing of wounds. One of the options for reconstructive surgery is local muscle rotational flaps by the flexor carpi ulnaris (FCU) and brachioradialis (BR). This study aimed to explore the morphometry and vascular anatomy of FCU and BR. Thirty formalin-embalmed cadaveric upper extremities (16 right and 14 left) were utilized for this study. The average length of the FCU muscle belly was 28.96 ±2.16 cm within a range of 24.3 to 32.5 cm, and the average length of the tendon was 10.05 ± 2.2 cm, with a range of 6.9 to 14.3 cm. The number of vascular pedicles for FCU was one in 5, two in 21, and three and four in 2 specimens respectively. All the pedicles arose from the ulnar artery. The average length of the BR muscle was 28.2 ±3.58 cm, with a range of 22.8 to 36.8 cm, and the average length of its tendon was 8.2 cm, with a range of 5.7 to 13.5 cm. In 90% of specimens, BR had only one vascular pedicle and in 10% there were two pedicles. These pedicles arose from the radial recurrent artery and the radial artery. Detailed morphometric and topographic anatomy of the vascular pedicles of FCU and BR are provided in this study, which can be considered the morphological database for the South Indian population.

Rehabilitation of mandibular resected patients using fixed immediately loaded corticobasal implant -supported prostheses. A case series

Introduction and importanceAliments such as congenital conditions, pathological, and iatrogenic circumstances may result in mandibular defects that can severely disturb the patients' oral health, functions (mastication, speech), aesthetics, and quality of life and present a rehabilitating challenge. Case presentationwe present a multidisciplinary treatment approach for three cases presented with mandibular resection as a consequence of cystic, benign, and malignant tumour eradication that were rehabilitated with immediately loaded fixed corticobasal implant-supported prostheses and a follow-up period of 5,5 and 4 years.The reported cases present with excellent implant survival, along with healthy peri-implant tissues, stable prostheses, enhanced speech, chewing ability, aesthetics, superior patient satisfaction, and improved overall self-esteem. Clinical discussionA multidisciplinary oral and maxillofacial team is mandatory for the successful rehabilitation of patients with mandibular resection and to restore soft and hard tissue loss. The reported treatment modality offers the patient immediate fixed implant-supported prostheses omitting the need for a bone grafting procedure, with optimum peri-implant tissue health, excellent biomechanical and prosthetic results, and significant improvement in function and satisfaction. ConclusionCorticobasal fixed implant-supported prostheses can be a reliable treatment modality for mandibular resection, resulting in notable enhancements in the patients' oral health, appearance, mastication, speech, and self-esteem.