Mucosal Flap Research Articles

Modified Mucosal Advancement Flap Combined With De-Epithelialized Mucosal Flap for Labia Minora Hypertrophy.

This study aimed to explore a novel and effective modified technique for the improvement in labia minora hypertrophy. From January 2020 to December 2022, 25 patients with labia minora hypertrophy underwent surgical treatment using a modified mucosal advancement flap combined with a de-epithelialized mucosal flap for labia minora reduction. Postoperative follow-up ranged from 3 to 12 months. No hematoma or other adverse complications were observed in all 25 patients. All patients achieved good recovery and were satisfied with the postoperative appearance and function. Surgical treatment using a modified mucosal advancement flap combined with a de-epithelialized mucosal flap is an effective method for labia minora hypertrophy with minimal neurovascular injury, a high rate of satisfaction with the postoperative appearance, and a low complication rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endoscopic nasal multilevel skull base reconstruction combined with lumbar cistern drainage in the treatment of infection caused by cerebrospinal fluid leakage: A case report.

Traumatic cerebrospinal fluid leakage can cause complications such as meningitis, ventriculitis and brain abscess. It is necessary to formulate individualized treatment strategies, such as the use of antibiotics and skull base reconstruction methods. The application of nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage. Neuroendoscope has been widely used in the treatment of skull base diseases, and the application of continuous lumbar cistern drainage technology has effectively controlled cerebrospinal fluid leakage. This paper introduces a case of long-term cerebrospinal fluid leakage complicated with infection. Neuroendoscopic multilevel skull base reconstruction combined with lumbar cistern drainage has achieved good clinical results, and this combined treatment is rarely reported in the literature. In order to promote the surgical effect of cerebrospinal fluid leakage, this combined treatment scheme is introduced here. A 43-year-old male was admitted with headache for 7 days, aggravation with fever and vomiting for 2 days. Cerebrospinal fluid culture suggests central nervous system infection, history and symptoms suggest traumatic cerebrospinal fluid rhinorrhea, and computed tomography (CT) shows old skull base fracture. Intracranial infection was controlled after anti-infection treatment with sensitive antibacterial drug ceftriaxone sodium. Repair of cerebrospinal fluid rhinorrhea by transsphenoidal endoscope. Continuous lumbar cistern drainage (LCD) was performed after operation to promote the healing of the leak. After comprehensive treatment, the patient did not have CSF rhinorrhea again and was discharged. Antibiotics combined with endoscopic multi-segment skull base reconstruction and lumbar cistern drainage are effective in treating infection caused by cerebrospinal fluid leakage.

Multifactorial clinical analysis of factors affecting necrosis of nasal septal mucosal flap after salvage surgery for recurrent nasopharyngeal carcinoma.

To investigate the associated risk factors affecting necrosis of the nasal septal mucosal flap (NSF) after salvage surgery for recurrent nasopharyngeal carcinoma (NPC). A retrospective analysis was conducted on patients with recurrent NPC who underwent endoscopic salvage surgery and NSF repair. Factors analyzed included second-course radiotherapy history, recurrence T stage, recurrence time, and postoperative packing time. Logistic regression identified independent risk factors. Second-course radiotherapy, advanced T stage recurrence, longer recurrence time, and shorter postoperative packing time were identified as independent risk factors for NSF necrosis. Patients with second-course radiotherapy had an 8.338 times higher risk of flap necrosis. Advanced T stage and longer recurrence times were also associated with increased risk. Nasal packing for less than 5 days presented a higher risk of flap necrosis compared to packing for 5 days or more. The predictive model demonstrated good predictive ability. The second-course radiotherapy history, the recurrence T stage, the recurrence time, and the postoperative packing time are independent risk factors for necrosis of the nasal septal mucosal flap after salvage surgery for recurrent nasopharyngeal carcinoma.

Application of nasal pedicle mucosal flap based on nasal blood supply in reconstruction of nasal skull base defects

Objective: To evaluate the clinical efficacy of nasal pedicle tissue flap based on nasal blood supply in the reconstruction of nasal skull base defects. Methods: A retrospective analysis was conducted on 138 clinical cases of skull base tumors and cerebrospinal fluid rhinorrhea treated at the Department of Otolaryngology, Head and Neck Surgery at Xiangya Hospital of Central South University from March 2017 to March 2023. A total of 79 males and 59 females were enrolled, aged from 8 to 82 years, with a median age of 51 years, including 108 patients (78.3%) with skull base tumors and 30 patients (21.7%) with cerebrospinal fluid rhinorrhea (and/or meningoencephalocele). During the surgery, 88 cases (63.8%) were repaired with nasal septal mucosal flaps pedicled with the posterior nasal septal artery, 14 cases (10.1%) with mucosal flaps pedicled with the anterior ethmoidal artery on the lateral wall of the nasal cavity, 6 cases (4.3%) with mucosal flaps pedicled with the posterior lateral nasal artery on the lateral wall and nasal floor, 12 cases (8.7%) with mucosal flaps pedicled with the anterior ethmoidal artery and posterior ethmoidal artery, and 18 cases (13.0%) with nasal septal mucosal extension flaps pedicled with the sphenopalatine artery or internal maxillary artery. Patients were followed up for 12 to 72 months postoperatively. Endoscopic examination or skull base enhanced MRI was performed to assess the growth and tumor recurrence in the skull base repair area. The t-test was used for statistical analysis. Results: Among 138 patients, primary repair was successful in 133 patients (96.4%), while 5 patients (3.6%) experienced postoperative cerebrospinal fluid rhinorrhea. These 5 patients all underwent nasal septal mucosal flap repair with the posterior nasal septal artery as the pedicle. Complications included 1 case of mucosal flap necrosis, 1 case of mucosal flap central perforation, and 3 cases of mucosal flap survival peripheral leakage, of which were all successfully treated with a second repair. Conclusion: The use of nasal pedicle mucosal flap based on nasal blood supply is a reliable, safe, and effective technique for repairing skull base defects.

Anatomical investigation of the venous system in pedicled nasal septal mucosal flap and its application in nasal skull base reconstruction

Objective: To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers. Methods: Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap. Results: The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived. Conclusions: The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.

Analysis of risk factors for the failure of endoscopic endonasal skull base reconstruction

Objective: To analyze the influencing factors of skull base reconstruction failure after endoscopic endonasal skull base surgery (EESBS). Methods: A retrospective analysis was performed on 228 EESBS cases at the Affiliated Hospital of Qingdao University from 2018 to 2023. The clinical features associated with skull base reconstruction and postoperative cerebrospinal fluid leakage were collected and analyzed. Lasso regression was initially used for exploratory analysis, and risk factors for reconstruction failure were subsequently evaluated using multifactorial logistic regression. Results: A total of 157 cases of EESBS were included, with an overall reconstruction failure rate of 11.5% (18/157). No patients who underwent second-stage reconstruction with a tipped mucosal flap or multilayered free mucosal and fascial repair experienced further postoperative cerebrospinal fluid leakage. Variables identified through Lasso regression included history of surgery, history of radiotherapy, and site of leakage. Multifactorial logistic analysis showed that history of radiotherapy (OR=5.96,P=0.021) and site of leakage in the posterior skull base (OR=8.70,P=0.003) were significant risk factors for failure of skull base reconstruction. Conclusion: In cases with a history of radiotherapy and/or posterior skull base lesions in the operative area, reconstruction strategies should be strengthened to improve the success rate of one-stage repair, in particular, when intraoperative cerebrospinal fluid leakage occurs.

Comprehensive interdisciplinary treatment of patient with unilateral cleft palate and oroantral fistula using archwise Interdental distraction osteogenesis: A case report with 1-year follow-up

A unilateral cleft palate with a wide oroantral fistula necessitates meticulous treatment planning and precise execution to mitigate the risk of relapse. It is arduous to address substantial gaps through conventional surgeries using buccal, labial mucosal flaps, or tongue flaps and is associated with heightened failure rates. In recent years, the introduction of interdental distraction osteogenesis (DO) has facilitated successful interventions in mending extensive cleft defects. In this case report, an adult patient with unilateral cleft palate and oronasal fistula has been successfully managed with orthodontic treatment and interdental DO using a custom-made device. The patient received successful treatment through orthodontic treatment and interdental DO utilizing a custom-made device abiding by Ilizarov’s principles. The size of the oroantral fistula was reduced significantly with a successful approximation of the segments. Subsequently, prosthetic replacement of the distracted segment was performed to restore esthetics. Follow-up images and radiographs showcase the stability and integrity of the arches. The epilogue of this case report is that the implementation of transport distraction can be accounted as an effective treatment approach when meticulously planned and followed through. By integrating early detection, multidisciplinary interventions, and ongoing support, healthcare professionals can significantly enhance outcomes and empower individuals to lead fulfilling lives despite their condition.

Short-Term Clinical and Technical Outcomes of a Modified Zenker's Peroral Endoscopic Myotomy (Z-POEM) With Mucosal Flap Incision.

Zenker's diverticulum (ZD) per-oral endoscopic myotomy (Z-POEM) is an effective treatment for symptomatic (ZD). A modification to Z-POEM is the mucosal flap incision (MFI). We describe the technical and clinical success of patients who underwent Z-POEM with MFI. We included patients who underwent Z-POEM with MFI for ZD at 8 international centers. The primary outcome was the rate of clinical success, assessed by post-procedure Kothari-Haber symptom score (KHSS) without retreatment. Secondary outcomes included technical success, serious adverse events, and clinical recurrence with need for retreatment. 36 patients (69% male, age 69 + 9 years) underwent Z-POEM with MFI for symptomatic ZD. Mean ZD size was 32 mm (+ 14). Clinical success was achieved in 35 (97%) cases. Median pre-procedure KHSS was 6 and median post-procedure KHSS was 1 (P <0.0001). Technical success was achieved in all cases. Mean procedure time was 57 minutes (+ 32), median follow up time was 196 days (IQR 39-499). There was one adverse event (3%) which was treated endoscopically. Z-POEM with MFI has a high rate of technical and clinical success. Prospective evaluation is needed to further validate this technique in patients with large ZD.

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Endoscopic and Open Treatment Techniques for Posterior Glottic Stenosis in Children: A Systematic Review and Meta-Analysis.

To evaluate the outcomes of open and endoscopic posterior cricoid split grafting and mucosal flaps for the treatment of pediatric posterior glottic stenosis (PGS). COCHRANE Library, CINAHL, PubMed, and Scopus databases. Studies were grouped by treatment method. Outcomes included decannulation rate, improvement in airway obstruction, remaining vocal symptoms, and subsequent airway procedures. A meta-analysis of continuous measures and proportions (%) with 95% confidence interval (CI) was conducted. Nineteen studies with 223 patients were included, with 72 patients having isolated PGS. Twelve studies (n = 23) reported endoscopic repair (group 1), while seven studies (n = 49) reported open techniques (group 2). Most patients in group 1 and group 2 had grade IV PGS (55.9% [26.1%-83.5%] and 56.9% [30.5%-80.8%], respectively). Post-operatively, 70.8% [43.5%-91.7%] of group 1 patients had tracheostomies with 83.4% [62.1%-95.5%] subsequently being decannulated, whereas 97.3% [89.1%-99.8%] of group 2 patients had tracheostomies post-operatively with 90.2% [79.2%-96.5%] subsequently being decannulated. Group 1 and group 2 had 87.1% [70.5%-96.3%] and 84.4% [64.9%-95.5%] improvement in airway obstruction, respectively. There are multiple open and endoscopic surgical options for pediatric PGS. Posterior cricoid split with cartilage graft and mucosal advancement flaps can be performed for high PGS grades. Endoscopic and open techniques are efficacious with high decannulation rates and improvement in airway obstruction, with endoscopic surgeries offering a less invasive approach. Laryngoscope, 2024.

Unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty for bilateral vocal cord paralysis--clinical analysis of 66 cases

Objective: To analyze the efficacy of unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty in the management bilateral vocal cord paralysis. Methods: A total of 66 patients with bilateral vocal cord paralysis hospitalized in the First Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed, among whom there were 8 males and 58 females, with ages ranging from 35 to 86 years old(mean age (57.8±11.6) years). All patients underwent suspension laryngoscopic CO2 laser unilateral arytenoid chondroplasty and mucosal flap under general anesthesia. Postoperative follow-up period extended from 6 months to 6 years, with a median duration of 28 months. The study compared the degree of dyspnea and voice quality (subjective and objective evaluation) of the patients pre- and post-operatively, and analyzed the clinical differences between patients with and without preoperative or intraoperative tracheotomy, the extubation rate of tracheotomized patients, the recurrence rate, and the complication rate. Continuous variables conforming to normal distribution were tested by t-test and categorical variables by χ² test,the Wilcoxon rank-sum test was used to analyze the improvement in dyspnea before and after surgery. Results: Compared with the preoperative period, 59 patients showed improvement in postoperative dyspnea (U=161.5, P<0.01); there was no significant difference in voice disorder index 10, subjective auditory-perceptual assessment, and maximal vocalization time (P>0.05), all of which remained within the relative normal range. Tracheotomy was performed in 32 out of 66 patients, with predominantly degree Ⅲ- dyspnea (46.9%, 15/32), including 26 patients with preoperative tracheotomy and 6 patients with intraoperative tracheotomy. Among the 34 patients who did not undergo tracheotomy, the majority presented with degree Ⅱ-dyspnea (82.4%, 28/34). All patients achieved successful extubation following surgery, with a mean median time to extubation of 1 month. Conclusions: The combination of unilateral arytenoid chondroplasty and minimally invasive mucosal flap plasty represents a refined and effective therapeutic approach for bilateral vocal cord paralysis. This minimally invasive technique has the potential to reduce the rate of tracheotomy.

Modified diverticular peroral endoscopic myotomy with peridiverticular adhesiolysis and mucosal flap reconstruction

Modified diverticular peroral endoscopic myotomy with peridiverticular adhesiolysis and mucosal flap reconstruction

Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction.

To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy (DCR) and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction (NLDO), and evaluate factors associated with the surgical success rate. Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital, Lebanon were reviewed. The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR. The success rates at 1y were 98.0% (49 out of 50) for modified DCR, significantly higher compared to 84.8% (117/138) for the conventional DCR; there was no significant difference in the success rate throughout the years in terms of both surgical techniques. The modified surgery vs traditional [adjusted odds ratio (aOR)=14.96] and having an adjunctive septoplasty surgery vs not (aOR=3.99) were significantly associated with higher odds of success. Mucosal flap preservation and apposition shows significant improvement in the surgical success rate. Moreover, there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

To evaluate the outcome of external dacryocystorhinostomy without flaps in the cases of adult chronic dacryocystitis

: To evaluatethe efficacy of external dacryocystorhinostomy without mucosal flaps in adult population.: In this prospective, non-comparative interventional study 50 adult cases with epiphora due to chronic dacryocystitis was selected. All patients were managed with external dacryocystorhinostomy without anastomosis of the nasal and lacrimal mucosal flaps and success rate was evaluated by relief of epiphora and lacrimal syringing on day 1, day 7, and then after 1 month, 3 months &amp; 6 months subsequently.: Total number of cases operated were 52 eyes with female preponderance (38 cases 78%), with left laterality (76%) with success rate of 92%. With mean operating time 27.71min. : External dacryocystorhinostomy without mucosal flaps is a better method of managing the cases of chronic dacryocystitis with higher success rate with minimal skill and time consumption.

Clinical Outcomes of Endonasal Dacryocystorhinostomy Using Fibrin Glue for Lacrimal Sac and Nasal Mucosal Flaps

Purpose: To assess the clinical outcomes of fibrin glue in endonasal dacryocystorhinostomy (DCR) for patients with primary nasolacrimal duct obstruction and to compare the surgical success rates between groups with the lacrimal sac flap using fibrin glue and without flap formation.Methods: In this prospective study, a total of 45 patients (63 eyes) underwent endonasal DCR. Fibrin glue was applied to the mucosal flap at the osteotomy site in the nasal cavity. The subjects were divided into two groups: group 1 (with lacrimal sac flap using fibrin glue), consisting of 20 patients (28 eyes), and group 2 (without flap), including 25 patients (35 eyes). To evaluate the two groups, subjective symptoms were asked to the patients, and endoscopic examinations were performed.Results: There were no statistically significant differences observed in terms of age, sex, timing of tube removal, or follow-up period between the groups. Group 1 showed significantly better results compared to the control group in terms of the degree of granuloma observed at 6 months postoperatively and the level of patient discomfort reported at 3 months postoperatively.Conclusions: Endonasal DCR with the lacrimal sac flap using fibrin glue achieves higher functional success, reduces patient discomfort at 3 months postoperatively, reduces granuloma formation at 6 months postoperatively, and improves membranous closure compared to flapless surgery.

Prevention, detection and management of adverse events of third-space endoscopy.

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

Nasal Septum Perforation Repair: Simplicity and low Morbidity Using the Temporalis Fascia and Silicone Films.

Aim: We present a new, simple, and effective method for the closure of nasal septal perforations based on prolonged isolation of the surgical site. Nasal septal perforation usually results after rhinological surgical operations, primarily to correct septum deviation. When symptomatic, conservative and surgical treatments are required. Current techniques more often attempt direct mucosal closure by mobilizing local nasal mucosal flaps with or without interposed grafts. The reported success rates are sufficiently high approaching ≥ 90%. Method: Our current practice includes the insertion of a temporalis fascia graft between the septal mucosal flaps to cover the perforation, avoiding any effort to achieve mucosal closure. Instead of using sophisticated techniques and multiple synthetic grafts, we propose that the entire septum remains protected after perforation repair for 6 weeks between two thin silicone sheets which permit surgical site inspection and mucosal regrowth. We present our experience with 10 consecutive patients, two of whom had fairly large defects. Results: All cases, except one, had a successful outcome with complete closure of the defect after one year's follow up. No serious complications were reported and the silicone sheets were well tolerated by the patients. Conclusion: Our method is simple and consequently fast, resulting in high success rates, low morbidity, and high tolerance from the patients.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

Secondary cleft palate correction with 3D-printed thermoplastic polyurethane film – a case report

Cleft palate is an oronasal communication that can affect the area comprehending the lips and the soft palate. Its clinical signs vary depending on the degree of the defect and the age of the animal, ranging from nasal secretion, coughing, sneezing, halitosis, respiratory difficulty, aspiration pneumonia, and loss of body condition. Its diagnosis is based on inspection of the oral cavity and imaging tests. Palatal defects must be surgically corrected as quickly as possible, using mucosal flaps, grafts, or implants. A desire to evolve alternative treatments for cleft palates drives the search for ways to manufacture customized pieces. 3D printing and biomaterials have enhanced in detail and applicability; combined with design tools and imaging exams, they allow for the making of precise implants and anatomical models for the planning and execution of surgical procedures. This report describes the case of a female, mixed-breed feline treated at a veterinary clinic; it was diagnosed with secondary cleft palate, had a history of falling, and underwent previous palatoplasties with recurrence. A surgical reintervention was performed to implant a 3D-printed TPU film to close its secondary cleft palate.

Efficacy of injection of autologous adipose tissue in the treatment of patients with complex and recurrent fistula-in-ano of cryptoglandular origin

BackgroundAdipose tissue injections, a rich source of mesenchymal stem cells, have been successfully used to promote anal fistula healing. This study aimed to investigate the efficacy of adipose tissue injection in treating patients with complex and recurrent fistulas of cryptoglandular origin.MethodsWe conducted a prospective, single-center, open-label, non-randomized, interventional clinical trial from January 2020 to December 2022. We enrolled nine patients, who were evaluated after at least 12 months of follow-up. All patients had seton removal, fistula tract excision or curettage, and a mucosal flap if possible or, alternatively, an internal opening suture. We used a commercially available system to collect and process adipose tissue prior to injection. This system allowed the collection, microfragmentation, and filtration of tissue.ResultsSelected cases included six men and three women with a median age of 42 (range 31–55) years. All patients had an extended disease course period, ranging from 3 to 13 (mean 6.6) years, and a history of multiple previous surgeries, including two to eight interventions (a mean of 4.4 per case). All fistulas were high transsphincteric, four cases horseshoe and two cases with secondary suprasphincteric or peri-elevator tract fistulas. Six cases (66%) achieved complete fistula healing at a mean follow-up of 18 (range 12–36) months. Three cases (33.3%) experienced reduced secretion and decreased anal discomfort.ConclusionsIn patients with complex and recurrent fistulas, such as the ones described, many from palliative treatments with setons, the adjuvant injection of adipose tissue might help achieve complete healing or improvement in a significant percentage of cases.ClinicalTrialsThe study protocol was prospectively registered on ClinicalTrials.gov (NCT 04750499).