Onlay Graft Research Articles

Correction of Severe Secondary Cleft Lip Nasal Deformity.

The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND.

Correction of a Secondary Bilateral Cleft Lip Nasal Deformity in Adults Using Repositioning of Both Lower Lateral Cartilages and Nasal Tip Plasty Through an Open Bilateral Reverse-U Incision.

Correcting a secondary bilateral cleft lip nasal deformity is very complex with many challenges due to its complexity. This study presents the surgical results after correcting a secondary bilateral cleft lip nasal deformity using isolation and repositioning of the lower lateral cartilages, the columellar strut, and an onlay graft on the nasal tip. Eighteen patients who had bilateral cleft lip nasal deformities and who had surgery performed between September 2013 and December 2019 were included in this study. The age of the patients ranged between 19 and 52 years. Open rhinoplasty with bilateral reverse-U incision was performed. The lower lateral cartilages were isolated and repositioned. Nasal tip support is provided using a columellar strut with a septal cartilage or Medpor strut. In the vertical component of the nasal tip, a conchal cartilage graft was used. The mean follow-up period was 2 years (ranging from 1 to 6 years). Fourteen of the 18 patients underwent photogrammetric evaluation. After surgery, the projection of the nasal tip and angle increased, but nasal bridge length decreased. The columella-labial angle significantly increased by 10.1% after surgery which was statistically significant (P < 0.05). The angle between the nostril axes significantly decreased by 46.2% postoperatively and also reached statistical significance (P < 0.05), indicating that the displaced alar base and lower nostril sill improved and the major axis of the nostril changed more vertically oblique. All patients were pleased with their surgical results. The proposed technique was highly effective in correcting secondary bilateral cleft lip nasal deformities in adults.

“HORIZONTAL ALVEOLAR RIDGE AUGMENTATION WITH AUTOGENOUS BLOCK BONE GRAFT A CONE BEAM COMPUTED TOMOGRAPHY EVALUATION CASE SERIES”

Objective: The aim of the present study was to evaluate horizontal alveolar ridge augmentation using autogenous block grafts harvested from mandibular symphysis without barrier membrane in severe maxillary anterior ridge defects. Materials and methods: Six healthy patients with horizontal defects of the maxillary alveolar ridges were selected for alveolar ridge augmentation (class IV atrophy according to Benic and Hammerle classification). These defects were treated by autogenous block onlay grafts harvested from mandibular symphysis protected by anorganic bovine bone particles only. bone width was assessed preoperative, immediately post-operative and after 6 months at re‐entry by cone beam computed tomography. Result: All block grafts sites provided sufficient ridge width for proper implant placement. Mean bone gain was 3.9mm. No soft tissue dehiscence occurred in any of the cases. Conclusion: A combination of autogenous block graft obtained from the symphysis, combined with particulates xenograft alone without barrier membrane is a predictable and successful technique for augmenting maxillary horizontal ridge deficiency.

Moderate and Major Saddle Nose; the Causes and Correction

Back ground: Saddle nose deformity is of different types and classifications, and there are several surgical approaches and grafting materials selected by the surgeons for the correction. Objective: Study the causes, surgical steps, and outcomes of correction of moderate and major saddle nose by the author using autologous iliac crest bone graft. Patients and method: A retrospective case study of 34 patients, with saddle nose, corrected by dorsal onlay graft and columella strut harvested from autologous iliac crest bone via endo-nasal approach rhinoplasty, at Salah-Elden governorate during period from Jan. 2008- Dec. 2015. Results: The common cause of saddle nose was septal abscess 16 patients (47%), nasal trauma 7 patients (20.6%), then congenital and iatrogenic causes. The cosmetic results all 34 patients (100%) get good results and satisfied for the patient‟s and the surgeon, with follow-up surgeon satisfaction were in 32 patients (94%). Functional improvement was (94.7%). Conclusions: 1.Autologous iliac crest bone graft is good graft material for augmentation of saddle nose deformity. 2. Optimum cosmetic outcomes achieved by doing osteotomies and in fracture of nasal bones, tip plasty, and alar base resection.3. The procedure used for graft taken from iliac crest bone is relatively safe with low complications.

Treatment of Meatal Strictures by Dorsal Inlay Oral Mucosa Graft Urethroplasty: A Single-Center Experience.

Background: To report on the use of oral mucosa graft urethroplasty for meatal strictures using the dorsal inlay technique. Methods: Patients who underwent a single-stage dorsal inlay oral mucosal graft urethroplasty between January 2000 and May 2021 were included in this study. A follow-up of a minimum of 12 months was necessary for inclusion. Exclusion criteria were stricture extension into the penile urethra, concomitant stricture at another location, flap urethroplasty for a meatal stricture, dorsal inlay urethroplasty with another type of graft, ventral onlay graft urethroplasty or staged urethroplasty. Recurrence was defined by the inability to pass a 14F metal sound through the reconstructed meatus irrespective of patients’ complaints. Results: Our study cohort included 40 patients. Buccal mucosal graft (BMG) urethroplasty was used in 25 patients and 15 patients were treated with the aid of lingual mucosal graft (LMG). The median follow-up was 85 (IQR: 69–110) months. Seven (17.5%) patients suffered a stricture recurrence of which four (10%) needed re-intervention. The median 5-y recurrent free survival (RFS) for the entire cohort was 85 (±6)%. The median 5-y RFS was 96 (±4)% versus 65 (±13)% for respectively BMG and LMG (p = 0.03). Post-operative complications were identified in 11 (27.5%) patients with only one (2.5%) patient who had a grade 3a complication. Conclusions: Dorsal inlay oral mucosa graft urethroplasty is a safe and feasible technique for selected patients with meatal stenosis.

Dorsal Onlay Oral Mucosa Graft Urethroplasty for Female Urethral Stricture

ObjectiveTo describe and assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for female urethral stricture. MethodsWe retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1-3 months after catheter removal. Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening. ResultsNineteen patients were included. The clinical success rate was 94.7% at 1-3 months and 90.9% at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs 7.4 ml/s preoperatively; P = .008 and 71.5 vs 161.1 ml preoperatively; P = .001 respectively). The de novo stress urinary incontinence rate was 15.7% at 1-3 months and 9.1% at 1 year. ConclusionDorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.

Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience

BackgroundFemale urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience.MethodsWe performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up.ResultsThere was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period.ConclusionThe technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage.

Although cartilage tissue is a priority material in both structural grafting and camouflage, in some special cases, there is not enough material for camouflage due to cartilage insufficiency after it is used in structural grafting. In these cases, it is vital that the bony parts of the septum be prepared as a paste graft and applied for camouflage. The author retrospectively reviewed 62 rhinoplasty patients in whom septal bony paste grafts were applied during surgery from April 2018 to December 2019. A total of 56 patients were female, and 6 were male. The average age was 28 years old (range 18 to 52). The follow-up period ranged between 12 and 29 months (mean: 20.5). Septal bony paste grafts were prepared using a microrasp attached to a motor system. Septal bony paste grafts were used for camouflage of osteotomy lines in 59 patients, dorsum smoothing in 47 patients, camouflage of tip grafts in 36 patients, and camouflage of dorsal onlay grafts in 21 patients. No serious complications related to septal bony paste graft application, including functional or aesthetic complications, were encountered. A septal bony paste graft can be applied for camouflage in rhinoplasty in cases where there is not sufficient cartilage tissue for this purpose. A microrasp attached to a motor system can be used for effective and rapid preparation of the septal bony paste graft. 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 .

PD22-05 TO TRANSECT OR NOT—A RANDOMIZED SCANDINAVIAN STUDY OF SEXUAL DYSFUNCTION AFTER URETHROPLASTY

INTRODUCTION AND OBJECTIVE:The most common methods of bulbar urethral stricture surgery are resection and primary anastomosis or augmentation with onlay buccal mucosal graft. The effects on sexual ...

MP56-19 PROMISING PRELIMINARY RESULTS FOR VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN FOSSA NAVICULARIS STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-19 PROMISING PRELIMINARY RESULTS FOR VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN FOSSA NAVICULARIS STRICTURES Alejandra Perez, Adam Nolte, Chase Mallory, Scott Jamieson, Jessica Boyer, Dhaval Jivanji, Spencer Liem, George Wayne, and Billy Cordon Alejandra PerezAlejandra Perez More articles by this author , Adam NolteAdam Nolte More articles by this author , Chase MalloryChase Mallory More articles by this author , Scott JamiesonScott Jamieson More articles by this author , Jessica BoyerJessica Boyer More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Spencer LiemSpencer Liem More articles by this author , George WayneGeorge Wayne More articles by this author , and Billy CordonBilly Cordon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nearly twenty percent of all anterior urethral strictures occur at the fossa navicularis (FN). Management balances restoring urethral patency while maintaining adequate cosmesis. Historically, FN strictures are often managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Augmentation with ventral onlay buccal mucosal grafts (VOBMG) has been traditionally discouraged for fear of poor graft support and risk of fistula formation. METHODS: We retrospectively reviewed clinical and procedural characteristics for all patients with FN strictures that underwent urethroplasty at our institution from August 2016 through February 2021. Our approach included a ventral incision from the meatus to corona leaving a dorsal strip of native urethra to which BMG graft is anastomosed over a 20-24F catheter. A glansplasty is then performed to support the graft. Outcomes included recurrence rates and complication rates. RESULTS: We identified 14 patients that underwent urethroplasty for isolated fossa navicularis strictures. Of these, 9 underwent a single stage VOBMG urethroplasty. Other approaches included staged Johansson repair, mucosal advancement, and fasciocutaneous flaps with glans cap, which were excluded from analysis. Average follow up period to date was 25.8 months. 1/9 (11%) developed a stricture recurrence requiring intervention with balloon dilation, after which there has been no further recurrence at 20 months follow-up. No UTIs, fistulae, or other complications were seen. CONCLUSIONS: Our research demonstrates that single-stage VOBMG is an effective means of treating FN strictures. Despite a limited number of cases, our series demonstrates promising short-term safety and efficacy for this procedure, carrying significant advantages over dilation and staged reconstruction. We observed good graft take, successful cosmetic and functional outcomes and no evidence of urethra-cutaneous fistulas. Further series follow-up and comparative data will help to elucidate durability of outcome and refine treatment options. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e976-e976 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandra Perez More articles by this author Adam Nolte More articles by this author Chase Mallory More articles by this author Scott Jamieson More articles by this author Jessica Boyer More articles by this author Dhaval Jivanji More articles by this author Spencer Liem More articles by this author George Wayne More articles by this author Billy Cordon More articles by this author Expand All Advertisement Loading ...

MP53-04 DOUBLE-FACE AUGMENTATION URETEROPLASTY WITH BUCCAL MUCOSAL GRAFT: A NOVEL SURGICAL TECHNIQUE FOR RECONSTRUCTION OF COMPLEX URETERAL STRICTURES AND INJURIES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-04 DOUBLE-FACE AUGMENTATION URETEROPLASTY WITH BUCCAL MUCOSAL GRAFT: A NOVEL SURGICAL TECHNIQUE FOR RECONSTRUCTION OF COMPLEX URETERAL STRICTURES AND INJURIES Mohamed Nafie Mohamed NafieMohamed Nafie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to demonstrate our new surgical technique in reconstruction of long-segment ureteral stricture or injury that is not amenable to primary excision and anastomosis. We used this technique as an alternative to intestinal segment interposition due to its high morbidities or tubularized graft interposition due to its high failure rate. METHODS: From January 2019 to January 2021, seven cases of complex upper ureteric stricture were operated by our new technique of double augmentation with buccal mucosal grafts (posterior inlay graft quilted to the psoas muscle and anterior onlay graft fixed to an omental flap as adouble _face augmentation). The perioperative and follow-up data were recorded. Surgical success was assessed by serial ultrasound, ureterograms and renal scan. Complete success was defined as the absence of clinical symptoms, no need for ancillary procedures normal ureterograms and a stable estimated glomerular filtration rate (eGFR) without serious complications. RESULTS: At median follow-up of 10 months (range, 4-23), all patients achieved the successful criteria of treatment without serious complications. The median length of stricture was 4.5 cm (range, 4-7). The median length of the harvested buccal mucosa graft was 7 cm (range, 5-10), 1.7 cm width ( range 1.5- 2) divided in two long grafts. The median operative time was 150min (range, 120-230). The median estimated blood loss was 100 ml (range, 50-200). The median hospital stay was 2.5 days (range, 2-4). The median time for DJ stent removal was 1.5 months (range, 1-2). Retrograde ureterogram was done at the time of DJ stent removal, followed by serial ultrasound every three month, Intravenous urography at 6 month and renal isotope scan at one year then ultrasound every 6 months. CONCLUSIONS: The double_ face augmentation ureteroplasty with buccal mucosal graft is a feasible and safe surgical technique for complex ureteral strictures and injuries, with low peri-operative morbidity and excellent intermediate-term outcomes. It can be used as a substitution to intestinal segment incorporation or tubularized graft. Source of Funding: No © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e940-e940 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Nafie More articles by this author Expand All Advertisement Loading ...

V09-12 ROBOTIC-ASSISTED URETEROLYSIS AND BUCCAL MUCOSA URETEROPLASTY FOR IDIOPATHIC RETROPERITONEAL FIBROSIS

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-12 ROBOTIC-ASSISTED URETEROLYSIS AND BUCCAL MUCOSA URETEROPLASTY FOR IDIOPATHIC RETROPERITONEAL FIBROSIS Laura Kidd, and Daniel Eun Laura KiddLaura Kidd More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a 66 year-old male who initially presented with back pain and renal failure and was found to have a retroperitoneal mass on imaging. Biopsy confirmed IGG4+ retroperitoneal fibrosis. He alternated nephrostomy and JJ stent drainage, intermittently failing stents, even requiring emergent dialysis at one point. He completed a course of high-dose steroids and was referred to us. He underwent successful robotic repair. METHODS: Antegrade and retrograde pyelograms showed bilateral proximal ureteral narrowing and medialization, as well as a focal high-grade left proximal stricture. The ureteroscope could not pass it, and was left at the level of the defect. The patient was positioned supine in slight Trendelenberg, with legs slightly down; ports were placed according to a retroperitoneal lymph node dissection set-up. The fibrotic rind was extremely dense, and localization of the ureters was significantly aided with indocyanine green via the nephrostomy tube, as well as near infrared fluoroscopy. Bilateral ureterolysis was performed, followed by omental wrap on the right. The left stricture was excised and adjacent ureteral tissue was friable and poor quality. The ureterotomy was extended until patency was encountered, at the level of the renal pelvis – a defect of 8 cm. This required additional mobilization with downward nephropexy to eliminate tension. A buccal graft was harvested, arranged into a longer, thinner segment, and used as an augmented onlay graft to complete the repair. This was wrapped with omentum as well. RESULTS: Estimated blood loss was 50cc, total operative time was 502 minutes. The patient was discharged on post-operative day 1. Pathology was consistent with retroperitoneal fibrosis. Postoperative right nephrostomy tube and left JJ stent were able to be removed. Eight-month renal scan showed no obstruction and the patient was asymptomatic at last follow-up. CONCLUSIONS: Retroperitoneal fibrosis can be a highly morbid and difficult entity to treat. If more conservative management with tubes and drains fails, ureteral reconstruction should be attempted by a skilled surgeon. Depending on the degree of fibrosis, ureters can be difficult to localize and adjunct measures, such as use of indocyanine green and intraoperative ureteroscopy, can be extremely helpful. The reconstructive urologist should be prepared for longer-than-anticipated defects and have operative comfort in maneuvers to gain additional length when needed, such as downward nephropexy. Buccal grafts, when appropriately harvested and fashioned, can work well for intermediate to long-length onlays. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e691-e691 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Kidd More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...

Free Vascularized Fibular Graft for Congenital Pseudarthrosis Tibia: A Case Series

Introduction: Congenital pseudarthrosis tibia (CPT) probably one of the most difficult to treat among all diseases in the children. There are several surgical approaches that have been used to treat CPT including on-lay graft, double on-lay grafts, pedicle grafts, osteotomy, bypass graft and intramedullary rods. Prognosis of CPT has changed considerably with the use of Free Vascularized Fibular Graft (FVFG). Despite these advances, several operations are often necessary to obtain union of CPT and the risk of amputation is never entirely eliminated Case presentation: We presented 2 case with CPT. The first case is a 4 year old girl with CPT-Associated Neurofibromatosis, patient was brought to orthopedic polyclinic complaining bend on her right leg since she was born, the parent also complained her child has abnormality when walking since she was 14 months old. The second case is a 3 year old girl with CPT complaining bend on her right leg, abnormalities and pain when walking since she was aged 1 years 11 months. We performed free vascularized fibular graft for both of the patient. Result: The results in our cases showed bone union in 14 weeks, 16 weeks and 18 weeks respectively. The optimal of technique options should be adapted to the type of pseudarthrosis and especially to the extent of the bone defects. good results can be found with intramedullary nailing with a bone graft or the Ilizarov technique Conclusion: The optimal of technique options should be adapted to the type of pseudarthrosis and especially to the extent of the bone defects Keywords: Congenital pseudarthrosis tibia, Free vascularized fibular graft, case series.

Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

Perichondrial Attached Diced Cartilage (PADC), a Novel Graft Material for Nasal Augmentation: 10 Years of Experience.

Achieving dorsal augmentation with onlay grafts presents several challenges. Visibility and warping of grafted cartilages can ruin an otherwise successful operation. A shortage of septal cartilage and rib donor site morbidity compound the problems associated with this procedure. The aim of this study was to find an autologous material for dorsal nasal augmentation that does not disperse upon implementation. This material also should have minimal resorption, resist warping, and not require a wrapping membrane. In 30 patients, concha cartilage of the ear with attached perichondrium and fascia were removed. The concha cartilage was diced while it was attached to the posterior soft tissue. The purpose was to develop graft material for dorsal augmentation. In an average of 19.56 months follow-up, no sign of resorption, infection, inflammation, volume loss, or displacement of the grafted material was observed. Aesthetically the results were acceptable and most of the patients were satisfied with the outcome. Perichondrial attached diced cartilage is a new material for the rhinoplasty surgeon to apply in different onlay nasal augmentation procedures in the unduly reduced nasal dorsum. This technique transforms uneven, peculiarly shaped concha cartilage into a flexible, versatile, and durable material. The donor site is in the surgical field and easy to access.

Obliteration and Contouring of Comminuted Anterior Wall Frontal Sinus Fracture Using Pericranial Flaps.

Summary:One of the common postoperative complications of comminuted fractures of frontal sinus are contour deformity, hardware extrusion, adherence and/or palpability, and skin thinning. We are presenting our novel technique with pericranial flaps to decrease these complications. The study was performed from January 2019 to January 2020, on 40 cases of comminuted fractures of anterior wall of frontal sinus, 28 men and 12 women, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 25), motorcycle crashes (n = 11), and falling from heights (n = 4). Our novel technique involves the use of two anteriorly based pericranial flaps; one flap is used for obliteration of the frontal sinus and the other is used to overlay the hardware used to restore forehead contouring and to eliminate the possibility of early extrusion or late plates or mesh palpability. Two patients had postoperative minimal disruption of forehead lacerations healed with secondary intention and minimal scarring. Excellent patient compliance without any complaint of mesh palpability. No adherence occurred and no skin thinning. This technique (two anteriorly based pericranial flaps) may be more reliable to obliterate the frontal sinus also overlaying the hardware used to improve forehead contour and decrease the incidence of mesh palpability and skin adherence than using hardware without flap coverage.

Retrospective analysis of time-related three-dimensional iliac bone graft resorption following sinus lift and vertical augmentation in the maxilla

The atrophic maxilla frequently requires bone grafting using an onlay graft (OG) or sinus lifting (SL) before implant rehabilitation. The resorption of bone grafts is influenced by the time until implantation, quality of donor bone, and grafting technique. The aim of this study was to investigate the impact of both grafting techniques on the time-related resorption of autologous iliac bone graft. Forty-three patients underwent either onlay grafting or a sinus lift at 73 sites in the maxilla. Graft height was measured by cone beam computed tomography after augmentation and during follow-up for up to 12 months prior to implant insertion. The effect of time and technique on graft resorption was evaluated retrospectively. The reduction in bone graft height was greater for OG than SL over the investigated time intervals (OG = 51%, SL = 28%; P = 0.002). Each technique followed a specific course of resorption, which was independent of the initial graft height and could be calculated by a non-linear regression model. Iliac bone graft undergoes rapid resorption when used as an OG prior to implant insertion. For SL, this resorption is reasonably lower. This is especially crucial to determine the optimal time for implant insertion after graft healing to improve implant survival.

Long-Term Outcomes of Implants Placed in Autogenous Onlay Bone Grafts Harvested from Mandibular Ramus and Risk Analysis.

This study evaluated the long-term survival and success rates of dental implants placed with autogenous onlay block bone grafts harvested from the mandibular ramus. Patients treated with onlay bone graft from the mandibular ramus due to a severe vertical alveolar defect from 2001 to 2017 were included in this study. The marginal bone loss, success, and survival time of the implants were recorded and analyzed with clinical factors, such as time from bone graft to implant placement, type of implant prosthesis connection, history of periodontitis, and insertion depth. Seventy-five implants in 40 onlay bone-grafted areas of 38 patients were included, with a mean follow-up period of 102 months (range: 14 to 192 months). Two grafts were removed before implant placement. Of the 75 implants, 11 implants were lost. History of periodontitis and marginal bone loss at 6 months after implant placement were significantly associated with implant success. The receiver operating characteristic curve showed that a marginal bone loss of 0.75 mm after 6 months of implant placement was related to implant success, with a sensitivity of 72.2% and specificity of 89.6%. Implants placed with onlay bone graft from ramal bone had more frequent biologic complications, and failures may be predicted by measuring the amount of implant bone loss after 6 months of placement.

Free Tissue Transfer for Repair of Chronic Esophageal Perforations.

ObjectiveAnterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life-threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis. Presentation is variable but often results in chronic morbidity. Herein we examine our experiences in the management of esophageal perforation with microvascular free tissue transfer.Study DesignRetrospective review from January 2013 to September 2020.SettingSingle academic tertiary care center.MethodsThis study comprised all patients (age, 41-73 years) undergoing free tissue transfer for the repair of chronic esophageal perforation secondary to anterior cervical discectomy and fusion at an academic tertiary care center. Four patients underwent repair via vastus lateralis myofascial onlay grafting for defects ≤2 cm in greatest dimension, while 1 patient underwent a fasciocutaneous radial forearm free flap repair of an 11 × 5–cm defect.ResultsDefect location ranged from hypopharynx to cervical esophagus. Mean operative time was 6.2 hours; the average length of stay for all patients was 6.6 days. Of 5 patients, 1 required additional hardware placement for spine stabilization. All patients underwent gastrostomy tube placement to bypass the surgical site during healing, and all eventually resumed an oral diet postoperatively. Recurrent fistula occurred in 1 of 5 patients. No flap failures were encountered in the study population.ConclusionVastus lateralis myofascial onlay grafting and fasciocutaneous radial forearm free flap are robust, relatively low-morbidity interventions with a high success rate for definitive repair of chronic esophageal perforation. Repair should be undertaken in concert with a spine surgeon for management of the cervical spine.

Skin Necrosis Following Rhinoplasty: A Review and Proposed Strategy on Identifying High-Risk Patients.

Vascular compromise leading to cutaneous loss following surgical rhinoplasty is a devastating complication. The objective of this review is to identify all reported cases in literature published in English and summarize the current evidence to identify the patients at risk of this complication following surgery. A comprehensive literature review using Medline and Embase databases was performed to capture all reported cases of cutaneous vascular compromise following rhinoplasty from database inception through September 2020. Nonsurgical rhinoplasty cases were excluded. We identified eight studies that featured vascular cutaneous compromise following surgical rhinoplasty. A total of 18 patients were included in the analysis. The majority of the patients were females with a mean age of 30.9. Risk factors included smoking in 23.5% patients and revision setting. Extensive tip thinning, tight splinting and taping with dorsal onlay grafting, or combining extended alar base excision with revision open rhinoplasty were among surgical techniques associated with vascular compromise. The most commonly affected aesthetic nasal subunit in our review was the dorsum followed by the nasal tip. Conservative management primarily was utilized in 72.2% of patients, allowing the defect to heal by secondary intention. Studies reporting on cutaneous vascular compromise following surgical rhinoplasty are of low level of evidence. This review is the largest summary reporting on this complication to date, aiming to caution surgeons about associated techniques and management options. We also share an expert opinion on preoperative assessment of nasal skin to guide surgeons to potentially avoid rhinoplasty surgery in this subset of patients.