Pedicle Graft Research Articles

Iliotibial band autograft is a suitable alternative graft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes.

Despite encouraging clinical, biomechanical and histological results, ACL reconstruction using the ITB was slowly abandoned. The hypothesis was that the current literature supports the use of ITB as the graft of choice for ACL reconstruction because of its good outcomes. A systematic search of the literature was performed in the PubMed, MEDLINE, Cochrane, and Ovid databases to identify published clinical studies relevant to ACL reconstruction with ITB autograft and studies comparing ITB autograft with bone-patellar tendon-bone (BPTB) and hamstring (HT) autografts (none were found). The results of the eligible studies were analyzed in terms of graft failure, instrumented knee laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, Tegner activity score, return to sports rate, return to sports at pre-injury level and complications. Nineteen clinical studies including 1,210 patients with ACL reconstruction met the inclusion criteria. Graft failure occurred after ITB autograft in 4.2% of patients. Postoperative mean side-to-side laxity was 1.41mm with 21% of patients having greater than 3mm side-to-side difference. Lachman test and pivot-shift test were negative (grade 0) in 57% and 85%, respectively, and were grade 0 or 1 in 95% and 97%, respectively. Functional outcomes were satisfactory in 84% of patients with good to excellent results (Lysholm score > 84). Mean postoperative Lysholm score was 93.3 and 84% of patients had an objective IKDC grade of A or B. Mean postoperative Tegner score was 6.8. The return to sports rate was 89% and 61% of patients returned to their pre-injury level. A comparison of 89 ITB versus 80 BPTB autografts revealed no significant differences in graft failure (n.s.), instrumented mean side-to-side knee laxity difference (n.s.) or Tegner score (n.s.). The graft survival rate and clinical and functional outcomes for ITB autograft are satisfactory. By allowing ACL reconstruction and lateral tenodesis to be done with a single, continuous, pedicled graft through an outside-in femoral tunnel, this technique may become the preferred alternative for primary or secondary ACL surgery. Level IV.

Myocutaneous sliding flap for reconstruction of divided eyelid nevus

ObjectiveTo evaluate the myocutaneous sliding flap for restructuring the eyelid of divided nevus, thus optimizing the aesthetic outcome. DesignA retrospective clinical study. ParticipantsClinical data from patients with a small or medium-sized divided nevus of the eyelids between January 2015 and December 2018 in the Shanghai Ninth People's Hospital were reviewed. MethodsThe safety and efficacy of a surgical approach using a myocutaneous sliding flap were evaluated based on postoperative features and complications. ResultsThis study included 53 patients with an average age was 21.6 years (range, 2–68 years). The lesions involved the inner canthus in 5 patients (9.43%) and the lateral canthus in 14 patients (26.42%). Three (5.66%) patients had undergone primary surgery elsewhere. Overall, the eyelid margins were in good shape postoperatively at an average follow-up of 22.7 months, and there were no obvious eyelid deformities, lagophthalmos, or other unacceptable complications postoperatively. The nevi were benign intradermal (60.38%), junctional (16.98%), and compound types (22.64%) without malignant transformation, as confirmed by pathologic examination. No malignant transformation was observed until the end of the follow-up period. ConclusionA myocutaneous sliding flap can provide an appropriately size pedicle graft and achieve satisfactory cosmetic results for divided eyelid nevus.

Application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing destructive wounds

Objective: To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds. Methods: The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed. Results: Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site. Conclusions: Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

Descemetocele asociado a distiquiasis bilateral en un perro: Reporte de caso

This study aims to report a case of bilateral descemetocele associated with dystichiasis, which received surgical treatment. Bilateral keratoplasty with pedicled conjunctival flap and manual epilation. The patient (Shih Tzu dog, 5 years old) was seen at the Doctor Vet clinic (Nucleus of Veterinary Specialties), located in the Commercial Area Local Residencial Norte, Quadra 712, Bloco G, Loja 15 Asa Norte - Brasília DF. The tutor reported that the patient was quieter than usual, with a lot of eye discharge, keeping her eyes always closed and showing a lot of pain when cleaning. In the specific physical examination, the patient was responsive to the threat, when evaluating the eyeball, bilateral dystachiasis (eyelids), presence of greenish secretion in the mucosa of both eyes, hyperemic conjunctiva of both the right and left eyes was observed in the cornea was noted, with the aid of a slit lamp, the right eye with intense and diffuse edema with vessels and descemetocele, already in the left eye, in addition to the same corneal changes of the right eye, showed dorsal bullous keratitis. The fluorescein test was performed for diagnostic purposes. In view of the above, the animal was diagnosed with bilateral descemetocele and dystichiasis. For treatment, keratoplasty and manual epilation were indicated respectively. Keratoplasty using a pedicled conjunctival graft proved to be effective, repairing and preventing the progression of the descemetocele and consequently corneal rupture in both eyes, leaving only a scar on the cornea. However, since it is a patient who presents with cilia disorders, periodic clinical monitoring is essential.

Anatomical basis of a pedicled cuboid bone graft based on the lateral tarsal artery for talar avascular necrosis.

Vascularized pedicled bone-grafting from the cuboid to the talus provides low donor site morbidity and satisfactory outcomes in patients with early-stage talar avascular necrosis. We investigated the anatomy of the rotational vascularized pedicled bone graft from the cuboid. 15 embalmed cadaver specimens were perfused with red latex via the popliteal artery. The lateral malleolus was dissected. The course of the lateral tarsal artery and the vascular territory in the cuboid supplied by the lateral tarsal artery were observed. Vessel diameters were measured. The course of the lateral tarsal artery to the cuboid was consistent, and a vascularized pedicle of the lateral tarsal artery was present in all specimens. Mean diameter of the lateral tarsal artery was 1.40 ± 0.12mm (range 1.67-1.25). Mean length of the vascularized pedicle was 67.15 ± 3.18mm (range 62.43-74.36). The pedicle bone graft was long enough to reach the bony border of both the lateral and medial malleolus. A vascularized pedicled cuboid bone graft based on the lateral tarsal artery has clinical utility for early-stage talar avascular necrosis.

The use of a pedicled buccal fat pad for reconstruction of posterior mandibular defects

BackgroundThe pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible.Case presentationThis study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area.ConclusionIn conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.

Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth

BackgroundWhen symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique.MethodsA retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated.ResultsThere were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications.ConclusionsAlthough sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

PRONATOR QUADRATUS VASCULARIZED MUSCLE BONE PEDICLE GRAFT IN NONUNITED SCAPHOID FRACTURE WITH FIXATION

Background: Left untreated, scaphoid nonunion can progress to carpal collapse and a predictable pattern of radiocarpal arthrosis. The goals of surgery for scaphoid nonunion include uniting the fracture and restoring carpal alignment. Objective: To assess the effect of pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation. Patients and Methods: The study was conducted on 20 patients with a history of scaphoid fracture since three months ago and no clinical or radiological signs of healing at Al-Azhar University Hospitals from January 2018 till February 2019. The patients underwent pronator quadratus vascularized muscle bone pedicle graft in scaphoid nonunion with fixation. Results: The mean age of the studied cases was 34.27 ± 11.74 years and male predominance with all of the studied patients noted no complications wither early or late and returned to their previous level of activity. All the cases achieved bony union (100%) in a mean of 12.5 weeks. There was improvement in mean radiolunate and scapholunate angles. Average range of motion and modified Mayo score. There were no early complications of surgical site infection or sensory disturbances in the area of the radial nerve. There were also none late septic complications. No radiographic progression of arthritis was noted in any patient within the available follow-up time. All patients returned to their previous level of activity and satisfied with the late clinical and functional results. Conclusion: Volar vascularized bone grafts is an easy method and provides excellent results while needing no special equipment. Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.

A prospective study of outcome in management of neglected fracture neck of femur by internal fixation and tensor fascia lata muscle pedicle graft

Background: Fractures of the neck of the femur have always presented great challenges to Orthopaedic Surgeons and remain in many ways today the unsolved fracture as far as treatment and results are concerned. Methods: Early anatomical reduction, compression of the fracture, and rigid internal fixation are used to promote union, but the surgeon probably has less control over osteonecrosis as the blood supply to the femoral head after femoral neck fracture is quite precarious. Many different devices have been devised for internal fixation of femoral neck fractures, but currently two are commonly used. They are multiple cannulated screws and Dynamic Hip Screw with an additional anti-rotation screw. We studied 14 cases of 1 month-to-one year old fracture neck of femur. All of them had viable head of femur. There was varying degree of resorption of neck of femur, One patient had pathological fracture neck of femur but head of femur was viable. 12 cases were treated with closed reduction, internal fixation with cannulated cancellous screws, augmented with Tensor fascia lata (TFL) muscle pedicle graft to the neck of femur .2 cases were treated with closed reduction, internal fixation with Dynamic hip screw, augmented with TFL Muscle pedicle graft to the neck of femur. Results: 12 cases showed union of fracture, 2 cases were lost in follow up, all 12 patients were able to return to routine daily activities, and one case had avascular necrosis (AVN) with poor function of hip. Conclusion: Fracture neck of femur new or old when treated with stable reduction, alignment as per Garden's index, rigid internal fixation with augmentation by Tensor fascia muscle pedicle grafting for re-establishment of vascularity to head of the femur resulted in 100% union.

Neglected flexor tendon injury for 10 years, un-usual finding and one stage repair without free tendon graft: Case report.

IntroductionIn delayed or neglected cases of flexor tendon injury, reconstruction of flexor digitorum profundus (FDP) is usually performed using free tendon graft due to the retraction of tendon ends and shortening of the tendon. Flexor digitorum superficialis (FDS), palmaris longus or plantaris tendons can be used as a free tendon graft [1–3].Presentation of caseThis is a case report of female patient 17 years old with neglected cut of her left Ring finger's FDP and FDS tendons zone II with suspected concomitant digital nerve injury, the injury was neglected for 10 years in the patient's non-dominant hand.DiscussionUpon exploration unusual finding of spontaneous healing of the proximal stumps of FDS and FDP tendons raised the idea of doing the repair one stage without free graft by using pedicled intra-synovial graft from the sublimis tendon to reconstruct the FDP tendon.The patient after 4 months follow-up and after completion of the physiotherapy program regained the ability to actively flex her finger to near full flexion with improved function and cosmesis.ConclusionDelayed flexor tendon reconstruction in neglected cases is still offering good results even after long periods of delay provided that the finger's joints are still supple and mobile.

Hand Surgeons Are Tackling Tougher Scaphoids: A Study of ABOS Candidate Data.

This study will evaluate whether those who have completed a hand fellowship treat a disproportionate number of scaphoid fractures based on recent American Board of Orthopaedic Surgery (ABOS) data. We hypothesize that surgeons who have completed a fellowship in hand surgery will address most surgically treated scaphoid fractures, particularly those with fracture nonunions or requiring graft. We queried the ABOS database for case log information submitted for part II of the ABOS examination. This search included all cases with Current Procedural Terminology codes for procedures related to scaphoid fixation. Demographic information, case volume, type of case, and complication rate were compared for hand fellowship-trained surgeons and those who had completed other fellowships as well as non-fellowship-trained surgeons. During the study period, 1686 surgeons reported treating 4244 scaphoid fractures. Of these surgeons, 1180 had completed a hand surgery fellowship. Hand fellowship-trained surgeons were shown to have operatively treated more scaphoid fractures both in total volume and on a per-surgeon basis. Hand fellowship-trained surgeons were also found to have performed a significantly higher proportion of difficult cases, which were those listed as being a malunion/nonunion or those incorporating a pedicle graft. There was no difference in the complication rate between the 2 groups. Among those orthopedic surgeons reporting case information for part II of the ABOS certification examination, statistically significant differences exist in case volume and case difficulty among surgeons with different areas of fellowship training. Complication rates increase with patient age and examination year.

Lateral Pedicle Graft Procedure for the Treatment of Isolated Tooth Recession- A Case Report

Gingival recession is defined as the apical migration of the gingival margin from its physiologic level which further causes pathologic exposure of root surfaces. Mucogingival esthetic surgery includes the treatment of mucogingival esthetic alterations. The Mucogingival problems may be caused by gingival recession which is often associated with non-carious cervical lesion or by root caries or by altered passive eruption. Root coverage is achieved by many procedures like free gingival autografts, pedicle graft and connective tissue grafts. Recession can be treated by surgical or non-surgical means. surgical procedure includes various methods of increasing the width of keratinized tissue such as frenectomy in case of high frenal attachment &amp; root coverage procedures and nonsurgical approach include-restorations, crowns, veneers and gingival masks. Lateral displaced pedicle flap was first described by Grupe and Warren in 1956 which was indicated in area to cover isolated apical migration of gingiva, &amp; denuded root surfaces that have adequate amount of donor tissue adjacent to the recipient site. In few clinical studies it is seen that the success rate with Lateral pedicle graft is 70%, it is preferred over free gingival autografts in narrow and shallow gingival defects. This case report present the predictability of root coverage by using Lateral pedicle grafts in single tooth narrow and shallow gingival recession. Keywords: Lateral pedicle graft, Gingival recession, Attachment loss, Graft.

Lateral Pedicle Graft: A treatment modality for root coverage of localized gingival recession: A case report

Lateral Pedicle Graft: A treatment modality for root coverage of localized gingival recession: A case report

DOUBLE PAPILLA REPOSITIONED FLAP FOR THE TREATMENT OF ISOLATED RECESSION - A CASE REPORT

Gingival recession can result in an unesthetic appearance, hypersensitivity, and root caries. The physiological well-being of the patient is a significant factor associated with the success of dental therapy.Numerous techniques are advocated for recession coverage. Although, connective tissue graft serves as a gold standard, it requires a second surgical site -a major disadvantage. When aesthetic demand is high and vestibule is shallow, double papilla flap can serve as a potential treatment alternative. The double papilla technique evolved from treating defects where tissues adjacent or apical to the defect alone may be inadequate for grafting purpose.The double papilla technique combines the esthetic results of pedicle graft with the predictability and usefulness of free gingival graft making it an effective and predictable method of obtaining esthetic root coverage.

Corneal sequestra in cats: 175 eyes from 172 cases (2000-2016).

To report the clinical outcomes of different surgical treatments used to manage feline corneal sequestra in a large number of cases. Medical records of 172 cats affected by feline corneal sequestra and surgically managed by different techniques were retrospectively evaluated. Signalment, surgical technique, visual outcomes, postoperative corneal clarity and recurrence were evaluated. One hundred and seventy-two cats (175 eyes) of different breeds, ages and sex were included in the retrospective case series. The Persian was the most represented breed (123/172; 71.5%), followed by Exotic Shorthair breed (21/172; 12.2%), Domestic shorthair breed (21/172; 12.2%) and a smaller group of other different breeds (7/172). Surgical management included a superficial (84/175 eyes) or deep (91/175 eyes) lamellar keratectomy in association with the following covering techniques (tectonic support and/or protective support): nictitans membrane flap (n=84), conjunctival pedicle graft (n=52), BioSISt graft (n=9), corneoconjunctival transposition (n=7), corneoconjunctival transposition+nictitans membrane flap (n=6), conjunctival free island graft (n=6), BioSISt+conjunctival pedicle graft (n=6), BioSISt+nictitans membrane flap (n=4) and bridge conjunctival graft (n=1). At the end of the retrospective case series, visus was present in all patients and no or mild corneal opacity was detected in 86% (151/175 eyes) of the patients. Sequestra recurred in 20 eyes (20/175; 11.4%) within 2 years. This paper describes the clinical outcomes of a large number of cases of feline corneal sequestra treated with varying surgical techniques and provides useful insight regarding the prognosis and outcomes of these techniques within feline ophthalmology.

Periosteal pedicle graft with coronally advanced flap and its comparison with modified coronally advanced flap in the treatment of multiple adjacent gingival recessions-a randomized clinical trial

The present study aimed at evaluating clinical utility of periosteal pedicle graft with coronally advanced flap (PPG ​+ ​CAF) vs modified coronally advanced flap (M-CAF) in cases of multiple adjacent gingival recessions involving maxillary and mandibular anteriors labially. Random allocation of 40 patients with 269 gingival recessions was done into two groups. In Test group (20 patients) periosteal pedicle graft followed by coronally advanced flap (PPG ​+ ​CAF) technique was performed and in control group (20 patients) modified coronally advanced flap (M-CAF) was attempted. Primary outcome measures included percentage root coverage (PRC), gingival thickness (GT), probing depth (PD), clinical attachment level (CAL), recession depth (RD) and width of keratinized gingiva (WKG). Secondary outcomes measures were patient centred outcomes, plaque index (PI) and gingival index (GI). Patients were recalled at baseline, 3,6 and 18 months postoperatively. ResultsThere was a significant decrease in the mean recession depth from 3.58 ​± ​0.53 ​mm (baseline) to 0.22 ​± ​0.01 ​mm (18 months) in PPG ​+ ​CAF test group and 3.7 ​± ​0.56 ​mm (baseline) to 0.21 ​± ​0.01 mm (18 months) in M-CAF control group. With 85% root coverage in test group and 78% root coverage in control group, the difference was statistically significant at 18 months. The test group showed significant higher clinical attachment level gain and increase in width of keratinized gingiva as compared to control group. ConclusionIn both the study groups PPG ​+ ​CAF and M-CAF, significant root coverage was achieved. However, in terms of increase in width of keratinized gingiva, gingival thickness and percentage root coverage, PPG ​+ ​CAF group presented significantly better results than M-CAF group at 18 months follow up. Thus, periosteum can be used as a pedicle graft along with coronally advanced flap as an alternative method in achieving better results with minimal cost.

Comparison of quality of bone and insertion torque values of early implants placed at 6 and 8 weeks in sockets preserved with advanced platelet-rich fibrin: A randomized controlled trial.

Aim:Successful functional and esthetic rehabilitation of edentulous jaws with implants depends on the optimal timing of placement, surgical protocol, materials used, cost-effectiveness, and satisfying patient needs. Increasing demand for shorter treatment times necessitates the immediate placement protocol. However, researchers have demonstrateda higher failure rate. A-PRF (Advanced platelet-rich fibrin) has exhibited accelerated bone regeneration potential. Early implant placement with a limited healing period, along with A-PRF, can be beneficial over conventional and immediate implant placement.Settings and Design:This prospective randomized clinical trial aims to assess the outcome of early implant placement in sockets preserved using A-PRF at six weeks and eight weeks of post-extraction. Two groups of 10 participantseach were formed. All patients underwent atraumatic extraction and socket preservation using A-PRF.Materials and Methods:A Partial-thickness pedicle graft was raised, and the extraction socket wasclosed. Implants wereplaced in at six and eight weeks of post-extraction in group A group B, respectively. The histomorphometric analysisassessedthe bone quality present at the timeof surgery. The insertion torque values were recorded during implant placement.Statistical Analysis Used:The obtained data were statistically analyzed using parametric tests, namely independent T-test for intergroup comparison.Results:T-test for torque values indicated a significantly higher torque value at eight weeks. The meanhistomorphometric value showeda significantly higher percentage of bone formation at eight weeks than at six weeks (P = 0.03).Conclusion:Within the study's limitations, early implant placement in extraction sockets preserved with A-PRF had significantly higher insertion torque values and predictable bone at eight weeks compared to six weeks.

Pedicled versus skeletonized internal thoracic artery grafts: a randomized trial.

ObjectiveConcerns have been raised regarding whether skeletonization of the internal thoracic artery could damage the graft and thereby reduces its patency. The objective of this study was to compare patency rates at mid- and long-term follow-up between pedicled and skeletonized left internal thoracic artery grafts.MethodsThis randomized controlled trial included 109 patients undergoing coronary artery bypass surgery. The patients were assigned to receive either one pedicled or one skeletonized left internal thoracic artery graft to the left anterior descending artery. Follow-up was performed at 3 years with conventional angiography, and at 8 years with computed tomography angiography. Differences between patency rates were analyzed with Fisher’s exact test and a generalized linear model.ResultsThe patency rates for pedicled and skeletonized left internal thoracic artery grafts were 46/48 (95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%) versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in patency rates for pedicled and skeletonized grafts was 5.4% (95% confidence interval: −4.2–14.5) at 3 years and 2.8% (95% confidence interval: −9.9–14.1) at 8 years. All failed grafts, except for one with a localized stenosis, were anastomosed to native coronary arteries with a stenosis less than 70%. Three patients suffered sternal wound infections (two in the pedicled group, one in the skeletonized group).ConclusionsThe skeletonization technique can be used without jeopardizing the patency of the left internal thoracic artery. The most important factor in graft failure was target artery stenosis below 70%.

Lateral Pedicle Graft for management of isolated gingival recession - A case report

Gingival recession is the apical shift of the marginal gingiva from its normal position on the crown of the tooth to levels on the root surface beyond the cemento-enamel junction.It is a widespread clinical finding in adults with more than 50% of the population having one or additional sites with gingival recession of 1mm or more and its severity increases with age. Root surfaces exposure in oral environment can cause root hypersensitivity, root caries and create esthetic problems. The pedicle graft is simple and less time-consuming surgical procedure with excellent results, without involving second surgical site for donor harvesting. In this case report the Miller’s Class-II isolated gingival recession defect was treated with lateral pedicle graft and postoperative clinical outcome showed stable & significant root coverage. Keywords: Gingival recession, Lateral pedical graft, laterally positioned flap, Root coverage, Mucogingival surgery

Lateral pedicle graft: A treatment modality for root coverage of localized gingival recession: A case report

Gingival recession has been defined as the apical shift of gingival margin from its physiologic level (1 to 2 mm coronal to cementoenamel junction) causing pathologic exposure of root surfaces. Mucogingival esthetic surgery is all about treatment of mucogingival esthetic alterations. Mucogingival problems may be caused by gingival recession often in association with non-carious cervical lesion or by root caries or by altered passive eruption. Patient with gingival recession frequently report to dental clinics which could lead to pain or hypersensitivity, esthetic problem, retention of plaque hence inflamed gingiva, root caries, abrasion and fear of tooth loss. Gingival recession can be treated by surgical or non-surgical means. Nonsurgical means include - restorations, crowns, veneers and gingival masks whereas surgical approaches includes various methods of increasing the width of keratinized tissue such as frenectomy in case of high frenal attachment & root coverage procedures. The lateral displaced pedicle flap was first described by Grupe and Warren in 1956. It was used to cover the isolated, denuded root surfaces that have adequate amount of donor tissue adjacent to the recipient site. The vestibular depth must be adequate to laterally slide the pedicle. A case of gingival recession is presented that was managed using LPG technique. This technique was selected because of certain advantages – single surgical area, preservation of blood supply of flap, the postoperative color being in harmony with surrounding tissue. Keywords: Lateral pedicle, Graft, Gingival recession.