Periosteal Preservation Research Articles

Modified dual osteotomy for Madelung’s deformity

Madelung’s deformity is one of the rare congenital deformities of the forearm and wrist, typically seen as positive ulnar variance and increased volar tilt due to the “Vickers” ligament. Different corrective surgical methods for this have been done in the literature. In this case of a 9-year-old Madelung’s like deformity, we have performed a modified dual osteotomy with periosteal preservation allowing natural articulation and bone to be modified, especially in a younger child. This article gives the surgical option to orthopedics for the future, especially in a younger child with severe deformity. This is a level V evidence-based therapeutic study.

Management of Distal Femur Unicondylar Fractures by Calcaneal Buttress Plating: A Prospective Interventional Study.

Unicondylar fracture of distal femur accounts for less than 1% of all femoral fractures. As conservative methods have shown substandard results, traditional surgical treatment includes open reduction and internal fixation by Herbert screws, cannulated screws, and conventional lateral locking plates. Though screw fixation has excellent results over long run, there is literature documenting the loosening and loss of articular congruency in elderly patients and in comminuted fracture patterns. Also, the traditional locking plates are precontoured to fit the lateral condyle, whereas there is no specific implant to fix the medial condylar fractures. The merit of the calcaneal plating is that it is easily moldable and can be used for either of the sides irrespective of fracture pattern. This study aimed to evaluate the clinical outcome of calcaneal plate (D-shape) fixation in distal femur unicondylar fractures. A total of 30 patients were studied, who met the inclusion criteria and consented to the surgery. After appropriate investigations, these patients were treated with calcaneal plating and were followed up postoperatively at 2 weeks, 1 month, 3 months, and 6 months for clinical evaluation. There was a gradual increase in the range of motion (ROM) with subsequent follow-ups. The overall mean ROM evaluated at 6 months was 108.46° ± 28.27° with P < 0.001 and was a statistically significant outcome. Also, the mean ROM for sagittal split fractures (~120°) was comparatively more than the coronally split fractures (~90°). The functional outcome assessed by Neer scoring showed excellent and satisfactory results in 24 (80%) patients, whereas the remaining six (20%) patients had poor results. None of the patients had nonunion, infection, or implant failure. With no specific implant for isolated unicondylar fractures, the use of calcaneal plate in our study has shown promising results probably due to its low profile design reducing the soft-tissue irritation and wide area of bone coverage by the plate offering regions of intermittent fixation due to its spanning design, thereby promoting periosteal preservation and ultimately fracture union.

Periosteal preservation: a new technique in resection of bone high-grade malignant tumors in children—about eleven cases

ObjectiveThe purpose of this study was to describe a surgical technique of bone resection with periosteal preservation and reconstruction in patients with high-grade bone malignant tumors and to determine its effect on local recurrences, and time and quality of bone union in bone autografting reconstruction.Patients and methodsWe retrospectively reviewed 11 cases of high-grade malignant bone tumors in children aged 4 to 16 years, who were treated with chemotherapy and tumor resection while preserving partially the adjacent periosteum. Tumors were located in the lower limb in eight cases; three tumors were in the humerus. The mean length of the bone defect after resection was 15.8 cm (range, 6–34.5 cm). Reconstruction was provided by non-vascularized autograft in eight cases (lower limb) and polymethyl methacrylate spacer in three cases (upper limb). Patients were followed up for a mean of 71 months.ResultsAt the last follow-up, no patients had local recurrence. Three patients were dead because of metastasis. Bone union was good in time and quality in all children who had bone autografting. In cases of PMMA reconstruction, there was periosteal bone formation around the spacer. According to the MSTS functional score, patients with lower limb localizations had a mean score of 27.75 points and patients with upper limb localizations had a score of 24/30.ConclusionPreservation of the periosteum in bone resection for malignant tumors could be a good adjuvant alternative for bone reconstruction, without increasing the risk of local recurrence. However, patients must be carefully selected.

Double-level Intraperiosteal Derotational Osteotomy for Congenital Radioulnar Synostosis.

Many operative methods have been reported for the treatment of congenital radioulnar synostosis (CRUS) and their indications remain controversial. The aim of this study is to evaluate the clinical, radiologic, and functional results of the 2-stage derotational osteotomy with periosteal preservation for CRUS in children. From a total of 102 children with CRUS, a retrospective evaluation of 14 consecutive patients (18 forearms) who underwent 2-stage derotational osteotomy of the distal third radius and proximal third ulna with periosteal preservation, bone segment removal, morselization and grafting and cast immobilization was performed. Children with bilateral involvement and/or pronation (>60 degrees), and substantial functional limitations in daily activities were considered candidates for surgery to obtain the desired position of 0 to 20 degrees of pronation. Electronic medical records, preoperative and postoperative clinical and radiologic examinations were reviewed. Also, functional results and parental satisfaction were assessed and statistically analyzed. The median age at the time of surgery was 6.87 (5.02 to 11.22) years. The median follow-up was 38.62 (24.79 to 81.20) months. The median preoperative pronation deformity was 80 (70 to 90) degrees, while the final position was 0 (0 to 10) degrees of pronation ( P <0.01). Elbow flexion and extension showed no changes after surgery. All patients successfully achieved union at 8 (6 to 10) weeks. No complications were observed, and no patient required revision surgeries. The ability to perform daily activities improved markedly, and all patients were satisfied with the results of the surgery. Two-stage double-level intraperiosteal derotational osteotomy is a safe, simple, and effective procedure in children with CRUS with severe deformity and limitation in performing basic daily living activities. Functional improvement and patient satisfaction are total, and so far no complications have been reported. Level III-treatment study, retrospective comparative study.

Complications Associated with Rhinoplasty: An Umbrella Review of Meta-analyses.

An increasing number of studies have investigated the effect of various methods in avoiding complications in rhinoplasty. Our study aims to analyze the connections between various choices in rhinoplasty and the rate of multiple complications by summarizing results in related meta-analyses. Through Pubmed, MEDLINE, Embase, and the Cochrane Database were associated systematic reviews searched to gather and review the available evidence of different plans and health outcomes in rhinoplasty for this umbrella review. The study included 14 systematic reviews with 128 meta-analyses of randomized clinical trials. Edema and ecchymosis were the two most investigated outcomes. The implementations of steroid, tranexamic acid, periosteal preservation, external approach in lateral osteotomy, and piezoelectric osteotomy were linked with significantly lower incidence of several complications. Multiple administration of steroids was found to be associated with fewer complications in a prolonged time. With summarized evidence of complications related to rhinoplasty, this research can help surgeons to avert patients from suffering complications and optimize cosmetic outcomes. 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 .

Surgical Treatment of Monostotic Craino-Facial Fibrous Dysplasia: Changing the Narratives

Background: Fibrous dysplasia mainly presents in its monostotic form in the cranio-facial region with serious cosmetic disfigurement and functional derangement of the affected and adjacent structures putting both patient and the attending surgeon in great dilemma. Surgical treatment is the only rewarding and generally accepted treatment option, however, controversy over the surgical technique to be adopted still exists. While in the past, surgeons generally adopted conservative shaving or contouring technique, over the recent years, advocates of radical surgery are winning more disciples. Objective: To highlight the locally destructive, functionally degrading nature of a neglected or poorly excised (shaved) lesion in patients and highlight the outcome of total excision and surgical technique adopted to obviate the need for autologous bone grafting and two-staged surgery. Subjects and Method: We present case series of three patients with giant monostotic fibrous dysplasia of the maxilla, surgically treated in our Centre, who were part of a total of eight cases managed over the past fifteen years in our department of Ear, Nose and Throat-Head and Neck Surgery. The pre-operative clinical assessment, relevant investigations and post-operative outcome are presented. Our surgical technique is highlighted. All the patients had unilateral lesion of the maxilla with gross cosmetic and functional defects. Two of the patients had ischaemic (pressure) atrophy of the cheek soft tissue and skin leading to skin metaplastic changes including leukoplakia, hyperpigmentation. Post-operative follow-up showed satisfactory cosmetic outcome and significant reversal of malocclusion and dental anarchy. There was no recorded recurrence throughout the follow-up period ranging from four to eleven years. Nasal airway was re-established bilaterally in all the cases. Conclusion: Total or near total excision surgical technique with periosteal preservation is our treatment of choice in the management of monostotic cranio-facial fibrous dysplasia. Given the fact that the growth of the tumours often does not cease after puberty against general belief, shaving or contouring technique should be relegated to the background. Our technique of no grafting which reduced cost and morbidity to the patient should be encouraged.

Effects of Periosteal Elevation Before Lateral Osteotomy in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials.

Objectives.Although osteotomy is an important part of rhinoplasty, it is known to be closely related to postoperative eyelid edema and ecchymosis. We aimed to evaluate the effects of periosteal elevation prior to osteotomy on eyelid edema and ecchymosis.Methods.Two authors reviewed studies in the Medline, Scopus, and Cochrane databases published through May 2019. Randomized controlled trials comparing periosteal elevation (subperiosteal tunneling) with periosteal preservation that reported eyelid edema or ecchymosis or subconjunctival hemorrhage as outcomes of interest were included. From each study, the baseline characteristics of the study subjects, the quality of the study, the number of patients in the treatment and control groups, and outcomes were extracted.Results.Data for meta-analysis were identified in six studies with a total of 208 patients. Eyelid ecchymosis and edema within 3 days postoperatively were significantly more common in the periosteal elevation group than in the preservation group, although such an association was not found for edema on postoperative day 7 (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], –0.09 to 0.50; I2=0%). There was no significant difference in subconjunctival hemorrhage on day 1 (SMD, 0.31; 95% CI, –0.09 to 0.72; I2=0%).Conclusion.Periosteal preservation during lateral osteotomy may reduce eyelid edema and ecchymosis compared to periosteal elevation. Further studies with rigorous research methods should be carried out to determine the effectiveness of different techniques in lateral osteotomy.

Association of Periosteal Sweeping vs Periosteal Preservation With Early Periorbital Sequelae Among Patients Undergoing External Perforating Osteotomy During Rhinoplasty.

Periorbital sequelae are a significant source of early postoperative morbidity after rhinoplasty, particularly after an osteotomy is performed. To compare postoperative periorbital sequelae after external perforating lateral osteotomy in rhinoplasty using a periosteal sweeping vs a periosteal preserving approach. This prospective cohort study conducted at a tertiary referral center located in Mansoura, Egypt, included 28 patients who underwent external perforating lateral osteotomy in open rhinoplasty between January and May 2017. Periosteal sweeping was performed on one side of the nose and periosteal preservation was performed on the other side during external perforating lateral osteotomy. Periorbital sequelae, including eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage, were assessed on both sides of the face on postoperative days 1, 7, and 21 by 2 independent surgeons using the scale first proposed by Kara and Gökalan in 1999. The scales for eyelid edema ranged from 0 to 4, for ecchymosis from 0 to 4, and for subconjunctival hemorrhage from 0 to 2, with higher values indicating greater edema, ecchymosis, and hemorrhage, respectively. Differences in the 3 time points and differences between the 2 osteotomy methods were analyzed. In total, 19 men and 9 women with a mean (SD) age of 23.7 (3.9) years were enrolled. All patients showed significant decreases in eyelid edema on postoperative days 7 and 21 compared with day 1 (1.71 and 1.39 vs 2.89 for the swept side, and 1.86 and 1.46 vs 2.68 for the preserved side; both P < .05) and in periorbital ecchymosis (2.02 and 1.13 vs 2.86 for swept side, and 2.05 and 1.13 vs 2.82 for the preserved side; both P < .05). A significant decrease in subconjunctival hemorrhage was observed on day 21 compared with days 1 and 7 (1.79 vs 2.11 and 2.11 for the swept side, and 1.71 vs 2.14 and 2.14 for the preserved side; both P < .05). The mean rank score for eyelid edema on day 1 for the swept side was significantly higher than that for the preserved side (33.18 vs 23.82, P = .02), and the mean rank score for periorbital ecchymosis on the swept side was significantly higher than that for the preserved side (33.59 vs 23.41, P = .01). Although both eyelid edema and periorbital ecchymosis appeared to remain greater on the swept side on postoperative days 7 and 21, the differences no longer reached statistical significance. Periosteal preservation was not associated with minimizing subconjunctival hemorrhage postoperatively. This study suggests that lateral nasal osteotomy is associated with varying degrees of eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage. Compared with sweeping the periosteum, preserving the periosteum in an external perforating lateral osteotomy was associated with less eyelid edema and periorbital ecchymosis in the early postoperative period. 2.

Ridge Expansion by Flapless Split Crest and Immediate Implant Placement: Evolution of the Technique.

Various treatment strategies and techniques have been proposed to perform alveolar bone augmentation; most common are guided bone regeneration, split crest, and autologous bone grafting. All of these techniques are reported to possess bone regenerative properties of osteoinduction and osteoconduction in relation to regenerated bone survival. Split crest resulted to be one of the most reliable bone augmentation techniques. In this study, we describe a new flapless-modified split crest technique on 4 patients to optimize the bone regeneration with bone augmentation implant insertion in 1 single stage. The rationale of this technique is to obtain a proper buccal cortex expansion preserving its vascular supply and avoiding periosteal elevation for better cortical bone preservation. The main advantages of this technique consist in a single surgical stage without donor sites, vascular periosteal preservation of vestibular cortical walls, preservation of alveolar bone height avoiding bone loss after implant kit drilling, and preservation of proper cortical thickness on both sides, thereby saving periosteal nourishment on the vestibular side. Indication for this technique could be extended to almost every implant insertion for alveolar height saving at drilling time for implant insertion, because of the alveolar crest shape.

Coccygectomy as a Surgical Option in the Treatment of Chronic Traumatic Coccygodynia.

Dear editor, We recently read the interesting article entitled Coccygectomy as a surgical option in the treatment of chronic traumatic coccygodynia: a single-center experience and literature review by Antoniadis et al. [1] which touches on an underrated topic in neurosurgical practice. Periosteal preservation and closure during the coccygectomy procedure have been found to be related to a low risk of infection [2]. Although Antoniadis et al. did not mention this in their case series, the information should be presented in a literature review. Additionally, some other treatment options, such as caudal epidural pulsed radiofrequency treatment, have been found to be efficient after unsuccessful non-surgical and surgical treatment modalities in the treatment of coccygodynia and should also be mentioned in the article. Atim et al. [3] achieved excellent and good results in 81% of cases treated with caudal epidural pulsed radiofrequency. We expect that these small additions will increase the value of Antoniadis' article.

Coccygectomy with or without periosteal resection

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

Comparison of Canine Mandibular Bone Regeneration by Distraction Osteogenesis versus Acute Resection and Rigid External Fixation

The present study was performed (1) to explore the mechanism of skeletal healing following distraction osteogenesis of the mandible and to evaluate whether the same process is involved following acute mandibular resection and rigid external fixation, and (2) to examine the role of the periosteum in skeletal healing in both models. The study was performed using 16 mongrel dogs divided into two equal groups. In the first group, distraction of 20 mm was performed at a rate of 1 mm/day. In the second group, bone resection of 20 mm was performed, followed by rigid external fixation. The buccal periosteum was stripped in four dogs from each group, and the periosteum was left intact in the remaining four dogs. Dogs were euthanized after a survival period of either 2 or 3 months, and the new bone regenerate was evaluated. Analysis consisted of three-dimensional computed tomography scanning, histometric analysis, and immunostaining. Analysis of bone mineral content in the residual gap was conducted. Bone mineral content was increased in 3- versus 2-month survival for all groups (p < 0.05). The distracted groups had greater bone mineral content than their acutely resected counterparts, with the difference achieving statistical significance by 3-month survival (p < 0.05). Although periosteal preservation resulted in increased bone mineral content over time for all groups (p = 0.044), periosteal preservation had no significant effect on bone mineral content in the distracted groups. After periosteal stripping, however, bone mineral content was significantly increased in dogs that underwent distraction rather than acute resection and rigid external fixation (p = 0.022). Regarding histometric analysis, analysis of fibrous tissue content in the bone regenerate demonstrated that by 3 months the distracted groups had significantly less fibrous tissue in the new bone regenerate than did the acutely resected groups (p < 0.001). Regarding immunostaining, diffuse localization of transforming growth factor-beta1 was observed in all groups at 2 months, returning to nearly baseline levels by 3 months. These data demonstrate that significant bone formation in a segmental gap can be achieved after acute mandibular resection and rigid external fixation if the periosteum is preserved. However, after periosteal injury or stripping, significant bone formation can only be achieved by distraction osteogenesis. In both processes, bone formation is preceded by up-regulation of transforming growth factor-beta1.

Distraction osteogenesis in craniofacial surgery: a review.

Distraction osteogenesis is a technique of new bone formation by the gradual separation of bony fragments. The method, although initially developed for limb lengthening, is now being applied in the treatment of craniofacial deformities. A number of principles have been established through careful scientific study to guide clinical practice, such as the ideal rate and rhythm of distraction, the need for periosteal preservation during bone division, a "latent period" of neutral fixation before, and a "consolidation period" after distraction. The technique is being applied in craniofacial surgery particularly for mandibular deformities and offers considerable advantages over previous methods such as osteotomy and inlay bone grafting. Donor site morbidity is avoided, the investing soft tissue envelope is concurrently expanded, and the magnitude of the procedure is less. However, the technique is still in its infancy and requires further modification and refinement before widespread acceptance as a treatment in mainstream craniofacial surgery. Problems with cutaneous scarring and socially undesirable external hardware, particularly in the pediatric population, have led to the emergence of intraoral miniature devices, with the ultimate goal of development of a multiplanar internal autodistractor. Furthermore, many principles well established in leg lengthening, such as the rate and rhythm of distraction, need to be reexamined and the parameters redefined with particular reference to the craniofacial skeleton. Distraction osteogenesis has an expanding role in craniofacial surgery.

Healing of reentry wounds with periosteal preservation.

Journal of PeriodontologyVolume 42, Issue 4 p. 225-232 Healing of Reentry Wounds with Periosteal Preservation Peter D. Roberson, Peter D. Roberson Department of Periodontology, Loyola University School of Dentistry, Loyola Medical Center, Maywood, Illinois.Search for more papers by this authorSaul Levy, Saul Levy Chairman, Department of Dentistry, Michael Reese Hospital and Medical Center, Chicago, Illinois.Search for more papers by this authorAnthony W. Gargiulo, Anthony W. Gargiulo Department of Periodontology, Loyola University School of Dentistry, Loyola Medical Center, Maywood, Illinois.Search for more papers by this author Peter D. Roberson, Peter D. Roberson Department of Periodontology, Loyola University School of Dentistry, Loyola Medical Center, Maywood, Illinois.Search for more papers by this authorSaul Levy, Saul Levy Chairman, Department of Dentistry, Michael Reese Hospital and Medical Center, Chicago, Illinois.Search for more papers by this authorAnthony W. Gargiulo, Anthony W. Gargiulo Department of Periodontology, Loyola University School of Dentistry, Loyola Medical Center, Maywood, Illinois.Search for more papers by this author First published: 01 April 1971 https://doi.org/10.1902/jop.1971.42.4.225Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume42, Issue4April 1971Pages 225-232 RelatedInformation

Periosteal Preservation in Operative Surgery

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