Posttraumatic Soft Tissue Defects Research Articles

Ankle function after reconstruction of post-traumatic soft tissue defects with soleus and/or gastrocnemius local muscle flaps

Local muscle flaps are especially advantageous when treating soft tissue defects, but one disadvantage is the potential functional deficits associated with the muscle transfer. In this study, we evaluated ankle function among patients (cases) who underwent reconstruction of soft tissue defects in the leg using local flaps of the gastrocnemius and/or soleus muscle. Function was compared between the affected and contralateral non-affected limb and against patients (controls) with open tibial fractures who required no soft tissue reconstruction. In a retrospective cohort study, ankle function was accessed as range of motion (ROM) and plantar flexion strength, and using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot summation and subscale scores. Among 31 patients who underwent soft-tissue reconstruction, 19 were available for functional evaluation. Controls were 23 patients with open tibial fractures not requiring flaps. Among cases, reconstruction was performed with a soleus flap in nine patients, a medial gastrocnemius flap in seven, a lateral gastrocnemius in one, and with both gastrocnemius and soleus flaps in one patient each. One patient developed partial flap necrosis. In cases, ankle dorsiflexion and plantar flexion were significantly decreased on the affected versus normal side. However, no deficit in plantar flexion strength was detected; nor any significant difference in AOFAS ankle-hindfoot scores in cases versus controls. Local muscle flaps are useful for reconstructing post-traumatic soft tissue defects in the leg. Some loss of ankle ROM should be expected, but likely no clinically-measurable deficit in overall ankle strength and function.

Реконструкция дефектов покровных тканей методом транспозиции локо-регионарных перфорантных островковых лоскутов

Introduction Treatment of chronic non-healing wounds in the presence of deep post-traumatic soft tissue defects is a challenge for trauma reconstruction. The objective of the study was to improve healthcare quality for patients with chronic soft tissue defects of the limb. The goals included evaluation of the effectiveness of reconstruction of defects of the lower limb using local transposition perforant flaps, and rationale for a preferred choice for the keystone perforator flap. Material and methods The review included 48 patients with post-traumatic and osteomyelitic soft tissue defects of lower limbs. Patients were divided into 2 groups. Patients of the study group were treated with regional perforator fasciocutaneous flaps combined with osteonecrectomy that could be also performed later (n = 22). In the comparison group (n = 26), post-traumatic and osteomyelitic defects were treated with conventional methods of local wound treatment, staged osteonecrectomies followed by autodermoplasty. Results The use of the transposition loco-regional perforator flaps resulted in the incidence of secondary necrosis reduced by 33.7% and the two-fold reduction in the average number of staged operations. One-stage reconstruction was performed in 72.7 % patients of the study group. The length of inpatient treatment decreased by an average of 30 bed days. Discussion The reduced length of treatment in the study group could be caused by the absence or a significantly reduced stage of local wound treatment; there were fewer complications in the form of secondary necrosis of deep-lying tissues that would require additional treatment stages. Conclusions Reconstruction of osteomyelitic defects with the transposition of loco-regional perforant flaps allowed lower complication rate and improved functional outcomes for patients with posttraumatic and osteomyelitic defects of soft tissues of lower limbs.

ROLE OF CROSS LEG FLAPS IN LEG AND FOOT RECONSTRUCTION: OUR EXPERIENCE

Introduction: The management of compound trauma has always been challenging. Free aps are the rst choice when soft tissue cover cannot be provided by local aps. When facilities for microsurgery are not available or certain factors preclude the microsurgical anastomosis or in cases of free ap failure, the cross leg aps have a big role to play in lower limb reconstruction. We are presenting our retrospective study on 30 cases of distal leg and foot defects covered successfully by cross leg aps. The aim of this study is to highlight the usefulness of cross legAims and objectives: aps in lower limb reconstruction. A retrospective study was done on 30 patients from January 2015 toMaterial and methods: December 2021 who underwent perforator based fasciocutaneous cross leg ap for post traumatic soft tissue defects of distal leg and foot. The mechanism of injury, size and site of defect were recorded. All aps were planned in reverse and limbs were immobilised with external xator. Post-operative complications if any were noted. The patients were followed till the ap became stable. The mechanism of injury was road side accident in 26 cases, machine injury in 2 cases and fall fromResults: height in 2 cases. 19 patients had soft tissue defect of distal 1/3rd of leg and 11 patients had foot defects. 26(86.67%) patients underwent distally based fasciocutaneous cross leg ap and 4(13.33%) patients underwent conventional anteromedially based fasciocutaneous ap. All aps survived well. 2 patients had discharge and 1 had margin necrosis but were managed conservatively. The perforators based fasciocutaneous cross leg aps provide an easy, simple, reliable and viableConclusion: cover for distal leg and foot reconstruction.

ИСПОЛЬЗОВАНИЕ ЛОСКУТА ШИРОЧАЙШЕЙ МЫШЦЫ СПИНЫ ПРИ ПОСТТРАВМАТИЧЕСКОЙ ФУНКЦИОНАЛЬНОЙ НЕСОСТОЯТЕЛЬНОСТИ ВЕРХНЕЙ КОНЕЧНОСТИ

Objective: To improve the outcomes of surgical correction of upper limb dysfunction (ULD) using the latissimus dorsi flap (LDF). Methods: ULD occurred in 76 patients with Volkmann's ischemic contracture (VIC), post-traumatic soft tissue defects, and brachial plexitis in 57, 11, and 8 cases, respectively. Out of 57 patients with VIC, in 30 cases, a skin defect was observed along with severe degenerative changes in soft tissues, neurovascular bundles (NVBs) and tendons. Post-traumatic forearm defects (n=11) in 5 cases were accompanied by damage to the NVBs and tendons. In brachial plexitis, isolated injury to the musculocutaneous nerve occurred in 6 patients, and a combination of nerve lesions with radial nerve palsy – in 2 patients. Results: Transposition of LDF to the biceps brachii for the treatment of brachial plexitis, free muscle transplantation for the treatment of VIC and forearm soft tissue defects were performed in 8, 57, and 11 cases, respectively. Active forearm flexion after the muscle flap transposition was noted after 4 weeks. In contrast, after graft transplantation in VIC, the grip function restoration began after 6 months and improved within 1 year and beyond. Conclusion: Using the LDF in surgical correction of post-traumatic ULD allowed restoring the lost functions of the crushing grip and forearm flexion. For the forearm, only free flap transplantation with a relatively long period of limb function recovery is possible. In contrast, the traspositioned LDF to the biceps allows achieving the desired functional outcomes in the shortest possible time. Keywords: Upper limb, latissimus dorsi flap, Volkmann's contracture, soft-tissue defect, brachial plexitis.

Comparison between Free Anterolateral Thigh Flap and Free Medial sural Artery Perforator Flap in Reconstruction of Posttraumatic Soft Tissue Defects of Dorsum of the Foot

Comparison between Free Anterolateral Thigh Flap and Free Medial sural Artery Perforator Flap in Reconstruction of Posttraumatic Soft Tissue Defects of Dorsum of the Foot

Comparison Between Free Anterolateral Thigh Flap and Free Medial Sural Artery Perforator Flap in Reconstruction of Post Traumatic Soft Tissue Defects of the Dorsum of the Foot

Abstract Background: The objective of this study is to compare between the free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot as regard the function, the aesthetic outcome, the complications and the patient satisfaction.Method: The study was conducted on 40 patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were allocated randomly into two groups. In group1 (20 patients), the defect was reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap.Result: In group 1 (ALT flap), Complete flap survival was achieved in all cases. Thirteen patients required secondary debulking procedures and scar revisions.In group 2 (MSAP Flap), Complete flap survival was achieved in 17 cases with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement.Conclusion: MSAP flap is good alternative in soft tissue reconstruction of the dorsum of the foot. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases. ALT flap is better than MSAP flap in larger defects coverage but may need secondary debulking procedures or primary thinning at the time of reconstruction.

Comparison between Free Anterolateral Thigh Flap and Free Medial Sural Artery Perforator Flap in Reconstruction of Post Traumatic Soft Tissue Defects of Dorsum of the Foot

Background: The objective of this study was to compare the pliability, the function, aesthetic outcome, complications and patient satisfaction between free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot. Method: The study was conducted on forty patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were divided randomly into two groups. In group1 (20 patients), the defects were reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in 100% of cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 85% with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is superior to ALT flap. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases.

ANATOMO-FUNCTIONAL CLASSIFICATION OF THE HAND POST-TRAUMATIC SOFT TISSUE DEFECTS

The aim: Develop a classification of post-traumatic soft tissue defects of the hand to standardize the care of this group of patients. And in order to simplify the choice of plastic technic for post-traumatic soft tissue defects of the hand by surgeons and traumatologists. Materials and methods: We analyzed the treatment of 54 patients with hand injury and PTSTD. 14 physicians used AFC in the choice of surgical method for the closure of PTSTDH. The practical application of AFC and effectiveness of providing medical care to patients with PTSTDH was performed on a ten-point scale by anonymous questioning immediately at the time of discharge from the hospital and 6 months after the injury. Results: The results of the practical application analysis of AFC by physicians were as follows: «convenience» – 8.7 ± 0.6; «usefulness» is 9.4 ± 0.2. The results of treatment for 54 patients were: hands «functionality» – 8,3 ± 0,4, «aesthetics» – 7,6 ± 1,7. The results in the retrospective group, in which the AFC was not applied, were as follows: «functionality» – 6.8 ± 0.7, and «aesthetics» – 5.6 ± 1.1 Conclusions: The proposed AFC of PTSTDH help to choose the proper method of surgical management and get good results.

Facial Fat Grafting in reconstructive maxillofacial surgery

Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FG was initially used as a technique to improve facial aesthetics. Over the years the technique has evolved into more complex reconstructive and regenerative procedures and new clinical applications. Methods: In the last two decades the indications of FG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects, aesthetics,congenital and other postsurgical volume deficits. Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate. Conclusion: FG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.

Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects.

This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5cm to 4.5 × 10.5cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.

Sequential propeller flaps in the treatment of post-traumatic soft tissue defects of the lower limb – a case series

IntroductionPropeller flaps have gained great popularity among reconstructive surgeons; however, the inability to directly close the donor site of large propeller flaps constitutes a well-known limitation of this technique. Skin grafting of the donor area is not always feasible nor desirable. To address large propeller flaps secondary defects, we investigated the use of a second propeller flap harvested from a nearby region of relative skin redundancy to assist the donor site closure generated by the first. Since the donor defect of the second flap is closed by direct suture, the aim of this “sequential” propeller flaps technique is to achieve complete, like-with-like, soft tissue restoration while avoiding skin grafting. MethodsFrom April 2018 to September 2019, eight patients presenting post-traumatic soft tissue defects were planned to be reconstructed by means of the sequential propeller flaps technique, for a total of 16 propeller flaps. The locations of the defects included the distal leg in four cases, the heel in two cases, the proximal lateral thigh in one case and proximal posterior thigh in the remaining one. All the flaps but one were harvested as a perforator-based propeller type and rotated by different degrees around the skeletonized perforator. In one patient, due to an intraoperative complication following the first flap harvest, the harvest of the second flap was abandoned. ResultsIn all but one patient, a complete, tension free primary closure of all wounds was achieved without complications, the functional recovery as well the esthetic outcome were excellent. One patient showed intraoperative signs of vascular insufficiency involving 15% of the first flap. The plan of harvesting the second flap was intraoperatively abandoned and the definitive wound closure with a free muscle gracilis was carried out the following week. ConclusionIn some selected cases, the use of multiple propeller flaps performed in sequence allows the surgeon to obtain complete, like-with-like wound closure with vascularized tissue avoiding a free tissue transfer procedure, however, it requires a vast experience with propeller flaps and meticulous preoperative planning.

Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries.

"Orthoplastics" is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.

The flip-flap puzzle flap: Another recycling option.

Post-traumatic soft tissue defects sometimes require sequential flap coverage to achieve complete healing. In the era of propeller flaps, which were developed to reduce donor site morbidity, Feng et al. introduced the concept of the free-style puzzle flap, in which a previously harvested flap becomes its own donor site by recycling the perforator. However, when a perforator cannot be found with a Doppler device, we suggest performing a new type of flap, the flip-flap puzzle flap, which combines two concepts: the free-style puzzle flap and the flip-flap flap described by Voche et al. in the 1990s. We present the cases of three patients who achieved complete healing through this procedure.

Posterior interosseous flap for resurfacing posttraumatic soft tissue defects of the elbow

Posterior interosseous flap for resurfacing posttraumatic soft tissue defects of the elbow

Reconstruction of Complex Full-Thickness Scalp Defects After Dog-Bite Injuries Using Dermal Regeneration Template (Integra): Case Report and Literature Review

The purpose of this article is to review the current applications of dermal regeneration templates in reconstruction of full-thickness scalp defects, most commonly resulting from oncologic surgery, and show its success in reconstruction of a complex full-thickness scalp defect resulting from a dog-bite injury. A systematic review conforming to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines was completed. A PubMed search was completed using key terms including Integra, dermal regeneration template, full-thickness scalp defects, dog-bite injuries, and scalp. Eligible articles were selected based on the characteristics of defect size, procedural protocol, and reconstruction modality. Outcomes reported were based on reports of follow-up, complications, and percentage graft take. The case report presents reconstruction of a complex full-thickness scalp defect due to a dog-bite injury with a dermal regeneration template. Fifteen articles were included. Reported ages ranged from 2 to 93years. The mean defect size ranged from 6 to 610cm2, with 67% of defects averaging more than 50cm2. All articles reported the 2-stage approach to Integra (Integra LifeSciences, Plainsboro, NJ)-based reconstruction with follow-up ranging from 5 to 23months, with only 2 articles reporting less than 90% graft take. Acellular dermal matrix provides an alternative reconstructive mechanism to free tissue transfer and flap reconstruction and offers a unique advantage in the medically complex patient, as well as in pediatric and geriatric populations. Successful Integra-based reconstruction of full-thickness complex scalp defects is well reported in the literature in relation to reconstruction of Mohs surgical defects, as well as burns of the trunk and extremities; however, reports of reconstruction of post-traumatic soft tissue defects of the head and neck are limited. On the basis of the reported successes from the reviewed literature, as well as the clinical outcome of the reported case, we believe Integra to be a valuable reconstructive tool in the algorithm for repair of post-traumatic, full-thickness, complex scalp defects when used appropriately.

КОРРЕКЦИЯ МЯГКОТКАНЫХ ДЕФЕКТОВ И ПОСЛЕДСТВИЙ ПОВРЕЖДЕНИЯ СОСУДИСТО-НЕРВНЫХ ПУЧКОВ ВЕРХНИХ КОНЕЧНОСТЕЙ

Objective: Improving the results of the post-traumatic soft tissue defects and the consequences of damage of the neurovascular bundles of the upper limbs (CDNBUL), determining the sequence of repairing damaged structures. Methods: The results of various surgical interventions in 60 patients with soft tissue defects and CDNBUL were analyzed. Causes of soft tissue defects and CDNBUL were: severe degree Volkmann’s contracture (24), complications of various wounds of the forearm and hand (19), the consequences of damage to electric machines (8), electrical injury (5) and gunshot wounds (4). Concomitant damage was noted to 52 arteries, intersection 32 and compression of 16 nerve trunks; the area of defects varied from 80 cm2 to 95.47 cm2. Results: An important criterion in the treatment of this category of patients is the determination of the stages of the operation. Depending on the duration of the injury and the nature of the damage, as well as the functional significance of the hand, in some cases skin and fascial (33) were used, in others – skin and muscle (24), and also avascular grafts (3). The nature of operations on damaged underlying structures also depended on the type of lesion. If the indications for the restoration of damaged nerve trunks were absolute in all cases (neurolysis – 8, epineural suture – 9, autonervous plasty – 10), then during restoration of vessels, indications for reconstruction were narrowed (reconstruction of arteries – 28, arteriolysis – 4). The final rehabilitation of victims in some cases was achieved by corrective operations on the hand itself. Conclusion: Achieving final functional results for soft tissue defects and CNDBUL requires the application of a number of complex reconstructive interventions. Keywords: Soft-tissue defects of the upper limb, transplants, Volkmann’s contracture, neurovascular bundle.

Abstract: 12.50 Adipose Cell Derived Regenerative Therapy (Acrt): A New Approach Of Lipotransfer In Scar Treatment

INTRODUCTION: Regenerative properties of autologous lipotransfer are recently described in patients with atrophic and painful scars. In this regard preliminary results of an European multicentre study (Germany, Netherlands) underline the aspect of regeneration and possible reconstruction of the subcutaneous layer using a certain lipotransfer technique (ACRT = adipose cells derived therapy) in symptomatic scars and posttraumatic soft tissue defects. MATERIALS AND METHODS: Since the start in June 2014 clinical and histological analyses were performed in 17 patients (6 burns and 11 trauma) treated with 2 to 4 water-jet assisted lipotransfer (WAL) procedures including a follow-up of at least 3 months. Skin biopsies were taken preoperative and after 3 months. The skin quality and scar improvement were measured by POSAS and VAS-score system and documented by digital pictures. If joints were affected due to scar contraction, the mobility was determined with the neutral zero method pre and postoperatively. Overall changes were detected in the resulted skin adhesion, colour and aesthetic outcome as well as in the histological structure of the scars treated in the study presented. RESULTS: Up to date 17 patients were treated by ACRT-protocol with a minimal invasive scar release and lipotransfer technique. Short operation time (56.2 min) with minor complications like haematoma on the donor (5.16%) has been achieved. However a significant decrease of pain in movement or skin stiffness was remarked in 56.3% of the patients after the first and in 75.1% after the second procedure. Histological analysis mainly showed a gain of cell layers in the epidermis and a rearrangement of the collagen fibres in the dermal layer. CONCLUSIONS: The current trial helped to develop a new protocol in scar treatment called ACRT. It has been successfully used in a range of different scar types with and without soft tissue defects in our patient group. 14.00–15.40 SESSION 4 – CRANIOFACIAL Moderators Benoit LENGELÉ Ion ZEGREA

Treatment of complex metacarpal defects with free chimeric iliac osteocutaneous flaps

Objective: The aim of this report is to present the clinical results of using free chimeric iliac osteocutaneous flaps based on the periosteal branch of the superficial circumflex iliac artery (SCIA) in complex metacarpal reconstructions.Methods: Reconstruction using free chimeric iliac osteocutaneous flaps was performed in a series of seven patients who underwent metacarpal reconstruction for complex metacarpal defects between March 2009 and March 2012. The procedure was performed for bone and soft tissue losses associated with posttraumatic infections (four patients) and posttraumatic bone and soft tissue defects (three patients).Results: The skin paddles of the chimeric flaps had a median size of 3 × 7 cm, and the iliac segments had a mean size of 1 × 1 × 3 cm. The median follow-up time was 18 months. All the flaps survived completely with no signs of infection. Osseous union occurred within a mean period of 3 months, and the range of motion achieved for the metacarpal phalangeal joints was 0–80°. The patients were satisfied with the aesthetic outcome.Conclusions: Chimeric iliac osteocutaneous flaps may be a useful alternative for treating complex metacarpal defects because they yield a thinner skin paddle and less bulky bone segment than traditional flaps.

Innervated Free Groin Flap.

Innervated Free Groin Flap.

Versatility of Pleuripotent Undifferentiated Stem Cells Aspirated from Bone Marrow and its Applications in Oral and Maxillofacial Surgery

Bone marrow (BM) derived pleuripotent undifferentiated stem cells represent a promising population for supporting new concepts in cellular therapy. The aim of this study is to evaluate the versatility of pleuripotent undifferentiated stem cells derived from BM aspiration and its applications in oral and maxillofacial surgical procedures. A total of 30 patients out of which 15 were with hard tissue defects (cystic lesions n=6, post surgical alveolar defects n=4, peri implant defects n=3, alveolar clefts n=2) and 15 soft tissue lesions (leukoplakia and lichen planus n=6, oral submucous fibrosis n=7, post traumatic soft tissue loss n=2) were included in the study on randomized clinical basis. The patients received autologous BM derived mononuclear cells which were being locally delivered into the lesion and followed up. The parameters used were (1) To compare and evaluate the bone regeneration by radiographic assessment at the end of 3rd and 6thmonth postoperatively. (2) Duration of the procedure. (3) Clinical improvement in the management of soft tissue lesions. (4) Assessment of wound healing by Vancouver burn scar assessment of wound. (5) Safety, postoperative infections and complications. For hard tissue lesions CT scans and OPG revealed adequate regenerated bone, bridging the defect after 3months. Hounsfield units of regenerated bone after 6months were more or less similar to native bone which was statistically significant (unpaired t test=p<0.05). For soft tissue lesions (1) 7 cases of OSMF showed adequate clinical mouth opening (one way anova test=p<0.05), reduction in burning sensation and blanching of mucosa, (2) 6 cases of leukoplakia and lichen planus and 2 cases of post traumatic soft tissue defects showed good clinical improvement by Vancouver burn scar assessment of wound index. The study shows that there is a definite beneficial effect in bone regeneration and soft tissue wound healing with the use of BM-derived mononuclear cells.