Postoperative Healing Phase Research Articles

Implant-associated fracture of the tibial plateau in cementless medial unicondylar knee prosthesis : Locking plate osteosynthesis

Cementless medial unicondylar knee prostheses with mobile inlays have proved to be successful and are increasingly being used worldwide; however, there is a risk of fracture of the medial tibial plateau in the postoperative healing phase. In most cases we observed split fractures starting from the keel of the implant. These can be treated with a small posteromedial locking plate, whereby the upper screws are inserted through the keel slot and then interlocked. This achieves an optimally strong bond between the implant and the screws and a stable construct. A longitudinal skin incision is made at the level of the keel slot. A radial T‑plate is placed subcutaneously. The plate is fixed with a lag screw in the middle section. The compression usually closes the fracture gap. Then three locking cortical bone screws are inserted through the keel slot in the transverse section of the plate. Distal fixation by locking or standard screws. Immediate pain-adapted partial weight bearing, unrestricted mobility. Healing of the fracture and full weight bearing mostly achieved after 4weeks.

Biomolecular Mechanisms and Case Series Study of Socket Preservation with Tooth Grafts.

Twenty patients requiring tooth extraction underwent socket preservation utilizing the extracted tooth as the grafting material. After a 4-month healing period, the defects were significantly filled with newly formed hard tissue. Subsequently, bone biopsies were performed during dental implant placement to evaluate histological outcomes. The tissue exhibited a similar density to medium-density bone, displaying a homogeneous and uniform appearance without any visible signs of inflammation. The post-operative healing phase was free from infective complications or indications of graft particles within the regenerated bone structure. The histomorphometric analyses revealed the following results: bone total volume, BV% 52.6 ± 13.09, vital bone VB% 40.39 ± 15.86, residual graft % 12.20 ± 12.34. The study demonstrated positive bony healing in guided regenerative surgery procedures using autologous tooth grafts. However, further research with an extended follow-up period is necessary to thoroughly assess the potential of demineralized dentin autografts.

Innovative Concepts and Recent Breakthrough for Engineered Graft and Constructs for Bone Regeneration: A Literature Systematic Review.

Background: For decades, regenerative medicine and dentistry have been improved with new therapies and innovative clinical protocols. The aim of the present investigation was to evaluate through a critical review the recent innovations in the field of bone regeneration with a focus on the healing potentials and clinical protocols of bone substitutes combined with engineered constructs, growth factors and photobiomodulation applications. Methods: A Boolean systematic search was conducted by PubMed/Medline, PubMed/Central, Web of Science and Google scholar databases according to the PRISMA guidelines. Results: After the initial screening, a total of 304 papers were considered eligible for the qualitative synthesis. The articles included were categorized according to the main topics: alloplastic bone substitutes, autologous teeth derived substitutes, xenografts, platelet-derived concentrates, laser therapy, microbiota and bone metabolism and mesenchymal cells construct. Conclusions: The effectiveness of the present investigation showed that the use of biocompatible and bio-resorbable bone substitutes are related to the high-predictability of the bone regeneration protocols, while the oral microbiota and systemic health of the patient produce a clinical advantage for the long-term success of the regeneration procedures and implant-supported restorations. The use of growth factors is able to reduce the co-morbidity of the regenerative procedure ameliorating the post-operative healing phase. The LLLT is an adjuvant protocol to improve the soft and hard tissues response for bone regeneration treatment protocols.

Application of the Buccal Fat Pad in Oral Reconstruction: Covered With Collagen Membrane or Not?

To evaluate the clinical effectiveness of collagen membrane as biological dressing in protecting the covered buccal fat pad (BFP) from physical damage during postoperative healing phase in the reconstruction of oral soft tissue defect. A retrospective cohort study was performed in patients undergoing oral defects reconstruction using BFP. The predictor variable was the application of collagen membrane or not. The primary outcome variable was the wound healing. Other variables considered included age, gender, pain score, time taken for epithe-lialization, defect size and site. Postoperative follow-up was done at 1 week, 3 weeks, 6 months, and 1 year. Thirty patients in Zhuhai People's Hospital were selected and randomly divided in 2 groups. Group i patients were reconstructed using BFP alone, whereas collagen membrane was used as a covering over BFP in group II patients. In group I, 4 patients developed dehiscence 1-week postoperative, and underwent infection with food lodgment along with another 1 patient at 3-week follow-up, whereas none of the group II patients developed dehiscence or infection. Pain score was lesser in group II patients as compared to group I. Time taken for epithelialization was about 3 weeks in both groups. Combined application of collagen membrane protects the covered BFP from masticatory physical damage and food lodgment, which reduces infection and graft loss. It is worthy of consideration as an effective method for the reconstruction of selected moderate-sized oral defects, especially in larger size or at distant location.

The relation between fracture activity and bone healing with special reference to the early healing phase – A preclinical study

BackgroundFracture healing outcome is to a great extent steered by the mechanical environment. The importance of early phase mechanical fracture stimulation is still controversially discussed, both clinically and scientifically. Furthermore, the role of fracture activity, defined as the number of stimulatory events per time, is particularly for the direct postoperative phase unknown. MethodsTibial defects of seven Swiss mountain sheep were stabilized with a dynamizable bone fixator, which allowed for defined interfragmentary motion by limiting the maximum axial displacement. The fixator was further equipped with a telemetric measuring unit to continuously log all occurring displacement events above a predefined amplitude threshold over an 8-weeks observation period. Callus size was measured over time from X-rays. Ultimate torsional strength of the healed defects was assessed after euthanasia. ResultsOne animal had to be excluded from the experiment due to technical reasons. The remaining six animals exhibited consistently the highest fracture activity in week 1 post-operation with 6′029 displacement events per week for the animal with the lowest activity and 21′866 events per week for the most active animal. Afterwards fracture activity gradually decreased over time. Strong and significant correlations were found for fracture activity in week 1 and 2 with torsional strength of the healed bone (R ≥ 0.881, p ≤ 0.02). No significant correlations were observed at later timepoints. Fracture activity in week 1 and 2 also correlated strongly with the maximum callus area as measured from X-rays (R ≥ 0.846, p ≤ 0.034). ConclusionsThe data demonstrates a positive effect of, within limits, frequent fracture stimulation on bone healing and suggests the importance of the mechanical environment in the direct post-operative healing phase. Clinically, the findings may advocate for the concept of direct post-operative weight bearing. This, however, requires clinical validation and must be considered within the full clinical context including the risk for fixation failure from overloading.

High short-term return to sports rate despite an ongoing healing process after acute meniscus repair in young athletes.

Acute meniscus repair in young athletes is always a challenge due to the long rehabilitation process and time to return to sport (RTS). The purpose was to investigate signal alterations in short-term follow-up after acute meniscus repair on specific magnetic resonance imaging (MRI) scan sequences. It was hypothesized that (1) MRI signal changes over the first postoperative healing phase and represent a continuous healing process and (2) meniscus healing properties correlates with clinical outcomes and RTS. Young athletes with traumatic meniscus lesion and arthroscopic meniscus repair within 6weeks and available preoperative MRI were enrolled. Clinical examination, outcome scores (IKDC, KOOS, Lysholm Score, Tegner activity score) and RTS were surveyed preoperatively and 6 and 12weeks and 6months after surgery. Radiological follow-up examinations were performed 2, 4, 6, 12weeks and 6months after operation using a 3T-MRI. Evaluation was based on ISAKOS meniscus classification system, meniscus healing were classified according to Henning's criteria. At final follow-up (FU) 30 patients (28month, 2week) with a total of 35 meniscus tears (19 medial, 16 lateral) were included. Clinical scores improved significantly after surgery: IKDC Score (preOP: 39.4 ± 18.5, final FU: 78.8 ± 15.3) KOOS (preOP: 45.7 ± 22.1, final FU: 82.7 ± 12.5) and Lysholm Score (preOP: 42.8 ± 23.7, final FU: 84.4 ± 13.8) (p < 0.01). Tegner activity score showed a steadily increase to 4 (range 3-9) at 6months but did not reached the pre-injury level of 6 (range 3-9). RTS rate was 100% whereof 44.8% reached their pre-injury level. MRI examination revealed a continuous healing process and menisci were classified as 55.9% healed, 35.3% partially healed and 8.8% non-healed at final FU. This study showed that MRI signal alterations of the meniscus steadily occur within the first 6 months postoperatively. MRI reveals an ongoing healing process at final FU that have to be carefully considered when RTS is discussed with high demanding patients. However, young athletes provide good clinical results and RTS rate even though MRI alterations are still present. Therapeutic study, prospective case series, Level IV.

Collagen Membrane Over Buccal Fat Pad Versus Buccal Fat Pad in Management of Oral Submucous Fibrosis: A Comparative Prospective Study.

The objective of this study was to assess the effectiveness of collagen membrane as biological dressing over buccal fat pad (BFP) during crucial postoperative healing phase in the surgical management of oral submucous fibrosis (OSMF). The study comprised of 40 patients of OSMF of group IVa (Khanna and Andrade). Patients were randomly divided in two groups (20 patients in each group). Group I patients were treated using buccal fat pad only, whereas collagen membrane was used as a covering over harvested BFP in group II patients. Postoperative follow-up was done at 1week, 3weeks, 6months and 1year. Mean postoperative mouth opening achieved in both the groups was comparable at every follow-up visit. Infection was evident in four patients of group I at 1-week follow-up, whereas none of the group II patients developed infection. Pain score was lesser in group II patients as compared to group I. Relapse was seen in two patients in group I and one patient in group II. Time taken for epithelialization was 2-3weeks in both the groups. Although intraoperative time was increased in group II application of collagen membrane reduced infection when compared with group I. Also, the chances of damage to BFP are reduced during the hygiene maintenance at surgical site and jaw-opening exercise. Reduction in pain scores during postoperative period in group II patients was an additional advantage.

Wound closure and wound healing. Suture techniques in contemporary periodontal and implant surgery: Interactions, requirements, and practical considerations.

In contemporary reconstructive periodontal and implant surgery, attaining uncomplicated wound healing in the early postoperative healing phase is the key to achieving a successful treatment outcome and is of central interest, from the clinical as well as the scientific perspective. The realization of primary wound healing is the central challenge in most cases. Two of the evidence-based factors that affect postoperative wound healing can be influenced by the surgeon: the blood supply to the surgical site and postoperative wound stability. The surgical suture is a key determinant of whether adequate wound stability is achieved in this context without complicating the course of wound healing by exerting unnecessary trauma or excessive tensile strain on the wound edges. Therefore, the inclusion of anchors in the suturing process that make it possible to achieve the best wound stability possible is often an important key to success. This article provides an overview of the principles of successful wound closure that are relevant to postoperative wound healing in order to equip dentists with the tools needed for the correct, indication-specific selection and performance of surgical suturing techniques in daily practice.

Rehabilitation of Supinator Nerve to Posterior Interosseous Nerve Transfer in Individuals With Tetraplegia

Despite being a routine part of the early surgical management of brachial plexus injury, nerve transfers have only recently been used as a reconstructive option for those with tetraplegia. Subsequently, there is limited published literature on the rehabilitation theories and techniques for optimizing outcomes in this population. This article seeks to address this void by presenting our centers' working model for rehabilitation after nerve transfers for individuals with tetraplegia. The model is illustrated with the example of the rehabilitation process after a supinator nerve to posterior interosseous nerve transfer. This nerve transfer reconstructs wrist, finger, and thumb extension. The topics covered in the model include the following: patient selection and presurgical planning/intervention, managing the postoperative healing phase of an individual who is wheelchair dependent, maximizing motor reeducation, increasing muscle strength, and ensuring use in functional tasks. This article provides a platform for further development and collaboration to improve the outcomes of patients who undergo nerve transfers after tetraplegia.

Maxillary sinus bone augmentation techniques.

Maxillary sinus expansion and atrophy can be difficult to overcome for patients who require functional dental prostheses. One solution for this problem is sinus augmentation and implant placement. Patients are evaluated and diagnosis is ascertained, leading to development of a treatment plan and surgical strategy. The surgeon decides on a surgical technique and grafting material, based on ultimate success, stability, and function as they relate to the goals. Complications can occur during an operation or during the postoperative healing phase. Dealing with these complications can be challenging; however, solving these problems positively affects the overall outcome and success.

Technical options in treatment of pilonidal sinus and hidradenitis suppurativa

Treatment of PS is depends on the disease presentation. Abscess, chronic sinus, complexity of sinus, chronic recurrent of pilonidal abscess affects the treatment strategy. Each statement has different management option but wide, meticulous shaving and hygiene always should be main part of the all of the management options. In patients, presenting initially with simple midline pits or sinus tracts without acute abscess shaving can be offered as the initial treatment. During both primary and postoperative healing phase, shaving should be continued on a weekly treatment. Patients with acute pilonidal abscess require incision and drainage, ideally making the incision lateral to the midline. Dressing change, baths and shaving should be continued until the wound has healed. The majority of acute abscess treated in this way do not occur. Many patients will present initially with chronic pilonidal sinus. Location of the sinus will help to choice to management way. In the case where all the disease sinuses and pits are located near and in the midline, the conservative midline excision or unroofing with curettage may be the first step treatment. However if the multiple draining sinuses exist and they are located far away from the midline, the simple excision may cause large wound defects. In these situations cleft lift procedures (Bascom) or excision with a rhomboid flap recon- and scarring. Management of the wound after total excision should be tailored to the individual patient. Although the incidence of squamous cell carcinoma is rare but it is the most serious complication of HS. The diagnosis and treatment of anal fistula and anorectal infection is a cornerstone of any busy and dedicated colon and rectal surgeons? practice. Pilonidal sinus (PS) is not strictly a disease of the anus, because of its proximity to the anus and the occasional difficulty in differentiation from anal fistula, these patients commonly referred to a colon and a rectal surgeon for the treatment1. Hidradenitis suppurativa (HS) which occurs more frequently in other areas of the body can be a diagnostic problem when it has seen and suspected in perineal area1,2. Both PS and HS may present as a prolonged and long-suffering course of treatment for the patient and surgeon. This paper reviewed the treatment options of PS and HS briefly.

545 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011545 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR Ayme Schmeeckle, Dennis Venable, and John Mata Ayme SchmeeckleAyme Schmeeckle Shreveport, LA More articles by this author , Dennis VenableDennis Venable Shreveport, LA More articles by this author , and John MataJohn Mata Shreveport, LA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previously, we reported a positive experience with fibrin glue (Tisseel TM) in securing skin grafts during genital reconstruction. It has been suggested that fibrin glue may decrease incidence of urethrocutaneous fistulae and postoperative bleeding when used during hypospadias surgery. Herein, we report our results of a retrospective review comparing a cohort of patients with mid to distal shaft hypospadias undergoing primary tubularized incised plate (TIP)reconstruction with and without fibrin glue. METHODS We reviewed a group of 39 patients, ages 7 months to 14 years, who underwent a TIP hypospadias repair from 2008 to 2010. 13 patients had a thin layer of fibrin glue applied over the neourethra and 26 patients did not. Averages ages were 27 months in the fibrin group and 10 months in the non-fibrin group. Two patients in the fibrin group had midshaft hypospadias compared to seven in the non-fibrin group. All patients had urethral catheters for 5 to 7 days postoperatively and Tegaderm dressings. We compared the complication rates of the two groups at a mean follow-up of 15 months. RESULTS Although there was a subjective assessment that minor bleeding stopped more readily in the fibrin group intraoperatively, estimated blood loss in all patients was negligible since all repairs were done with tourniquet control. No patient in either group developed significant hematoma or required return to the operating room for postoperative bleeding. In the fibrin group, 6 of the 13 (46.15%) patients developed a urethrocutaneous fistula compared to 2 of 26 (7.69%) in the non-fibrin group. One patient in each group had a partial glans dehiscence associated with the fistula. All patients who elected for fistula repair received successful surgical correction in the standard fashion without fibrin glue at 6 months postoperatively. CONCLUSIONS Patients receiving fibrin glue had a greater than six fold increased incidence of fistula formation. These findings suggest that fibrin glue may disrupt normal tissue incorporation in the postoperative healing phase. Although fibrin glue helped stop bleeding from glansplasty, it made no difference in the overall estimated blood loss. Further basic science studies on wound healing with fibrin glue as well as larger clinical prospective, randomized trials are needed to help define the role of fibrin glue in hypospadias surgery. Until the results of such trials are known, fibrin glue should be used with caution in patients undergoing hypospadias repair. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e221 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ayme Schmeeckle Shreveport, LA More articles by this author Dennis Venable Shreveport, LA More articles by this author John Mata Shreveport, LA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy

Nasal packing may influence the mucociliary clearance of the nose in the postoperative healing phase. In an attempt to overcome some of this problem, a haemostatic septal suturing technique was conceived. In this prospective study, we aimed to investigate the effects of nasal packing and septal suturing technique on mucociliary clearance by rhinoscintigraphy. Forty-eight adult patients who had undergone septoplasty were included in the investigation. Preoperatively, the patients were allocated into three groups: group 1, fingerstall packs filled with gauze and smeared with vaseline were used (11 male, 4 female); group 2, silicon septal splint packs were used (11 male, 4 female); group 3, haemostatic septal sutures were used (14 male, 4 female). Mucociliary clearance was measured by rhinoscintigraphy in all patients before surgery and 6 weeks after surgery. The nasal mucociliary clearance was presented as the velocity (mm/min) of nasal mucociliary transport of the (99m)Tc-MAA droplet. The mean velocity of nasal mucociliary clearances before and after surgery for group 1, group 2 and group 3 were 1.85 +/- 0.67 versus 2.43 +/- 0.78 mm/min, 2.36 +/- 0.80 versus 2.92 +/- 0.96 mm/min and 2.03 +/- 0.58 versus 2.62 +/- 0.65 mm/min, respectively. A significant difference in nasal mucociliary clearance was observed after surgery in all groups (p < 0.001). No significant differences were found between the groups regarding mucociliary clearance before and after surgery. Patients with septal deviation have a prolonged mucociliary transit time as compared with postoperative. Nasal packing did not significantly influence the mucociliary clearance in the postoperative healing phase.

RIB FRACTURE FIXATION WITH INTRAMEDULLARY SPLINTS

PURPOSE: Plating of serial rib fractures in flail chest injuries reduces the mortality associated with prolonged ventilation. However, rib plating is a highly invasive procedure and posterior fractures are difficult to access. This study investigated the durability and fixation strength of intramedullary rib splints for less-invasive fixation of posterior rib fractures. Tested was the hypothesis that splint constructs can withstand a loading history that spans the post-operative healing phase in osteoporotic ribs.

Migration of the Ball Electrode After Cochlear Implantation

To review the postoperative radiographic investigations of patients implanted with a cochlear implant. Retrospective case series. Thirty-nine patients (22-77 yrs old) implanted for sensorineural deafness in the cochlear implants program of the Academic Medical Center of Amsterdam. Cochlear implantation with Cochlear Nucleus 24 Contour and Cochlear Nucleus Freedom (Cochlear Corp., Lane Cove, New South Wales, Australia) implant. This retrospective analysis of the postoperative computed tomographic scans showed that, in a large number of the implantations, the external ball electrode of the cochlear implant migrated from the insertion place toward the magnet of the receiver/stimulator unit of the implant. It seems that this migration of the external ball electrode does not influence the function of the cochlear implant and the result of the hearing rehabilitation in the short term. Because of the magnetic field of the receiver/stimulator unit of the cochlear implant and the magnet of the external transmitting coil of the speech processor, it seems to be possible that the extracochlear ball electrode can migrate in the space between the temporal bone and the temporal muscle during the postoperative healing phase. The importance of our observation is still not clear.

Early Loading of Four or Five Astra Tech Fixtures with a Fixed Cross-Arch Restoration in the Mandible

Early Loading of Four or Five Astra Tech Fixtures with a Fixed Cross-Arch Restoration in the Mandible B. Collaert, H. De Bruyn, Clin Implant Dent Rel Res, 2002;4:133–135 Reduction of the extended postoperative period before placement of a final implant-supported restoration is likely to be perceived as beneficial by most patients. With this in mind, several recently developed clinical protocols have focused on the reduction of the postoperative healing phase before definitive restoration. Many of these involved placement of a fixed, implant-supported mandibular restoration in edentulous patients on the day of implant installation. The advantage of this approach is the immediate functional restoration of edentulous patients. One potential shortcoming of the procedure is the possible detrimental effects on osseointegration. Additionally, consideration must be given to the need to extend the surgical procedure with a time intensive construction and placement of the immediate prosthodontic restoration. The present study reports on 25 patients who received four or five implants in edentulous mandibles (total of 114 implants). Impressions were made immediately following surgical implant installation. Definitive, fixed, metal-resin, mandibular restorations were placed within 1 month after implant surgery. Radiographs made at the time of prosthesis placement were compared with radiographs made at the completion of the study 7 to 24 months later. No postoperative complications were noted, and no implants were lost during the follow-up period. The mean bone loss was recorded to be 0.7 mm. Final bone levels were indirectly related to abutment heights—short abutments being associated with greater bone loss. These authors demonstrated an effective clinical protocol for expediting placement of a definitive mandibular fixed restoration in edentulous patients. This 1-month protocol provided ample time for construction of a metal-resin prosthesis and yet restored the patient sooner than would be accomplished using more conventional approaches. Based on indicators monitored in this study, long-term successful performance of these restorations is expected.

Optimization of the neck region of dental implants with a bioactive, resorbable coating.

With the goal of shortening the postoperative healing phase and the minimization of the risk of peri-implantitis around dental implants, a polymer coating, with improved surface biocompatibility in the region of soft tissue penetration by the implant, was investigated. The polymer used was the relatively slowly resorbable poly-beta-hydroxybuterate (PHB) whose surface was further activated in a NH3--plasma. The influence of surface roughness of the substrate (commercially pure titanium) as well as the influence of the edge radii on the test samples was determined in prior studies. These studies formed the basis for an optimised coating process. In-vitro biocompatibility was determined using a human gingival primary cell culture. Surface morphology was determined with SEM and AFM to complement the cell culture studies.

Effect of packing on nasal mucosa of sheep

The effects of packing with ribbon gauze and neuropatties on the nasal mucosa was assessed using sheep as an animal model. Fourteen sheep either underwent ribbon gauze or neuropattie nasal packing. Trauma to nasal mucosa caused by ribbon gauze and neuropatties was compared to mucosa on the lateral aspect of the middle turbinate which was not in contact with any packing. This tissue was used as a control. Ribbon gauze packing resulted in significant loss of 68 per cent of the ciliated surface of the mucosa when compared with the control group with a 15 per cent loss of ciliated surface (p < 0.005). Neuropattie packing also resulted in significant loss of 50 per cent of the ciliated surface of the mucosa when compared with the control group (p < 0.005). There was no significant difference in loss of ciliated mucosa in the specimens packed with ribbon gauze or neuropatties (p = 0.25). Nasal packing results in a significant mucosal injury with loss of cilia. This may influence the mucociliary clearance of the nose in the post-operative healing phase. Pre-operative nasal packing should be used circumspectly and if possible avoided.

Load sharing in augmented anterior cruciate ligament repair: a mathematical analysis based on in vitro measurements

Objective. To quantify the stress on a reinserted anterior cruciate ligament (ACL) we studied the load sharing between the ACL and a 3.7 mm polyethylene terephthalate (PET) band in 10 knees of fresh human cadavers. Design. The load sharing between the Marshall sutures-ACL complex and the PET band and between the ACL and the PET band was calculated by means of a mathematical model. Background. Augmentation of a reinserted ACL with a synthetic band is an accepted treatment for a ruptured ACL. Methods. After transsecting the ACL at its femoral origin and reinserting it with four sutures using the Marshall technique we augmented it with the PET band. The augmentation device was inserted by the through-the-condyle (TTC) procedure and attached without preload to the femoral and the tibial condyle with 4 mm staples. Then the length of the ACL, the lengths of the Marshall sutures, the partial lengths and the angles between the different directions, and the adherence-friction force of the PET band were measured. Results. In the beginning the Marshall sutures-ACL complex takes over 40% of an externally applied load and the PET band 60%. After the hypothetical ACL healing phase the PET band takes over 27% and the ACL 73% of the load. Conclusions. An external force of 40 N acting on the knee will therefore lead to an elongation of the Marshall sutures-ACL complex and result in movement of the proximal end of the ACL away from the femoral condyle of at least 0.5 mm, which is highly undesirable in the early postoperative healing phase.

Skin grafting in otologic surgery

In the postoperative healing phase after auditory canalplasty or open cavity mas to idec tomy, re-epithelialization of these areas may be very slow or problematic. Exposed surfaces may predispose patients to secondary infection and result in recurrent otorrhea. Numerous methods of promoting the healing of the external auditory canal and mastoid cavity after such operative procedures have been explored. One such method is split-thickness skin grafting of the exposed area, a technique first described by Karl Thiersch in the 1800's. In recent years, Thiersch skin grafting has been advocated by numerous investigators. In this review of Thiersch skin grafting, the indications for and methodology of this technique are explored. In 1587, Gasparo Taglacozzi first described the transfer of skin and subcutaneous tissue from one part of the body to another. His landmark publication describing pedicle grafting techniques gave rise to the art of reconstructive surgery. 1 In the late 1800s, Karl Thiersch advanced the techniques of autotransplantat ion. He adapted the pinch graft technique forwarded by Jacques Louis Rieverdin in 1869, developing the concept of splitthickness skin grafting in otologic surgery. 2 In 1893, Siebenmann first advanced the concept of using the Thiersch method of skin grafting in the postoperative mastoid cavity to promote healing. 3 Although such grafting was popular through the early 1900s, it was no longer commonly used by the 1950s. In more recent years, investigators such as Guilford and Wright, 4 Crem5 6 7 13 ers and Smeets, Morris et al, and many others have re-explored the use of split-thickness and full-thickness skin grafts in the repair of the postoperative external auditory canal and mastoid cavity linings. Because of their work the technique of Thiersch grafting has been reborn in the field of otology. Morris et al, in 1992, reported on the experience of 54 patients undergoing Thiersch grafting at the Minnesota Ear Head and Neck Clinic. They proposed that, based on their experience, the use of split-thickness skin grafts in promoting healing of exposed external auditory canal and mastoid cavity surfaces was suited for patients with copious postoperative granulation tissue, a moist, thin epithelium lining the surgical cavity, and persistent otorrhea. They did not recommend the use of grafting if squamous epithelialization had started and was progressing well. In their study, 98% of patients had at least 75% uptake of the grafted material 2 weeks postoperatively, and 86% of patients had complete healing of the area at 1 year. The types of operations leading to grafting in this