Removal Of Periosteum Research Articles

Experimental model of normotrophic pseudarthrosis of a rabbit’s tibia

Background. The formation of a pseudarthrosis is one of the most severe complications of bone fractures. Pseudarthrosis occurs as a result of a disorder in the fracture union, has a poor prognosis and requires long-term treatment and repeated surgeries. A small number of representative pseudarthrosis models makes it difficult to conduct preclinical studies of promising pharmacological substances, bone replacement materials and surgical methods of treatment.The aim. To develop and to validate an experimental model of normotrophic pseudarthrosis of a rabbit’s tibia by creating diastasis between bone fragments, forming local vascularization disturbance and using unstable fixation.Materials and methods. The study was carried out on Soviet Chinchilla rabbits. The animals were divided into 2 groups: in experimental group, we formed tibial pseudarthrosis; in control group, we made a simple transverse tibial fracture. The pseudarthrosis was formed by segmental resection (5 mm) of the middle third of the tibia, bone fragments dilatation for 5 mm, removal of periosteum and bone marrow within 5 mm followed by daily destabilization of a fracture in an external fixation device. The duration of the experiment was 6 weeks. X-ray examination of the fracture area was carried out weekly, multi-layer spiral computed tomography (MSCT) and histological examinations were carried out at the end of the experiment.Results. The survival value in the experiment was 100 %. According to weekly X-ray examination, fracture union was registered only in the control group and occurred on average on the 22,8 ± 5,1 day, while the formation of pseudarthrosis was observed only in the experimental group, and radiographic signs of a pseudarthrosis were noted on average on the 33,6 ± 3,5 day. The formation of a pseudarthrosis by the end of the experiment was confirmed by MSCT and histological studies.Conclusions. The developed model of the normotrophic pseudarthrosis of a rabbit’s tibia can be used for experimental tests of various factors for stimulating reparative regeneration and methods for treatment of the pseudarthrosis.

The effects of romosozumab combined with active vitamin D3 on fracture healing in ovariectomized rats

BackgroundIn this study, we investigated the potential acceleration of fracture healing and bone mineral density-increasing effects of romosozumab and active vitamin D3 combination therapy for fractures in ovariectomized rats.MethodsOvariectomy was performed on 40 24-week-old female Sprague–Dawley rats. After 8 weeks, the rats were subjected to periosteum removal and osteotomy of the femoral shaft followed by osteosynthesis with intramedullary nailing to create fracture models. The rats were then divided into four groups: C group (control), R group (receiving romosozumab at 25 mg/kg once a month via subcutaneous injection), VD group (receiving active vitamin D3 at 0.2 µg/kg twice a week via subcutaneous injection), and R + VD group. Further, 10 rats were included in a sham group. At 10 weeks after the intervention, both femurs were removed and blood samples were collected from all rats. Soft X-ray imaging was used to evaluate bone union, and microcomputed tomography (micro-CT) was used for bone morphometric evaluation. Toluidine blue staining was used for the histopathological evaluation of the undecalcified specimens, and bone turnover marker levels were measured using enzyme-linked immunosorbent assay.ResultsBone morphometry analysis via micro-CT revealed increased mineral density of the trabecular bone in the R + VD group femurs, demonstrating the effectiveness of romosozumab plus active vitamin D3 combination therapy. However, there were no differences in bone union evaluated using soft X-ray imaging, indicating no acceleration of fracture healing.ConclusionsAlthough romosozumab and active vitamin D3 combination therapy increased trabecular bone volume, there was no evidence on its ability to accelerate fracture healing.Graphical abstract

Pleomorphic Adenoma of Hard Palate: A Case Series

ABSTRACT Introduction Pleomorphic adenoma of minor salivary glands of the hard palate is a rare benign tumor that has elements of both epithelial and mesenchymal tissues. It usually presents as slow-growing painless submucosal mass on the hard palate. Diagnosis rests on clinical features and tissue examination with radiological investigations helping in surgical planning. Aim and objective To add to the literature few more cases of this relatively rare condition and discuss its clinical presentation and management. Case description Here, we present a case series of three patients who presented with a mass over the hard palate that was subsequently diagnosed as pleomorphic adenoma and discuss the treatment of the same. Conclusion Treatment of choice is wide local excision with removal of periosteum or bone if involved. Recurrence rate is low. How to cite this article Gupta SR, Thorawade VP, Khan MHMS. Pleomorphic Adenoma of Hard Palate: A Case Series. Int J Otorhinolaryngol Clin 2020;12(1):11–13.

Examination of β-TCP/collagen composite in bone defects without periosteum in dogs: a histological and cast model evaluation.

After tooth extraction, the alveolar ridge is absorbed and changes shape. Recently, socket preservation has been proposed to prevent alveolar ridge absorption. However, there are few reports of socket preservation in a model without the periosteum, and alveolar bone regeneration and resorption inhibitory effects in this type of model remain unclear. Therefore, in this study, we conducted socket preservation at the bone defect without the periosteum using a canine model. Ten beagle dogs were extracted. A 5mm × 7mm × 4mm bone defect was created without the periosteum. Defects were filled with beta-tricalcium phosphate (β-TCP)/collagen (Col), β-TCP, collagen, or left intact (Control). The observation periods were 4 and 8weeks (n = 5 per group). Evaluations were made of the newly formed bone area, residual granular area, horizontal width and vertical dimensional change. The newly formed bone area at 4weeks after surgery in TCP/Col, Collagen, β-TCP, and Control groups was 21.50%, 17.26%, 18.22%, and 17.47%. Compared to the control group, the TCP/Col group showed a significant difference in bone regeneration and horizontal width. TCP/Col is suggested to be effective for bone regeneration and suppression of alveolar ridge resorption in the bone defect periosteum removal model.

Histological Comparison of New Bone Formation Using Amnion Membrane Graft Versus Resorbable Collagen Membrane: An Animal Study.

The purpose of this article was to evaluate the bone induction effects of an amnion membrane-protected graft compared with a collagen membrane-protected graft in the repair of tibial bony defects in dogs. This study was performed using the tibial bone of dogs. After the removal of periosteum, similar holes were made with a 16-mm trephine drill (38 holes in total). For the study group, 10 holes were covered by absorbable collagen and 16 holes by amniotic membrane. In the control group, 12 holes were made and covered by the overlying soft tissue. Tibial bones were exposed after 6 and 12 weeks, and the samples were harvested and histologically processed. New bone formation was evaluated by histomorphometric study. Four Iranian mixed dogs older than 1.5 years were included in this study. The new bone formation was less in the control group when compared with the collagen group ( P = .863). The collagen group showed less bone formation than the amnion group ( P = .194), but this difference was not significant. However, bone formation in the amnion group was significantly more than in the control group ( P = .050). Using the amniotic membrane appears to accelerate bone formation in guided bone regeneration. However, further studies should investigate its clinical impact on bone healing.

Osteogenesis of Crouzon-Mutated Cells in an Experimental Model.

Crouzon syndrome is an autosomal-dominant congenital disease due to a mutation in the fibroblast growth factor receptor 2 protein. The purpose of this study is to evaluate wound-healing potential of Crouzon osteoblasts and adipose-derived stem cells (ADSCs) in a murine model. Parietal skull defects were created in Crouzon and mature wild-type (WT) CD-1 mice. One group of WT and Crouzon mice were left untreated. Another group was transplanted with both WT and Crouzon adipose-derived stem cells. Additional groups compared the use of a fibrin glue scaffold and periosteum removal. Skulls were harvested from each group and evaluated histologically at 8-week and/or 16-week periods. Mean areas of defect were quantified and compared via ANOVA F-test. The average area of defect after 8 and 16 weeks in untreated Crouzon mice was 15.37 ± 1.08 cm and 16.69 ± 1.51 cm, respectively. The average area of the defect in untreated WT mice after 8 and 16 weeks averaged 14.17 ± 1.88 cm and 14.96 ± 2.26 cm, respectively. WT mice with autologous ADSCs yielded an average area of 15.35 ± 1.34 cm after 16 weeks while Crouzon mice with WT ADSCs healed to an average size of 12.98 ± 1.89 cm. Crouzon ADSCs transplanted into WT mice yielded an average area of 15.47 ± 1.29 cm while autologous Crouzon ADSCs yielded an area of 14.22 ± 3.32 cm. ANOVA F-test yielded P = .415. The fibroblast growth factor receptor 2 mutation in Crouzon syndrome does not promote reossification of critical-sized defects in mature WT and Crouzon mice. Furthermore, Crouzon ADSCs do not possess osteogenic advantage over WT ADSCs.

ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW)

In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB) without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р0,05). VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р0,05). Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS) in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and increased bleeding of the wound. Patients after simple release of ECRB demonstrated minimal postoperative pain which allows early rehabilitation and return to daily and professional activities.

Multiple Primary Recurrent Basaliomas (mPR-BCCs) of the Scalp with Cranial Bone Invasion.

We present a 68-year-old patient with multiple primary infiltrative BCCs in the scalp area, initially treated 14 years ago with superficial contact X-ray therapy, end dose 60 greys, followed by electrocautery (x2) several years later. He presented in the dermatologic policlinic for diagnosis and therapy of two additional, newly-formed pigmented lesions, and because of an uncomfortable, itchy, burning sensation in the area where lesions had been treated years before. Screening cranial computer-tomography (CT) examination revealed two deformities in the form of tumor-mediated osteolysis, affecting the diploe of the tabula externa on the left parietal and parasagittal areas. Complete excision with removal of periosteum and partial removal of the tabula externa was planned with neurosurgeons at a later stage. BCC is one of the most common malignant skin tumours of the head and neck region (about 90% of cases) and is characterised by a significant potential for local infiltration and destructive growth. Recurrent, invasive BCC of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols had not been established. The primary treatment of aggressive BCCs is surgical, with a thorough examination of excision margins to ensure complete resection. Procedural-based options include standard excision, curettage, curettage with electrodessication, and Mohs micrographic surgery (MMS), with MMS being the gold standard for the definitive treatment of BCC. Improper removal or electrocautery (as in our case) of the several aggressive forms of BCC seems to be a particular problem, and not only for dermatologic surgeons. The risk of subsequent invasion and destruction of the cranium, underlying dura, and cranial nerves by basal cell carcinoma (BCC) is extremely low, with an estimated incidence of 0.03%, but is a potential complication over time. Computed tomography is the modality of choice for detecting tumour invasion into bone, which commonly appears as irregular demineralization or osteolysis.

Comparative study regarding two experimental models in order to assess the effects of limited periosteum removal

Comparative study regarding two experimental models in order to assess the effects of limited periosteum removal

Lizard tail skeletal regeneration combines aspects of fracture healing and blastema-based regeneration.

Lizards are amniotes with the remarkable ability to regenerate amputated tails. The early regenerated lizard tail forms a blastema, and the regenerated skeleton consists of a cartilage tube (CT) surrounding the regenerated spinal cord. The proximal, but not distal, CT undergoes hypertrophy and ossifies. We hypothesized that differences in cell sources and signaling account for divergent cartilage development between proximal and distal CT regions. Exogenous spinal cord implants induced ectopic CT formation in lizard (Anolis carolinensis) blastemas. Regenerated spinal cords expressed Shh, and cyclopamine inhibited CT induction. Blastemas containing vertebrae with intact spinal cords formed CTs with proximal hypertrophic regions and distal non-hypertrophic regions, whereas removal of spinal cords resulted in formation of proximal CT areas only. In fate-mapping studies, FITC-labeled vertebra periosteal cells were detected in proximal, but not distal, CT areas. Conversely, FITC-labeled blastema cells were restricted to distal CT regions. Proximal cartilage formation was inhibited by removal of periosteum and could be recapitulated in vitro by periosteal cells treated with Ihh and BMP-2. These findings suggest that proximal CTs are directly derived from vertebra periosteal cells in response to BMP and Ihh signaling, whereas distal CTs form from blastema cells in response to Shh signals from regenerated spinal cords.

Phenobarbitone for the Management of Neonatal Seizures - A Single Center Study

Introduction: Metopic suture which is placed between frontal bone and usually disappear during infancy and childhood, may persist from nasion to anterior angle of bregma, this is called metopism. Objective: To find the incidence of metopism in western Rajasthan and to compare it with other study in other parts of India and Abroad. Methodology: Present study was autopsy done on 200 dead bodies of all age group who were brought to J L N Medical college, Ajmer for autopsy during the period of 6 months. Vault was observed morphological for presence of metopism on both outer and inner side after removal of periosteum. Results: The incidence of metopism was 6.5% in all observed skull in this study. The incidence of metopism was observed more in child age group i.e. 100% in 0-5 years & 80% in 6-10 years as compare to the adults and old age groups i.e. 3.4% in 41-50 years. Conclusion: The presence of metopic suture simulates the fracture of frontal bone, therefore it should be properly ruled out in x-rays by radiologists and neurosurgeons.

Novel rat model of nonunion fracture with vascular deficit

Nonunion fractures occur frequently in humans, with profound implications (medical and non-medical). Although there are numerous animal models to study pathogenesis and treatment of nonunion fractures, there is apparently the lack of a definitive model for atrophic nonunion fracture. Therefore, the objective was to develop a low-cost rat model of nonunion fracture with a vascular deficit that enabled standardized quantitative analysis of bone growth and regeneration. The model was developed with two surgeries, performed apart. The first involved osteotomy of the femur diaphysis, removal of periosteum and endosteum, isolation of the fracture site using a latex artefact (Penrose drain tube), and reduction of the fracture using an intramedullary pin, whereas the second surgery was to remove the latex artefact. Based on radiographic imaging, micro-CT and histological analyses done 125 days after the fracture was induced, there was clear evidence of atrophic nonunion fracture, without pin migration or specimen loss. Perceived advantages of this model included low cost, ease of reproducibility, lack of specimen loss, and, finally, the potential to assess bone growth and regeneration under poor vascular conditions.

The effects of periosteum removal on the osteocytes in mouse calvaria

The effects of periosteum removal on the osteocytes in mouse calvaria

Biosynthetic Porcine Collagen Dressings as an Adjunct or Definitive Tool for the Closure of Scalp Defects Without Periosteum

BackgroundAggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. ObjectiveTo evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. Materials and methodsWe performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. ResultsThe most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. ConclusionsThe use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

Parche biosintético de colágeno porcino como herramienta coadyuvante o definitiva en el cierre de defectos del cuero cabelludo sin periostio

BackgroundAggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. ObjectiveTo evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. Materials and methodsWe performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. ResultsThe most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. ConclusionsThe use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

Effects of extensive circumferential periosteal stripping on the microstructure and mechanical properties of the murine femoral cortex

Extensive periosteal stripping (PS) is a risk factor for post-radiation pathologic fracture following surgery for extremity soft tissue tumors. The purpose of this study was to determine the effects of PS on bone structure and mechanical properties. Thirty-one skeletally mature mice underwent PS, with circumferential removal of periosteum from an 8-mm segment of the mid-diaphysis of the left femur. Thirty-one control mice underwent sham surgery in which the femur was isolated without manipulation of the periosteum. At 2, 6, 12, or 26 weeks following surgery, the left femora were examined by micro-CT to quantify cortical thickness (CtTh), cross-sectional area (CSA), bone volume (BV), and polar moment of inertia (PMI). Three-point mechanical bend testing was performed and peak load, stiffness, and energy to failure were determined. PS resulted in significantly decreased CtTh, CSA, BV, and PMI at all time points. Peak load, stiffness, and energy to failure were significantly reduced at 2, 6, and 12 weeks. There were no significant differences in mechanical properties at 26 weeks. In this mouse model, extensive circumferential PS resulted in sustained changes in bone structure that were still evident after 6 months, accompanied by reductions in bone strength that persisted for at least 3 months.

Galeal/periosteal flaps for the reconstruction of large scalp defects with exposed outer table

Conflicts of interest: none declared. Large surgical defects of the scalp provide a challenge for the reconstructive surgeon due to the relative inelasticity of scalp skin and the lack of an adjacent tissue reservoir. Often they necessitate a repair utilizing a full‐ or partial‐thickness skin graft. Not uncommonly, however, Mohs extirpation of more extensive or aggressive tumours may necessitate removal of periosteum resulting in exposure of bare bone, which is an avascular bed and may not support a skin graft placed directly upon it.1 The role of cortical bone fenestration in facilitating granulation of such defects to heal by secondary intention has recently been elegantly described by Barry et al.2 We discuss our techniques of utilizing galeal/periosteal flaps (GPFs) to resurface exposed bone, providing a vascular bed for a skin graft and allowing immediate reconstruction of large scalp defects. The procedure is performed under local anaesthetic as a day‐case. Following tumour extirpation, the wound and surrounding scalp are prepared and draped in a standard fashion. A radial incision is made through skin and subcutis only, at least 1·5 times the width of the surgical defect, to permit access to the underlying galea and facilitate dissection of the GPF (Fig. 1a). For smaller defects with exposed bone a single access incision may suffice. More commonly, however, an access incision either side of the defect is required to elevate two tension‐free GPFs and provide adequate bone coverage (Fig. 1b).

A perspective: engineering periosteum for structural bone graft healing.

Autograft is superior to both allograft and synthetic bone graft in repair of large structural bone defect largely due to the presence of multipotent mesenchymal stem cells in periosteum. Recent studies have provided further evidence that activation, expansion and differentiation of the donor periosteal progenitor cells are essential for the initiation of osteogenesis and angiogenesis of donor bone graft healing. The formation of donor cell-derived periosteal callus enables efficient host-dependent graft repair and remodeling at the later stage of healing. Removal of periosteum from bone autograft markedly impairs healing whereas engraftment of multipotent mesenchymal stem cells on bone allograft improves healing and graft incorporation. These studies provide rationale for fabrication of a biomimetic periosteum substitute that could fit bone of any size and shape for enhanced allograft healing and repair. The success of such an approach will depend on further understanding of the molecular signals that control inflammation, cellular recruitment as well as mesenchymal stem cell differentiation and expansion during the early phase of the repair process. It will also depend on multidisciplinary collaborations between biologists, material scientists and bioengineers to address issues of material selection and modification, biological and biomechanical parameters for functional evaluation of bone allograft healing.

Ossification of vascular pedicle in fibular free flaps: A report of four cases

The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described.

Studies on the biomechanics of the human clavicle (author's transl)

64 non preserved and 35 preserved clavicles were fractured in three defined positions in a bending test by a tension testing machine with electronic measurement of force. 30 non preserved bones were fractured in an axial infraction test. Force-deflection-diagrams were registered, and the values of maximum load, breaking load, ultimate deflection and energy were correlated to cross section and thickness of compacta. The significantly greater non preserved male clavicles are loadable at a higher level (medium breaking load about 1200 N) than female bones (medium breaking load abut 800 N). The breaking energy of the more flexible female clavicles is about 30% lower than those of males whereas elastic modulus of female clavicles is significant greater. Preservation has a significant influence on biomechanical properties of bones: ultimate deflection decreases; breaking energy, ultimate stress and elastic modulus increase. Breaking load is greatest in the middle portion of the clavicle, while deflection is greatest in the sternal portion. Removal of periosteum causes lower breaking load, deflection, ultimate stress and elastic modulus as well. With axial load clavicle fractures occur most frequently between middle and sternal third.