Secondary Healing Research Articles

Papilloma excision. Scalpel or CO2 Laser? A case report

A papilloma is a benign tumor arising from an epithelial surface. Mostly a papilloma appears as an asymptomatic intraoral lesion and is often associated with the human papilloma virus (HPV). In this case report two similar, verrucous papules, sessile bilateral on the back of the tongue, were surgically removed in a 65-year-old male patient. Thereby two different methods of treatment were compared. On the right side of the back of the tongue, excision by scalpel, as the gold standard treatment modality, was performed. On the left side a surgical removal by a CO2 laser was performed. In a photothermal procedure, without direct contact to the tissue, the laser beam is cutting through the mucosa. Secondary wound healing can take place. Both methods were compared in relation to their application, wound healing, quality of the biopsy and morbidity. Postoperative less discomfort and a slightly faster wound healing could be seen after scalpel removal. The histopathological examination was comparable for both methods.

What Factors can have an impact on the wound Healing Process from an oral surgery perspective? A Review

Wound healing is a complex and dynamic process that involves a series of intricately regulated phases, each contributing to the restoration of tissue integrity. This comprehensive review dives into the fundamental aspects of wound healing, exploring the physiological mechanisms, phases, and influencing factors. The review begins with describing the significance of wound healing and navigates through sequential phases, such as hemostasis and inflammation, proliferation, remodelling, wound classification and closure techniques, thus providing insights into the diverse strategies employed in clinical settings. Much focus lies to bone healing, addressing both primary and secondary healing mechanisms, as well as the bone healing in extraction sockets. A significant segment of the review explores the factors affecting wound healing, which are categorized into local, surgical, and systemic factors encompassing ageing, diabetes mellitus, hormonal changes, immunocompromised conditions, medications, smoking, alcohol consumption, obesity, and nutrition deficiency. A synthesis of the reviewed content highlights the interplay of these factors in the ‘wound healing’ process. Understanding these elements is imperative for clinicians and researchers alike to develop effective therapeutic interventions tailored to individual patient needs. This review serves as a valuable resource for those seeking a comprehensive understanding of the intricate dynamics of wound healing in the human body.

Continuous External Tissue Expansion for Closure of Forehead Flap Donor Site.

Continuous external tissue expansion has been shown to be effective in the management of craniofacial wounds resulting from tumor resection, trauma, and wound dehiscence. Forehead flap donor sites are typically managed with secondary intention healing. However, this can create esthetic problems in pigmented skin because of the tendency to form thick scars. Here, the authors describe the use of continuous external tissue expansion for the management of a paramedian forehead flap donor site. A Dermaclose device was used at the time of forehead flap elevation and removed at the pedicle division and inset. Sufficient skin expansion was achieved for primary closure. The final scar was esthetically pleasing. External tissue expansion is ideal for forehead flap donor sites as the second stage of the operation provides an opportunity for expander removal and wound closure.

Repair of Tracheo-Cutaneous Fistula Following Tracheostomy

Tracheo-cutaneous fistula is a relatively uncommon complication that can occur after tracheotomy. The possibility of fistula increases in proportion to the duration of intubation and it occurs due to the transposition of stratified squamous epithelium in the passage between the tracheal mucosa and the skin. There are several surgical techniques to repair trachea-cutaneous fistula, such as primary suture, fistulectomy and primary suture, fistulectomy and secondary intention healing, and using local or regional flap. In addition to these techniques, we would like to introduce a technique used in our hospital.

Clinical and biological concept of application of surgical navigation template using flapeless technique

Introduction. Currently, the direction of minimally invasive surgical interventions in surgical dentistry is relevant to reduce the time of postoperative rehabilitation. Detachment of the mucoperiosteal flap during dental implantation leads, depending on the extent of the defect, to a hematoma, which increases the risk of complications (suture dehiscence, wound infection). Because of this, treatment tactics have been developed that allow dental implantation to be performed using surgical navigation templates using a flapless technique. However, despite the obvious effectiveness and efficiency of the method, there are few experimental studies to substantiate the flapless technique of dental implantation.Purpose: clinical substantiation of the effectiveness of the use of flapless navigation techniques for dental implantation Materials and methods: the clinical study included 40 patients with secondary partial edentia. The patients were divided into two groups: the main and control groups. A life history was collected, as well as a history of the development of the present disease. The patients underwent dental implantation surgery in the area of the lateral groups of teeth. In the main group, dental implantation was carried out using a navigation template with a complete protocol and the use of a “flapless” technique; in the control group, dental implantation was carried out with a full-thickness incision and detachment of the mucoperiosteal flap. The evaluation criteria were clinical parameters of healing in the early postoperative period, the height of the soft tissues around the dental implant in the late postoperative period (CBCT, probing), as well as the presence of complications (mucositis, peri-implantitis). The data was entered into a table for further statistical analysis.Results. In the control group, the average height of the formed gingival cuff was 1,55±0,43 mm, 95% CI (1,34–1,75), with primary healing the average height was 1,64±0,44 mm, 95% CI (1,31–1,98), with secondary healing the average height is 1,46±0,43 mm, 95% CI (1,17–1,75). In the main group, the average height of the formed gingival cuff was 2,42±0,45 mm, 95% CI (2,21–2,62), with primary healing the average height was 2,40±0,45 mm, 95% CI (2,17–2,63), with secondary healing mean height 2,50±0,53 mm, 95% CI (1,19–3,81). In the control group, the average loss of marginal bone tissue was 1,27±0,47 mm, 95% CI (1,05–1,49), with primary healing the average loss was 0,96±0,29 mm, 95% CI (0,73–1,18), with secondary healing the average loss is 1,53±0,44 mm, 95% CI (1,23–1,82). In the main group, the average loss of marginal bone tissue was 0,50±0,31 mm, 95% CI (0,35–0,65), with primary healing the average loss was 0,48±0,33 mm, 95% CI (0,31–0,65), with secondary healing the average loss is 0,63±0,12 mm, 95% CI (0,35–0,92). Comparison of the main and control groups in terms of the height of the formed gingival cuff showed a statistically significant difference (p<0,001). This indicator differs significantly between groups with primary (p=0,0004) and secondary wound tension (p=0,004). In the early period, in the control group of 20 patients, 8 (40%) had mucositis, 2 (10%) had peri-implantitis, in the main group 3 (15%) had mucositis. In the late period, in the control group, 7 (35%) had mucositis, 1 (5%) had peri-implantitis, in the main group, 2 (10%) had mucositis. A comparison of the main and control groups in terms of the presence of pain, as well as the presence of complications in the early and late periods, showed a significant difference. In the control group, 60% of patients felt pain, and in the main group, 15% (p=0,009). The presence of complications in the early period was observed in 50% in the control group and in 15% in the main group (p=0,042). In the late period, the proportion of complications decreased and amounted to 40% in the control group and 10% in the main group (p = 0,03). The groups differ in the proportion of primary and secondary healing, so in the main group 85% of patients had primary healing, and in the control group patients with secondary healing of 55% predominated (p = 0.02). Comparison of the study and control groups in terms of loss of marginal bone tissue showed a statistically significant difference (p<0,001).Conclusion. The use of a flapless navigation technique can reduce the likelihood of complications in the early and late postoperative periods, while predictably controlling the height of the gingival cuff.

THE EFFECT OF IMMEDIATE AND DELAYED MECHANICAL STIMULATION ON SECONDARY BONE HEALING

Secondary bone healing is impacted by the extent of interfragmentary motion at the fracture site. It provides mechanical stimulus that is required for the formation of fracture callus. In clinical settings, interfragmentary motion is induced by physiological loading of the broken bone – for example, by weight-bearing. However, there is no consensus about when mechanical stimuli should be applied to achieve fast and robust healing response. Therefore, this study aims to identify the effect of the immediate and delayed application of mechanical stimuli on secondary bone healing.A partial tibial osteotomy was created in twelve Swiss White Alpine sheep and stabilized using an active external fixator that induced well-controlled interfragmentary motion in form of a strain gradient. Animals were randomly assigned into two groups which mimicked early (immediate group) and late (delayed group) weight-bearing. The immediate group received daily stimulation (1000 cycles/day) from the first day post-op and the delayed group from the 22nd day post-op. Healing progression was evaluated by measurements of the stiffness of the repair tissue during mechanical stimulation and by quantifying callus area on weekly radiographs. At the end of the five weeks period, callus volume was measured on the post-mortem high-resolution computer tomography (HRCT) scan.Stiffness of the repair tissue (p<0.05) and callus progression (p<0.01) on weekly radiographs were significantly larger for the immediate group compared to the delayed group. The callus volume measured on the HRCT was nearly 3.2 times larger for the immediate group than for the delayed group (p<0.01).This study demonstrates that the absence of immediate mechanical stimuli delays callus formation, and that mechanical stimulation already applied in the early post-op phase promotes bone healing.

BIOMECHANICS AND DESIGN OF INTRAMEDULLARY NAILS

Intramedullary nails (IMNs) are the current gold standard for treatment of long bone diaphyseal and selected metaphyseal fractures. Their design has undergone many revisions to improve fixation techniques, conform to the bone shape with appropriate anatomic fit, reduce operative time and radiation exposure, and extend the indication of the same implant for treatment of different fracture types with minimal soft tissue irritation.The IMNs are made or either titanium alloy or stainless steel and work as load-sharing internal splints along the long bone, usually accommodating locking elements – screws and blades, often featuring angular stability and offering different configurations for multiplanar fixation – to secure secondary fracture healing with callus formation in a relative-stability environment. Bone cement augmentation of the locking elements can modulate the construct stiffness, increase the surface area at the bone-implant interface, and prevent cut-through of the locking elements.The functional requirements of IMNs are related to maintaining fracture reduction in terms of length, alignment and rotation to enhance fracture healing. The load distribution during patient's activities is along the entire bone-nail interface, with nail length and anatomic fit being important factors to avoid stress risers.

Use of Collagen Powder in Secondary Intention Healing After Mohs Surgery or Excisional Surgery: A Retrospective Study

Background. Little is known about the usefulness of collagen powder in secondary intention healing in patients undergoing cutaneous surgery. Objective. To investigate the clinical outcomes associated with application of collagen powder in cutaneous surgery and patients’ perceptions of the procedure. Methods. A retrospective chart review of 266 patients who underwent Mohs surgery or excisional surgery at a single institution between January 2020 and January 2022, and who had secondary intention healing of wounds assisted by powdered collagen was conducted. Personal interviews were conducted with 63 of those patients (23.7%). Tumor characteristics, estimated healing times, and patient satisfaction were scored. The Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale were used to assess the resulting wound bed. All data underwent statistical analysis. Results. Of 266 granulating wounds with an average defect size of 6.0 cm2, excisional surgery was performed in 143 (54%) and Mohs surgery in 123 (46%). Most procedures (92.1%) were undertaken for nonmelanoma skin cancers. The average healing time was 6.3 weeks. The mean patient score for ease of use and overall impression of collagen application was 8.2 on a scale of 1 to 10, with 10 being most favorable. Conclusion. When clinically appropriate, granulation assisted by collagen powder should be considered for augmenting secondary intention healing.

Recurrent Squamous Cell Carcinoma of the Upper Eyelid Treated With Combination Therapy of ALA Photodynamic Therapy and Surgery With Secondary Healing

Background. Cutaneous squamous cell carcinoma (cSCC) frequently occurs in photoexposed areas. Surgery remains the mainstay of treatment in attempts to reduce recurrence, but it must be combined with other therapy because of the limited excision possible in the region of the eyelid, lip, and nose. Photodynamic therapy (PDT) is a relatively new treatment modality that involves the administration of a photosensitizing drug and its subsequent activation by specific wavelengths of light to produce reactive oxygen species that specifically destroy target cells. Case Report. An 87-year-old female presented 4 weeks after initial resection with recurrent medium-differentiated cSCC measuring 5.2 cm × 3 cm × 2 cm in the left upper eyelid. Subsequent treatment involved palliative resection with an additional 1 cm at 3 margins of the tumor (excluding the bottom edge of the double eyelid line) and 3 applications of PDT using 5-aminolevulinic acid as the photosynthesizing agent in the open wound over a 2-week period. The wound healed well within 6 weeks. During the following 4 years, the patient showed satisfactory progress in both aesthetics and function, with no sign of recurrence or metastasis. Conclusion. Refractory cSCC was successfully managed using a combination of PDT and secondary healing, and functions of the head and face were well protected. These results suggest that such management warrants consideration in clinical settings.

Correction to: Dehydrated human amnion/chorion membrane allograft for postoperative wounds following Mohs micrographic surgery: a retrospective comparative evaluation.

Introduction. Defects that remain after MMS cannot always be repaired immediately. When closure is not feasible, wounds are left to heal by secondary intention and may take weeks to close. In such cases, the use of an allograft that stimulates endogenous wound healing pathways may be desirable. Objective. This retrospective study assessed whether the use of dHACM allograft after MMS led to a statistically significant improvement in post-Mohs wound closure rates compared with secondary intention healing. Methods. This study evaluated 80 patients who underwent MMS and compared time to complete healing between wounds treated with dHACM allografts (n = 40) and wounds healed by secondary intention (n = 40). Wounds were assessed every 2 weeks, and photographs were taken. Statistical analysis was conducted. Results. Average time to complete wound healing was significantly reduced with the use of dHACM allograft compared with traditional secondary intention healing (5.2 weeks and 6.5 weeks, respectively; P = .01). Conclusion. The use of dHACM allograft resulted in more rapid wound healing, and this allograft is a potential alternative to traditional secondary intention healing methods. Further studies are needed to reinforce the results of this pilot study.

Soft-tissue volume augmentation using a connective tissue graft and a volume-stable collagen matrix with polydeoxyribonucleotide for immediate implant placement: a pilot study in a dog model.

The aims of this study were 1) to investigate the effects of a subepithelial connective tissue graft (SCTG) and a volume-stable collagen matrix (VCMX) on soft-tissue volume gain in the immediate implant placement protocol, and 2) to determine whether polydeoxyribonucleotide (PDRN) can enhance the effects of a VCMX. Dental implants were placed in 4 mongrel dogs immediately after extracting the distal roots of their third and fourth mandibular premolars. The gap between the implant and the buccal bone plate was filled with synthetic bone substitute particles. The following soft-tissue augmentation modalities were applied buccally: 1) control (no augmentation), 2) SCTG, 3) VCMX, and 4) VCMX/PDRN. After 4 months, histomorphometric analysis was performed. Tissue changes were evaluated using superimposed standard tessellation language (STL) files. Wound dehiscence was found in more than half of the test groups, but secondary wound healing was successfully achieved in all groups. Histomorphometrically, tissue thickness was favored in group SCTG at or above the implant platform level (IP), and group SCTG and the groups with VCMX presented similar tissue thickness below the IP. However, the differences in such thickness among the groups were minor. The keratinized tissue height was greater in group VCMX/PDRN than in groups SCTG and VCMX. Superimposing the STL files revealed a decrease in soft-tissue volume in all groups. Wound dehiscence after soft-tissue volume augmentation might be detrimental to obtaining the expected outcomes. PDRN appears not to have a positive effect on the soft-tissue volume gain.

Secondary Healing of Palatal Fistula by Simple Palatal Plate Obturator after Excision of Pleomorphic AdenomaA Case Report

Pleomorphic adenomas are the most common benign mixed tumours of the salivary glands. They typically occur at the junction between the hard and soft palate, but can also be found in the upper lip, buccal mucosa, floor of the mouth, tonsils, pharynx, and retromolartrigone. The present case of a 55-year-old woman focuses on the use of a palatal plate obturator to treat a soft palatal fistula that developed after the removal of a pleomorphic adenoma from the palate. By applying a self-cure resin to the posterior border of the palatal plate obturator, the postoperative issue of a palatal fistula was successfully managed. To aid in the healing of the palatal tissue and provide a scaffold for the regeneration of the surrounding palatal tissue, relief was applied to the intaglio surface of the palatal plate.

Evaluation of the Clinical Effect of Hyaluronic Acid Mouthwash on Palatal Secondary Wound Healing in Diabetic Rats

Objective: The objective of this study was to investigate clinical effect of topically administered hyaluronic acid (HA) mouthwash on healing of secondary palatal wound in diabetic (D) rats. 
 Methods: 60 Wistar albino male rats were divided into D and non-diabetic (ND) groups. Diabetes was induced to 30 randomly selected rats by initially administering 110 mg/kg of nicotinamide intraperitoneally, followed by 15 min of intraperitoneal injection of 65 mg/kg of streptozotocin solution. 5 mm excisional wounds were made in the centre of the palate. After that, 6 animals from each group were sacrificed. Then, both groups were subdivided into two groups: 0.12% HA mouthwash and saline (S) (n=12 per group), depending on the agent to be administered to the wound area (WA). On days 7 and 14, six rats from each group were sacrificed, and the WAs were measured through photographic measurements utilizing Image J software.
 Results: The WA decreased with time in each group (p

Modeling Stiffness and Stress in Serpentine Flexures for Use in a Compliant Bone Plate

Abstract Serpentine flexures offer several advantages for use in linear motion mechanisms, including distributed compliance to reduce stress and increase range of motion. In this work, we develop an analytical model for predicting the moment, vertical deflection, and maximum stress experienced in serpentine flexures in response to an input vertical force. Two classes of serpentines are introduced and modeled with linear motion boundary conditions enforced. Finite element analysis demonstrates a mean model error of 0.86% for these metrics across many flexure topologies. Experimental testing is performed to validate the force–deflection response of three steel serpentine compliant mechanisms. The model is able to predict the experimental stiffness data with a mean error at yield of 5.3%, compared to 6.5% with finite element analysis. Large displacement simulations show the model could remain below 10% error for deflections 3–7 times beyond the mechanisms’ deflection at yield. Finally, the model’s utility is demonstrated in the design of a novel single-piece compliant fracture fixation plate that leverages serpentine flexures to deliver controlled axial motion for long bone secondary healing. Model-derived stress-equivalent flexures are compared in their transverse and torsional rigidity. The proposed model and specific findings can be leveraged to design linear motion mechanisms that incorporate serpentine flexures across a wide range of applications.

A prospective randomized comparison of functional and cosmetic outcomes of a coronal zigzag incision versus a conventional straight incision pattern for craniotomy.

Wound healing problems after neurosurgical procedures can lead to serious complications and may require complex revision or even reconstructive surgery. Therefore, optimal surgical management is critical to prevent complications. In a recent experimental study in animals, the authors demonstrated the superiority of a zigzag skin incision over a straight incision pattern. In this study, the authors applied these findings to clinical situations of neurosurgical patients with an indication for a coronal skin incision. The aim of this study was to objectively assess the functional and cosmetic outcomes between straight coronal and zigzag incisions in neurosurgical procedures. This prospective, randomized, controlled, single-center trial included adult patients undergoing frontal craniotomy for cerebrovascular or tumor pathologies. The study primarily included patients who were not expected to receive adjuvant radiation or chemotherapy. The zigzag incision was standardized using a template. A common straight skin incision behind the hairline served as a control. Complication rates, functional (2-point discrimination, width of the wound, Vancouver Scar Scale [VSS], and Patient and Observer Scar Assessment Scale [POSAS]), and cosmetic outcomes were assessed postoperatively and at 3-month follow-up evaluations. Additionally, all patients answered a wound-specific questionnaire and the SF-36 questionnaire. Twenty-eight patients were randomized to the zigzag and 29 to the straight incision groups. Indications for surgery were cerebrovascular in 16 cases and tumors in 41 cases. Risk factors for wound healing were equally distributed in both groups. One patient in the zigzag group with poor postoperative compliance required surgery for secondary wound healing problems. Overall, the width of the scar was significantly smaller (p = 0.001) and local 2-point discrimination better (p = 0.005) in the zigzag group. Scores on the VSS (p = 0.003) and POSAS (p = 0.005) proved to be significantly superior in the zigzag group as well. A zigzag coronal skin incision pattern leads to significantly superior functional and cosmetic outcome scores. For certain patient groups, these findings may prove to be practice-changing.

Semiocclusive Therapy Versus Full Thickness Skin Grafts Versus Reverse Flow Homodigital Island Flaps in Reconstruction of Volar Oblique Fingertip Injuries

Background: Fingertip amputations are among the most common injuries seen in the hand. The mechanism, level, and direction of amputation are important factors in choosing the appropriate reconstructive option. Optimal management is a much-debated topic with advocates for operative and non-oper¬ative treatment. Aim of the Work: To compare the outcome of healing by secondary intention, full thickness skin grafts from the ulnar border of the hand, and reverse flow homodigital island flaps in the management of volar oblique fingertip amputations in the hand according to time of complete healing, aesthetic outcome, return to work timing and according to complications rate. Patients and Methods: This study was conducted on 75 patients who were presented to ER department, with volar oblique fingertip injury. Patients are classified into three equal groups, each group contain 25 patients. First group was managed conservatively with semiocclusive dressing. Second group was reconstructed with full thickness skin grafts. Third group was reconstructed with reverse flow homodigital island flaps. Results: In this study, we can confirm that surgical intervention with either technique, reconstruction with full thickness skin graft or reconstruction with reverse flow homodigital island flap is too much better than healing with secondary intention. With better results with full thickness skin grafts over homodigital island flaps specially in small defects with no exposed bones, a lesion represent most of fingertip cases in surgery. On the other hand homodigital island flaps are better in big defects and in cases with exposed bones. Conclusion: Fingertip injuries are the most common injuries in hand trauma patients. The major cause for adult patients is occupational accidents etiology. There are several classifications for fingertip injuries. Treatment options vary depending on the injury mechanism, defect’s size and plane, surgeon’s intention, patient’s needs, condition of the stump and the amputated part. Despite ongoing publication of new flaps for fingertip reconstruction, there is a paucity of evidence to support improved healing and function in a surgically reconstructed fingertip compared to conservative wound management. Controlled trials are sorely needed to distill the truth as to whether surgery is superior to secondary healing or not

Conservative Wound Treatment in DMT2 Patients Using Honey

Background : The number of diabetic patients in Indonesia is on the rise. In contrast to typical wounds in non DMT2 patients, chronic wounds in DMT2 patients heal more slowly, which makes it difficult to achieve complete primary wound healing. Thus, surgery is frequently required to achieve optimal healing. Patients' physical condition, age, comorbidities, and financial circumstances such as high medical costs frequently limiting patients from receiving comprehensive care, resulting alternative treatments are required to treat chronic wounds in DMT2 patients whom prefer conventional medications, addressing all circumstances. Honey, in addition to having fructose compounds, which has the benefit of increasing glucose homeostasis and insulin response, resulting in lower insulin and plasma glucose levels, also has been shown to contain anti-inflammatory and antimicrobial substances that aid in wound healing. Thus, it may be an alternative therapy for chronic wound in DMT2 patients.
 Methods : A Case-series studies of four DMT2 patients who were referred to Plastic and Reconstructive Outpatient ward with chronic wound were evaluated on a monthly basis following conservative treatment using Nusantara local honey-coated gauze.
 Result : Secondary wound healing, which can be assessed from the epithelialization process started from the peri-wound area has been obtained through monthly observations.
 Conclusion : Honey is used as an alternative therapy for patients with diabetic foot ulcers due to its anti-microbial and anti-inflammatory properties in the wound healing process. Furthermore, honey is considered less expensive and more affordable alternative for patients with co-morbidities that is impossible to operate, or with financial limitations.
 Keywords: DMT2, Chronic wound, Honey

Sesamoid arthritis with locked metacarpophalangeal joint misdiagnosed as trigger finger: a case report

Locked metacarpophalangeal joint (MCPJ) is mainly caused by joint pathologies, although tendinopathy is also a possible cause. Furthermore, it can be misdiagnosed as tendinopathy with triggering symptoms. Herein, we present a 60-year-old housewife with thumb flexion inability lasting for 4 months. Three weeks previously, she visited another clinic and was misdiagnosed with trigger thumb. Her symptoms did not resolve after trigger thumb surgery. At our clinic, physical examination and imaging studies were conducted. Sesamoid arthritic change with entrapment in the MCPJ was found, and the entrapped sesamoid bone inhibited flexion of the MCPJ of the thumb. Based on the examinations, radial sesamoidectomy was planned. After surgery, the patient recovered a passive full range of motion immediately. Despite a rehabilitation program, at 6 months postoperatively, severe stiffness and contracture at the MCPJ were noted. Therefore, a second operation with tenolysis and volar plate release was conducted under wide-awake anesthesia. Intraoperatively, severe adhesion was observed in flexor tendon, volar plate release was performed, and small defects were found in the volar plate when thumb was fully extended. To prevent secondary healing of the volar plate defect, a dorsoradial adipofascial flap was used. At 6 months after the second surgery, the patient’s range of motion in the MCPJ had improved, and she resumed activities of daily living without other complications. Hand surgeons frequently misdiagnose conditions as trigger finger if there is triggering or locked-joint symptoms. An accurate preoperative diagnosis with a detailed physical examination and imaging studies are essential for better operative results.

LEARNING CURVE OF LAPAROSCOPIC OVARIECTOMY IN CATS – A CASE SERIES

"Minimally invasive surgery is constantly improving and breaking grounds due to its benefits such as, fast recovery and less pain. But these procedures need a lot of effort from the surgeon, more than an opened technique, since the focus becomes a monitor and not a directly visible organ. In cats two procedures can be performed for spaying, ovariectomy and ovariohisterectomy. The first one can be performed using a two port laparoscopy technique. This study describes the surgical approach for a laparoscopic two port ovariectomy and emphasizes on the time needed for the procedure, taking into study 8 young healthy short hair cats and a veterinary surgeon with limited experience in laparoscopy, but with some little experience in using the laparoscopic instrumentation. None of the surgeries needed conversion. In one case we observed a wound dehiscence, that healed by secondary healing. The surgeon’s time of surgery improved as the number of cases increased."

A Prospective Follow-up Study of Fingertip Amputation Treatment With Semi-occlusive Dressing.

The aim of this prospective cohort was to evaluate the conservative treatment of fingertip amputation with exposed bone, with a semi-occlusive dressing. Ten patients with an amputation distal to the distal interphalangeal joint were treated via secondary healing under a semi-occlusive film dressing. We followed up the patients weekly until the fingertip had healed, then a final clinical visit at 6 months, and a patient-reported outcome assessment at 2 years after the injury. All 10 patients completed the 6-month clinical follow-up, and seven patients completed the final patient-rated outcome assessments at 2 years. There were no complications during the study period, all the patients were satisfied with the results, and all answered "fully agree" on choosing the same treatment method again in a similar injury. Our results show that conservative treatment of fingertip amputation is feasible and can provide good results.