Soft Defects Research Articles

Management of complex distal radius fractures

Complex injuries of the distal radius can be associated with articular comminution, severe soft tissue injury, large metaphyseal and/or diaphyseal bone defects, carpal ligament tears or its combinations. We recommend a standardized three step approach for the management of these severe injuries: external fixation as an emergency procedure; treatment of soft tissue damage and further diagnostics as needed; definitive adapted operative therapy after thorough analysis of the specific injury.

Modifying the two-stage cleft palate surgical correction.

This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps. Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions. A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.

Modifying the Two-Stage Cleft Palate Surgical Correction

Abstract Objective: This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Patients: Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). Interventions: The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal...

Measurement of switching field reduction of single domain particles in a two-dimensional array

The mechanism of switching of uniaxial, single domain, single crystalline epitaxial garnet particles on a two-dimensional square array was investigated, and the reason for the wide distribution of switching fields was studied. In spite that the particles were found very uniform, the existence of soft magnetic defects, not connected to visible crystalline or manufacturing defects of the material, was found to be responsible for the broad distribution of the switching field, H c=280±85 Oe, as measured on a large number of individual particles. Very good quantitative correlation was found between the strength of the these defects and the switching field.

Effect of Selection for Improved Body Composition on Muscle and Meat Characteristics of Broilers from Experimental and Commercial Lines

Meat quality (pH, color, and drip loss) and muscle characteristics (composition and metabolic pattern) were compared among four broiler lines: an experimental line, a commercial line selected for increased body weight and breast yield, and the respective unselected control lines. By comparison to their controls, the commercially selected birds exhibited higher body weight and breast yield (127 and 61%, respectively), whereas only breast yield was increased (21%) in the experimental selected line. Commercial selection resulted in higher protein content and lower moisture in the breast muscle. Experimental and commercial selection decreased the heme pigment content, which could explain why breast meat of the selected birds was more pale and less red. This change in the color did not correspond to a pale, soft, and exudative (PSE) defect, as the selected birds did not exhibit excessive drip loss. By comparison with their controls, both selected lines showed a lower rate and extent of pH decline postmortem, which was consistent with the lower glycolytic potential they also exhibited. However, no significant changes in the metabolic pathways of breast muscle, as measured by enzyme activities, could be found to explain differences in rates of pH decline among lines. This study did not support the idea that selection had a negative impact on meat quality, despite evidence of modified breast metabolism.

Effects of CT threshold value to make a surface bone model on accuracy of shape-based registration in a CT-based navigation system for hip surgery

To clarify the effects of different CT threshold values used to make computer models on the accuracy of surface registration in a CT-based navigation system, a simulation study was performed using CT data of 30 patients who underwent total hip arthroplasty with navigation guidance. Surface models of the pelvis for use in clinical applications were made by contouring the periosteal boundary at threshold ranging from 140 to 260 Hounsfield units (HU) (mean, 200 HU). In each case, the threshold was determined to be approximately 200 HU, based on the balance between soft tissue noise and surface defects. Ten pelvic surface models were made from each set of CT data, using 10 different CT threshold values ranging from 50 to 320 HU with an increment of 30 HU. The center of the acetabulum was defined as the target point in each set of CT data, so that each set of 10 surface models should have the same reference point for measuring the positional and rotational differences among the models after registration. The average residue of registration reached its nadir was minimum with the 200 HU models, and there were no significant differences in residue of registration among the models made at thresholds ranging from 110 to 320 HU. The target registration errors for position and rotation both showed strong correlation with the residue of registration ( R=0.879 and 0.880, respectively). We thus conclude that accurate surface registration can be obtained with computer models made at thresholds ranging from 110 to 320 HU by assessing the balance between soft tissue noise and bone surface defects.

Bilateral overlapping mucosal single-pedicle flaps for correction of soft palate defects.

The clinical outcomes of bilateral overlapping single-pedicle flaps used for repair of congenital cleft of the soft palate in 10 animals (nine dogs and one cat) are reported. Six animals had concurrent cleft of the hard palate repaired using a previously described mucoperiosteal flap technique. Animals ranged from one to 13 months of age at surgery, with follow-up ranging from two to 12 months. Healing was uncomplicated in all cases and provided excellent functional results.

The uvulopalatal flap for reconstruction of the soft palate.

To determine the indications, complications, and outcomes of the uvulopalatal flap in the reconstruction of defects of the soft palate. Retrospective review. Patient data were obtained from the hospital records of 18 patients who had soft palate defects reconstructed with the uvulopalatal flap over a 5-year period at a tertiary academic medical center. Eleven patients had the uvulopalatal flap as the sole method of reconstruction, whereas this flap was used in combination with a radial forearm free flap, pectoralis flap, and skin graft in 4, 2, and 1 patients, respectively. All flaps were successful in soft palate reconstruction. One flap was successfully revised after additional tumor resection. A partial flap dehiscence occurred in one patient and healed uneventfully. Speech and swallowing function was dependent on initial tumor stage and the scope of tumor resection. The uvulopalatal flap is a simple and effective method of soft palate reconstruction either alone or in combination with other methods of reconstruction for selected oropharyngeal defects.

Wire scalpel for surgical correction of soft tissue contour defects by subcutaneous dissection.

Increasing demand exists for cosmetic correction of soft tissue contour defects. Treatments include simple tissue augmentation techniques or more complex surgeries with consequent relevant recuperation time for the patient. The search for new simple techniques to correct scars and age-related wrinkles and folds is therefore one of the main goals of cosmetic dermatologic surgery. To improve the cosmetic outcome of patients suffering from soft tissue contour defects by the use of a novel surgical instrument and technique, subcutaneous dissection by wire scalpel. Fifty-four patients were treated with the wire scalpel technique with no skin incisions to correct a total of 132 depressed cosmetic defects of the face. Forehead lines, glabellar, nasolabial and oral commissure folds, upper lip wrinkles, and acne scars were treated. A 2-month to 4-year follow-up allowed subjective and photographic evaluation of results. Good or satisfactory results were obtained in 79.7% and 16.6% of the cases, respectively. Minor complications did not change the overall positive outcome of the surgery. Subcutaneous dissection by wire scalpel is a simple, safe, and effective method to improve the contour appearance of patients affected with scars or age-related contour defects.

Dielectric permittivity and Fe-and Cu-doping effect in KTaO3 AND K1-xLixTaO3

The temperature-frequency behavior of the permittivity ϵ' (T, f) and tan[δ(T, f)] (5—300 K, 100 Hz-1 MHz) were comparatively studied in nominal pure KTaO3 and K1-xLixTaO3 (x = 0.001, 0.01 and 0.03) doped by Cu and Fe single crystals. In the ϵ' (T, f) behavior doping of KTaO3 by Fe (1 wt%) and Cu (0.8 and 3 wt%) results in ϵ' increasing at lowest temperatures up to ≈ 6000 at 5K) only. However for tan [δ(T, f)] a pronounced dielectric dispersion occurs below 70 K, with tan [δ(T)] maxima positions obeying the Arrhenius law with universal values of activation energy Δ ≈ 900—1000 K and of high temperature relaxation time τ0 ∽ 10−14 s. In contrast, in K1-xLixTaO3 doping by Cu and Fe results in a well pronounced low-temperature dielectric relaxation contribution in the ϵ' (T, f) behavior and dipole ordering effects. This effect appears to be very strong for Cu doping. So in K0.97Li0.03TaO3:Cu (0.2 wt%) appearance of a low temperature phase transition is suggested. The possible mechanisms of polarization relaxation, dipole ordering and ferroelectric-type phase transition with a critical dynamic central peak in K1-xLixTaO3 doped by strong soft dipole defects are discussed.

Ophthalmic plastic applications of acellular dermal allografts

Purpose Clinical problems of contracted conjunctival fornices, superior sulcus defects, and soft tissue contour defects in the periorbital region have not shown good, sustained results with a range of autologous and alloplastic implants. AlloDerm (Lifecell Corp., Woodlands, TX) is an acellular dermal graft processed from human donor tissue. The authors sought to assess the efficacy of AlloDerm as a soft tissue replacement in a variety of oculoplastic applications. Design Retrospective, noncomparative case series. Participants Twenty-three patients. Methods Applications were broadly classified as barrier/scaffolding (i.e., primary and secondary implant coverage, lid spacer graft) and volume augmentation (i.e., superior sulcus and other periorbital soft tissue contour defects). Barrier grafts were applied as single sheets. Stacked sheets or rolled grafts were used for augmentation. Collectively, this material was used in 29 cases with 3 to 16 months’ follow-up. Main outcome measures Clinical evaluation of outcome and complications. Results As a soft tissue scaffolding and barrier implant, AlloDerm persisted sufficiently to permit repopulation with native tissue. Rolled/stacked implants demonstrated unpredictable resorption. Upper eyelid grafts seemed to have higher resorption rates than lower eyelid grafts. One case of anophthalmic superior sulcus augmentation required two revision surgeries to provide sufficient volume augmentation. The grafts were well tolerated, with no cases of infection or explanation. Conclusion Acellular human dermis is an excellent barrier and reconstructive grafting material that provides an alternative to autologous grafts and other alloplastic material, avoids harvesting autologous tissue, possesses excellent handling properties, and is associated with minimal inflammation. Long-term follow-up is required to evaluate persistence.

Radial forearm free flap for soft palate reconstruction.

Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. However, soft palate obturators have several disadvantages. Device stability and retention are impaired in patients who are edentulous. In addition, prosthetic obturators cover large areas of sensate mucosa in the hard palate, maxillary alveolus, and oropharynx, contributing significantly to the loss of sensory feedback from the oral cavity and oropharynx. Considerable evidence suggests that sensory impairment within the oral cavity and pharynx results in impaired mastication, deglutition, and articulation. A minority of patients find palatal obturators to be unsatisfactory, secondary to either inconvenience or device discomfort.

A simple, expeditious method for placement of thermoplastic impression material for speech aid prostheses

The dental literature has discussed the attention to detail required when making impressions for speech aid prostheses, but many operators often do not capture all the patient’s soft and hard tissue details when making either preliminary or definitive impressions for frameworks, castings, and baseplates.1-3 In maxillofacial prosthetics, one responsibility of the clinician is the reestablishing of palatopharyngeal integrity and providing the potential for acceptable speech by generation of the speech aid prosthesis. Speech aid prostheses constructed for patients with soft palate defects must function in concert with soft palate tissues displaying considerable movement, yet the objective of obturation is to provide the ability to control nasal emission during speech and to prevent the leakage of material into the nasal passage during deglutition. The use of a 20-cc or 30-cc plastic disposable syringe (B-D 30 cc syringe, Becton-Dickson and Co., Franklin Lakes, N.J.), in conjunction with Iowa wax (Miner, Concorde, Calif.), modeling plastic and a custom tray with loops or mesh work is a simple procedure to ensure detailed final impressions when capturing soft palate defects on a consistent basis. Iowa wax can also be used to impress maxillary hard palate defects to generate the bulb portion of an obturator. The operator may also use a functional impression technique to allow the wax to flow to the pharyngeal walls. This article describes a simple procedures that can assist the dentist in routinely capturing soft palate anatomic defects when making final impressions for speech aid prostheses.

A soft configuration model for wearless sliding friction

A phenomenological model of soft potential configurations is proposed to describe sliding friction in the wearless regime. This model accounts for the static and dynamic behavior. The physical origin of the logarithmic speed or time dependence for the friction coefficient is described. Means to control the friction coefficient by controlling the soft defect density are discussed.

Reconstruction of soft palate defects

Surgical resection of oropharyngeal tumors or extensive uvulopalatoplasty can result in soft palate defect. Two innovative techniques for surgical closure of soft palate defects are described.

Structure, Cation Distribution, and Properties of Nanocrystalline Titanomagnetites Obtained by Mechanosynthesis: Comparison with Soft Chemistry

Nanocrystalline Fe-based spinels with composition Fe2.5Ti0.5O4were synthesized using two different routes: soft chemistry and high-energy ball milling. In the first case, two steps were involved: precipitation in an aqueous solution followed by thermal annealing under a reducing mixture of N2/H2/H2O gases. In the second case, the spinel phase was directly formed in the mill at room temperature and under argon atmosphere from Fe, Fe2O3, and TiO2in stoichiometric proportions. The as-prepared powders are characterized by X-ray diffraction, scanning and transmission electron microscopy, surface area measurement, and Mössbauer spectrometry. In both cases, the crystallite's size is about 15 nm, but whereas in the case of mechanosynthesis, the ball-milled powders consist of aggregates, those obtained by soft chemistry are very well dispersed. In contrast to the soft chemistry route, both lattice defects and cation site inversion are induced by high energy ball milling, as evidenced by X-ray diffraction and thermogravimetric analysis. Finally, the particle coercivity is studied and discussed according to particle size and the degree of oxidation of Fe cations inferred from thermogravimetry.

Use of buccal mucosal flaps for the correction of congenital soft palate defects in three dogs.

To present an alternative surgical technique for the repair of soft palate defects in dogs. Three Foxhound cross dogs. Bilateral buccal mucosal flaps, based at the palatoglossal arches, were raised. One flap was rotated so that the mucosal side created the floor of the nasopharynx. The second flap was rotated so that the mucosal side formed the roof of the oropharynx. The mucosa of the remnant of the soft palate and the pharyngeal walls was incised and the flaps sutured to these free mucosal edges. The caudal ends of the two flaps were sutured to each other. Complete closure of the soft palate defect was obtained in all three dogs. The dogs were monitored for between 1.5 and 3 years postoperatively, and no long-term problems were encountered. This surgical technique resulted in an excellent functional separation of the oropharynx and nasopharynx and allowed reconstruction of a large bilateral soft palate defect. By using the buccal mucosal flaps, as described in this report, a tension-free closure of large soft palate defects can be obtained, thereby eliminating a major cause of failure of this type of reconstructive surgery.

Reconstruction of the soft palate by uvulopalatal flap.

Surgical removal of the soft palate in cases of neoplastic disease has a functionally detrimental effect on the patient, resulting in rhinolalia and nasal regurgitation. The authors describe their original surgical technique for repairing the lateral soft palate defect using a uvulopalatal flap. The flap is readily available and the procedure is single staged and without sequela. The aim of this reconstructive procedure is to obtain a diminished soft palate defect by primary surgery. In five patients who underwent a partial excision of the soft palate, the surgical defect was corrected at the time of initial surgery by a uvulopalatal flap. In this technique, the surface of the defect was diminished, postoperative rhinolalia and regurgitation were unremarkable, and sometimes an obturator was obviated. Using a local myomucosal flap, the procedure is simple, safe, and effective.

Distribution of Salt and Moisture in Mozzarella Cheese with Soft Surface Defect

Brine-salted Mozzarella cheese sometimes develops a soft, wet surface during storage, and the objective of this study was to compare distributions of salt and moisture in two surface types of cheese blocks. Seven 9.1-kg blocks of Mozzarella with soft, wet surfaces and 5 9.1-kg blocks with firm, dry surfaces were obtained from five different cheese companies. Moisture and salt distributions were determined using a sampling plan that provided three concentric samples at different depths within each of three cross-sectional slices from the end of the block and three slices from the middle. Salt distributions in cheeses with soft, wet surfaces were similar to those in cheese with firm, dry surfaces; salt content increased from center to surface and was higher at the ends of the block. In contrast, moisture distribution differed markedly. The moisture content decreased from center to surface in blocks with firm, dry surfaces, but the pattern was the reverse in blocks with soft, wet surfaces, which also had higher moisture contents at the ends of the block. The data are consistent with the hypothesis that the temperature differential, which develops during exposure of the warm cheese to cold brine and then dissipates slowly during postbrine cooling, is important in the development of soft surface defect.

Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.