Soft Tissue Closure Research Articles

Treatment of Comminuted Mandibular Angle Fractures Using Champy Technique.

Isolated and noncomminuted mandibular angle fractures are commonly fixed with a single miniplate on the superior border (Champy technique) through an intraoral approach. However, the use of this technique for comminuted mandibular angle fractures has not been reported yet. This article verified that the Champy technique can also be used to treat comminuted mandibular angle fractures. The authors compared the therapeutic effects of using the Champy technique for intraoral fixation of comminuted mandibular angle fractures with or without alveolar bone defect. The dislocated teeth were removed. Iodoform gauze was used in a patient with alveolar bone defects and incomplete closure of soft tissue. A patient with comminuted mandibular angle fractures without alveolar bone defect experienced primary wound healing and good occlusion after surgery. A patient with comminuted mandibular angle fractures accompanied by alveolar bone defect and incomplete closure of soft tissue has an intraoral fistula and bone resorption until 2 months postoperatively. At 6 months postoperatively, the occlusion remained stable and callus healing had been completed. The Champy technique for intraoral single plate fixation is feasible for comminuted mandibular angle fractures. Incomplete closure of soft tissue leads to exposure of the bone marrow cavity, resulting in delayed fracture healing.

3D-Printable Biopolymers for Socket Preservation Technique: Soft Tissues Response: A Pilot Randomised Clinical Study.

The aim of the present parallel clinical study is to evaluate the efficacy of 3D-printed biopolymers compounded with osteoconductive material (beta-tricalcium phosphate and hydroxyapatite) for soft tissue closure after tooth extraction. this study followed the CONSORT reporting guidelines; 39 patients were treated with socket preservation using 3D-printed biopolymers and randomly divided into 3 groups (Test 1, Test 2, and Control). All cases were treated without flap elevation, careful cleaning and debridement of the sites, and then randomly sealed as follows: In T1, with a 3D-printed disk of poli-D-lactic acid with 10% of hydroxyapatite; in T2, using a 3D-printed disk of poli-ε caprolactone with 20% of β-tricalcium phosphate; and in T3, the socket was left open to heal. At baseline (extraction time) and 6 weeks after extraction, the rate of exposure was evaluated and stratified according to the site (anterior, posterior). No dropouts were observed during the 6 weeks follow-up. All sites underwent uneventful healing with no complications. For posterior teeth, Test 1 and Test 2 showed full healing of the soft tissues with a reduction of the exposed area from 46.5 ± 8.25 mm2 to 0.6 ± 0.84 mm2 and from 47.1 ± 8.67 mm2 to 0.6 ± 0.7 mm2, respectively. The Control group exhibited a reduction from 45.6 ± 7.25 mm2 to 1.2 ± 0.9 mm2. Both Tests 1 and 2, when compared to the Control group, showed statistically significant better healing (p < 0.05). Anterior teeth showed a complete closure of the socket 4 weeks after the extraction with no noticeable differences between Test and Control. Both materials used in this study showed evidence to achieve the purpose. Ethical Guidelines: written informed consent was obtained from the participants of the study, as requested by the Ethics Committee for Health Research Faculty of Dentistry, Universitas Trisakti, with the following number: 641/S3/KEPK/FKG/5/2023.

Prospective comparative study of medial parapatellar and medial subvastus approaches in total knee arthroplasty

Introduction Total knee arthroplasty (TKA) is the treatment of end-stage osteoarthritis in patients who failed to respond to conservative treatment in providing significant pain relief and improving joint function. The medial parapatellar approach (MPP) allows adequate patellar eversion and sufficient knee flexion to expose the knee joint, but the incision through the quadriceps tendon may impair the extensor mechanism of the knee post-operatively. The subvastus approach (SV) completely spares both the quadriceps tendon and muscle and provides adequate exposure of the knee joint for the replacement procedure, SV maintains integrity of the patellar blood supply and reduces post-operative pain resulting in shorter hospital stay.The aim of this prospective study was to compare the results of the medial parapatellar and subvastus approaches in primary total knee arthroplasty (TKA) regarding postoperative pain, recovery of muscle strength, range of knee motion and return to regular daily activities.Materials and Methods Sixty patients underwent TKA at El-Hadara university hospital in Alexandria. The medial parapatellar apphroach (MPP) was performed in 30 patients while the subvastus approach (SV) was used for the other 30 patients. The choice of approach was randomly assigned.Results The statistical analysis of the results at the end of a 6-month follow-up showed that there were no significant differences between the patients in group 1 (MPP) and group 2 (SV) with respect to age, gender, comorbidity, side operated or body mass index (BMI). Regarding the functional knee scores (IKDC, WOMAC), there were no differences at 4 weeks, 3 months and 6 months postoperatively between the two groups. However, we found better outcomes in the SV group regarding the VAS score during the first five postoperative days, earlier quadriceps recovery by assessment of Straight Leg Raising test (SLR), while the operative time was longer in the SV group with less blood collected postoperatively in hemovac drain in the same group.Discussion In our study during the operation via the MPP approach, the index suture positioned at the superomedial border of the patella and the opposite suture on the medial retinacular flap had enabled the surgeon to avoid patellar maltracking during closure of the wound. In the SV group, the L-shaped incision of the medial capsule was considered an efficient landmark for accurate soft tissue closure avoiding the patellar maltracking.Conclusion The subvastus approach offers the advantage of keeping the integrity of quadriceps muscle and the extensor mechanism remains intact post-surgery. It causes less pain and less blood loss postoperatively than the regular parapatellar approach. The patient could recover the knee function in a shorter time with fewer complications, which is greatly in line with the concept of ERAS (Enhanced Recovery After Surgery).

The Impact of the Chlorhexidine Gel (WISDOM®) on Postoperative Sequelae Associated with the Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical Trial

Background: One of the most prevalent procedures in oral surgery is the removal of impacted mandibular third molars, typically accompanied by trismus, edema, and pain. Several methods and biomaterials were implemented to mitigate or avoid these surgical problems. Objectives: To evaluate the efficiency of chlorhexidine gel (WISDOM®) in minimizing postoperative sequelae associated with the impacted mandibular third molar that will be surgically extracted and its role in promoting early soft tissue closure of the surgical site. Methods: The study design was a double-masked and randomized, controlled clinical study that included healthy patients needing the removal of a mandibular third molar through surgery. The participants were randomly assigned to two groups. The extraction site of the study group was filled with a mixture of gel foam and WISDOM®. In contrast, we filled the extraction sites of the control group patients with gel foam and sutured the surgical sites for both groups. The patients were evaluated on the first, third, and seventh postoperative days for pain, swelling, trismus, and early soft tissue healing. Results: Sixty eligible patients were enrolled in this study. The study group exhibited a statistically significant decrease in pain, edema, trismus, and early soft tissue healing on the first, third, and seventh postoperative days compared to the control group. Conclusions: WISDOM® gel can effectively reduce postoperative pain, trismus, and swelling and promote early soft tissue healing after surgical removal of an impacted mandibular wisdom tooth.

Multi-flap reconstruction for a recurrent giant phyllodes tumor

Few case reports have discussed the incidence and management of giant recurrent phyllodes tumors with borderline to malignant features. We report that of a recurrent case in a 57-year-old female who underwent wide excision with en bloc resection of the 3rd to 7th right anterior ribs and upper abdominal wall. Rigid chest wall reconstruction was achieved using methyl methacrylate and synthetic mesh. This is the first reported case wherein three locoregional flaps, namely the latissimus dorsi, thoracoepigastric and extended external oblique flaps were used to cover a defect measuring 1452 cm2 in size. With this combination of flaps, deformity was minimized, and the resultant outcome was aesthetically and functionally acceptable. Reconstructive goals of intrathoracic organ protection, restoration of chest wall rigidity, maintenance of adequate respiratory function and soft tissue closure were achieved. Careful planning and individualized treatment together with multidisciplinary collaboration remains vital in the successful management of large recurrent malignant phyllodes tumors.

Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial

ObjectivesThis single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group.Materials and methodsPeriodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery.ResultsIn total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01).ConclusionsThe usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure.Clinical relevanceThis study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.

Soft tissue defect closure using an Ilizarov frame: a case series.

The Ilizarov technique is a well-known procedure for limb deformity corrections. However, in the present study, the purpose was to examine the potential of wound closure by means of an Ilizarov frame. Two main cases are presented, a further seven were retrospectively reviewed. The first case experienced a chronic wound at the tibial tuberosity. A fistula was excised followed by antibiotic therapy, however, dehiscence at the wound occurred for which an Ilizarov procedure was used. After two weeks the frame was removed and the wound was closed. The second patient underwent osteosynthesis of a tibia and fibula fracture but was complicated by infection. An Ilizarov device was applied for bone healing as well as the skin defect. Nine patients were included in total. Four of them attained enough skin length via the Ilizarov procedure for secondary closure. Three had the frame removed before having full wound covering and needed further granulation of the wound. Finally, two more patients underwent graft reconstruction. Three patients suffered from infectious complications. The gold standard in soft tissue closure remains skin or flap reconstruction, however, this is not advisable in poor overall health and decreased local vascularity. If an Ilizarov frame is present for bone reconstruction, it can simultaneously be used for skin closure. The results shown in the current study indicate that a satisfactory outcome can be achieved.

Assessment of Early and Late Management of Submental Gunshot Wounds.

Background: Management of submental gunshot wounds is becoming more common and requires complex surgical decisions. Objective: Compare outcomes of early and definitive reconstructive techniques following submental gunshot wounds. Methods: Retrospective chart review evaluated subjects who sustained a self-inflicted submental gunshot. The incidence of complications requiring unplanned operations was compared for early management techniques of skin/soft tissue, bone, and mucosal lining and definitive reconstructive techniques using Fisher's or Pearson Chi-square exact test with p ≤ 0.05 considered statistically significant. Results: The total of 27 patients were included. Early techniques included skin = primary soft tissue closure (n = 19) versus wound vacuum-assisted closure (n = 8); mandible = open reduction internal fixation (ORIF) (n = 19) versus external fixation (n = 8); and oral mucosal lining = primary mucosal closure (n = 20) versus dermal substitute (n = 7). Definitive management included ORIF (n = 10, 37%), ORIF with bone grafting (n = 8, 30%), and microvascular free-flap (n = 9, 33%). The incidence of complications requiring unplanned operation when using dermal substitutes for mucosal lining management was statistically higher than primary closure (p < 0.001); otherwise the complication rates of surgical techniques were equivalent. Conclusion: Several surgical decisions and techniques can be utilized at the time of early and definitive management of submental gunshot wounds. Only the use of dermal substitutes for mucosal lining is associated with a significantly higher rate of unplanned operation.

Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection.

This study has investigated cases of pin site infection (PSI) which required surgery for persistent osteomyelitis (OM) despite pin removal. Patients requiring surgery for OM after PSI between 2011 and 2021 were included in this retrospective cohort study. Single-stage surgery was performed in accordance with a protocol at one institution. This involved deep sampling, debridement, implantation of local antibiotics, culture-specific systemic antibiotics and soft tissue closure. A successful outcome was defined as an infection-free interval of at least 24 months following surgery. Twenty-seven patients were identified (the sites were 22 tibias, 2 humeri, 2 calcanei, 1 radius); about 85% of them were males with a median age of 53.9 years. The majority of infections (21/27) followed fracture treatment. Fifteen patients were classified as BACH uncomplicated and 12 were BACH complex. Staphylococci were the most common pathogens, polymicrobial infections were detected in five cases (19%). Seven patients required flap coverage which was performed in the same operation.After a median of 3.99 years (2.00-8.05) follow-up, all patients remained infection free at the site of the former OM. Wound leakage after local antibiotic treatment was seen in 3/27 (11.1%) cases but did not require further treatment. Osteomyelitis after PSI is uncommon but has major implications for the patient as 7 patients needed flap coverage. This reinforces the need for careful pin placement and pin site care to prevent deep infection. These infections were treated in accordance with a protocol and were not managed simply by curettage. All patients treated in this manner remained infection-free after a minimum follow-up of 2 years suggesting that this protocol is effective. Pin site infection is a very common complication in external fixation. The sequela of a chronic pin site OM is rare but the implications to the patient are huge. In this series, more than a quarter of patients required flap coverage as part of the treatment of the deep infection. Frank FA, Pomeroy E, Hotchen AJ, et al. Clinical Outcome following Management of Severe Osteomyelitis due to Pin Site Infection. Strategies Trauma Limb Reconstr 2024;19(1):21-25.

Cellular experimental study and mechanism of surface modification of 3D printed titanium materials to modulate the sealing and antimicrobial properties of oral implants

Investigating the role of surface-modified 3D printed titanium implants in modulating oral soft tissue closure and antimicrobial properties. Eighteen 6-month-old healthy adult New Zealand White rabbits were selected as experimental animals, the left and right mandibular teeth of each experimental animal were randomly divided into two groups, and the bilateral first premolar teeth were extracted after general anesthesia, and one implant was implanted into each of the magnesium/zinc ionized surface-treated group (experimental group) and the surface-untreated group (control group), with a total of 36 implants, i.e., 18 implants for the experimental group and 18 implants for the control group. Bilateral mandibular samples from both groups were removed after 2 and 4 weeks of implantation to investigate the attachment and spreading of human gingival fibroblasts (HGFs) on the surface of the samples, their proliferative and migratory behaviors as well as the expression levels of related gene proteins (CoL-1 and TGF-β), and HE staining of the soft tissues of the samples and inflammatory cell counts. After 2 and 4 weeks of implantation, the experimental group’s HGFs adhesion and spreading were significantly better than that of the control group, the migration and proliferation of HGFs were significantly greater than that of the control group ( p &lt; .05), and the expression of CoL-1 and TGF-β genes was significantly higher than that of the control group ( p &lt; .05), and the inflammatory cell count was significantly smaller than that of the control group ( p &lt; .05). Surface modification by magnesium and zinc ions enhances the sealing performance and antimicrobial performance of 3D printed titanium implants in oral soft tissues, with significant effects.

NECROTIZING SOFT-TISSUE INFECTIONS: A RETROSPECTIVE CASE SERIES AT A DISTRICT HOSPITAL IN SOUTH AFRICA

Necrotizing soft tissue infection (NSTI) is a rapidly progressive infection that typically starts in the dermis and epidermis and spreads along soft tissue planes, penetrating subdermal layers and can lead to massive tissue necrosis resulting in severe morbidity and mortality. The aim of this case series was to describe the epidemiology and burden of NSTI's at a District Hospital servicing a South African urban settlement.This retrospective case series was performed at a single centre. Consecutive patients were identified following a clinical diagnosis for NSTI. Further laboratory pre-operative work up was standardized including: use of validated Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC scores) and Human Immunodeficiency Virus (HIV) status. All patients who underwent surgical debridement were captured on the Theatre Database (www.medwebtools.org™). All patients received standardized perioperative, intra-operative and post-operative protocols for antibiotics, debridement and soft tissue closure or cover based on the severity of disease. Medical records, theatre notes, National Health Laboratory Service (NHLS) results and radiological results were captured for every patient.28 patients (14 male, 14 female) presented with NSTI over a 3 year period (2021–2023). The mean age was 39.5 years. The most common organisms cultured were Streptococcus pyogenes (10 patients), Staphylococcus aureus (9 patients), Bacillus cereus (3 patients).This retrospective case series is an important study because it demonstrates some of the highest incidence of NSTI globally; however, the cause of this is yet to be determined. Our results show that having a high clinical index of suspicion; using the LRINEC score to assess severity and using a standardized antibiotic and peri-operative protocol with early soft tissue cover that NSTI's can be managed effectively with a reduction in patient morbidity and overall length of hospital stay.

Novel use of interosseous absorbable mattress sutures for secondary sternal fixation: A case series

There is currently no consensus on the treatment of median sternotomy patients presenting secondarily with deep sternal wound infection or symptomatic sternal nonunion. We have developed a novel approach to sternal bone fixation when concerns for open wounds or microbial colonization preclude the use of permanent hardware placement: (1) sternal closure with absorbable interosseous monocortical horizontal mattress sutures followed by (2) multilayered soft tissue closure with pectoralis major advancement or turnover flaps. Benefits of this technique include: closure of retrosternal dead-space, tension offloading of the soft tissue closure, repair of transverse sternal fractures, and preservation of internal mammary artery (IMA) perforators for potential pectoralis turnover flaps. In our early experience, this technique has been successful at promoting functional sternal union - even in secondary closure of high-risk patients contraindicated for permanent hardware placement.

Comparing outcomes following direct admission and early transfer to specialized trauma centers in open tibial fracture treatment: a systematic review and meta-analysis.

Guidelines on the management of open tibia fractures recommend timely treatment in a limb reconstruction center which offer joint orthopedic-trauma and plastic surgery services. However, patient's transfer between centers remains inevitable. This review aims to evaluate the clinical outcomes and hospital factors for patients directly admitted and transferred patients to a limb-reconstruction center. A research protocol adhering to PRISMA standards was established. The search included databases like MEDLINE, EMBASE, and the Cochrane library up until March 2023. Nine articles met the inclusion criteria, focusing on open tibia fractures. Exclusion criteria were experimental studies, animal studies, and case reports. Outcomes of interest were operation and infection rates, nonunion, limb salvage, and the Enneking limb score. The analysis involved data from 520 patients across nine studies published between 1990 and 2023, with the majority (83.8%) having Gustilo Anderson type III open tibia fractures. Directly admitted patients showed lower overall infection rates (RR 0.30; 95% CI 0.10-0.90; P = 0.03) and fewer deep infections (RR 0.39; 95% CI 0.22-0.68; P = 0.001) compared to transferred patients. Transferred patients experienced an average five-day delay in soft tissue closure and extended hospital stays by eight days. Patients transferred without initial surgical management underwent fewer total surgical procedures. The direct admission group displayed more favorable functional outcomes. Low- to moderate-quality evidence indicates worse clinical outcomes for transferred patients compared to directly admitted patients. Early treatment in specialized limb reconstruction units is essential for improved results in the management of open tibia fractures. Therapeutic level IIa.

Recurrent osteomyelitis in patient of osteopetrosis: A rare case report and management

: Osteopetrosis is a rare heritable disease. It sometimes presents as incidental finding with no symptoms to even life threatening complications. It may present as multiple fractures, compressive neuropathies, hypocalcaemia, and life-threatening pancytopaenia. In this article, A 15 years old female reported for evaluation and treatment of pain and pus discharge in the left side of mandible since 1 year after the extraction multiple deciduous tooth. pus discharge in the left side of mandible with draining fistula. Intraoral examination revealed exposed necrotic bone in mentioned region. : osteopetrosis of mandible may develop osteomyelitis. The osteomyelitis is usually due to tooth extraction or pulpal necrosis. However, its treatment is controversial.: Treatment regimens include high-dose systemic antibiotics along with thorough debridement of necrotic bone and primary closure of soft tissues &amp; may require Hyperbaric oxygen.

Predictors for infection severity for open tibial fractures: major trauma centre perspective

IntroductionOpen diaphyseal tibial fractures are the most common long-bone fractures and require a rapid approach to prevent devastating complications. Current literature reports the outcomes of open tibial fractures. However, there is no robust, up-to-date research on the predictive indicators of infection severity in a large open tibial fracture patient cohort. This study investigated the predictive factors of superficial infections and osteomyelitis in open tibial fractures.Materials and methodsA retrospective analysis of the tibial fracture database was carried out from 2014 to 2020. Criteria for inclusion was any tibial fracture including tibial plateau, shaft, pilon or ankle, with an open wound at the fracture site. Exclusion criteria included patients with a follow-up period of less than 12 months and who are deceased. A total of 235 patients were included in our study, of which 154 (65.6%), 42 (17.9%), and 39 (16.6%) developed no infection, superficial infection, or osteomyelitis, respectively. Patient demographics, injury characteristics, fracture characteristics, infection status and management details were collected for all patients.ResultsOn multivariate modelling, patients with BMI > 30 (OR = 2.078, 95%CI [1.145–6.317], p = 0.025), Gustilo-Anderson (GA) type III (OR = 6.120, 95%CI [1.995–18.767], p = 0.001), longer time to soft tissue cover (p = 0.006) were more likely to develop a superficial infection, and patients with wound contamination (OR = 3.152, 95%CI [1.079–9.207], p = 0.036), GA-3 (OR = 3.387,95%CI [1.103–10.405], p = 0.026), longer to soft tissue cover (p = 0.007) were more likely to develop osteomyelitis.Univariate analysis also determined that risk factors for superficial infection were: BMI > 35 (OR = 6.107, 95%CI [2.283–16.332], p = 0.003) and wound contamination (OR = 2.249, 95%CI [1.015–5.135], p = 0.047); whilst currently smoking (OR = 2.298, 95%CI [1.087–4.856], p = 0.025), polytrauma (OR = 3.212, 95%CI [1.556–6.629], p = 0.001), longer time to definitive fixation (p = 0.023) were for osteomyelitis. However, none of these reached significance in multivariate analysis.ConclusionHigher GA classification is a significant risk factor for developing superficial infection and osteomyelitis, with a stronger association with osteomyelitis, especially GA 3C fractures. Predictors for superficial infection included BMI and time to soft tissue closure. Time to definitive fixation, time to soft tissue closure, and wound contamination were associated with osteomyelitis.

Could Future Implant Failures be Predicted Based on Observed Bone Levels and Bone Loss After 5 Years? A Retrospective Investigation on Patients Presented in Previous Studies.

Purpose: To evaluate the diagnostic accuracy of bone loss/bone levels, as detected after 5 years of implant function, in identifying patients who suffered implant failures in the following 5 years. Materials and Methods: Data on radiographic measurements of marginal bone levels at prosthesis placement and after 5 years of function were retrospectively retrieved from 11 previous publications. Included patients were allocated into different subgroups with regard to bone loss/bone level during/after 5 years in function, respectively. A diagnostic test was used to estimate the accuracy of finding patients/jaws/implants at risk for a future implant failure by calculating sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) in different subgroups, respectively. Results: Altogether, 749 treated jaws (723 patients/3,363 implants) were included in the study group. Treated jaws in the high-level subgroups presented an overall higher risk of implant failures from 5 to 10 years in function (P < .05). Many treated jaws/implants were allocated into the high-level groups, but the proportions of implant failures were low in these groups. The diagnostic test comparing high- and low-level groups with and without implant failures showed low accuracy to predict implant failures; the PPV ranged from 4% to 33%. Lower PPVs were observed for diagnostic tests for individual implants (range: 4% to 6%). Conclusion: More severe bone loss was associated with higher risk of future implant failure. However, many patients/ implants with obvious bone loss in the study group and low prevalence of implant failures at the 10-year examination resulted in poor accuracy in identifying individual patients or implants at risk for failure. This suggests that it is difficult to predict future implant failures based only on radiographic measurements.

EVALUATION OF THE OUTCOME OF THE ILIZAROV TECHNIQUE FOR THE TREATMENT OF TIBIAL BONE AND SOFT TISSUE INJURY

This study was designed to assess the outcome of the illizarov method for treating patients with dead bone segments or open fractures along with severe soft tissue injury. This retrospective study was conducted at Bakhtawar Ameen Trust Hospital, Multan, from September 2019 to September 2022. A total of 35 patients having non-union tibial fractures and dead bone segments were included in the study. These patients had tibia grade 3 open fractures and had undergone bone grafting and soft tissue closure. The defective bone segment was debrided, and radical resection was done. Illizarov technique was performed on all subjects. All patients reported good smooth tissue coverage and bone transport. The mean docking period of bone transport in all subjects was 3.87 ± 0.45 months. A leg length discrepancy of 1 cm occurred in 4 subjects. No subject complained of pain at follow-up. The Illizarov method is effective for the management of bone and soft tissue injuries.

Minimal invasiveness in vertical ridge augmentation.

Vertical ridge augmentation is one of the most challenging procedures in implant dentistry because of the advanced skills required by the operator and the fact that bone augmentation is aimed outside the bony contour, in an environment of reduced blood supply. What is more, the flap management required to ensure soft tissue closure frequently leads to associated comorbidities in terms of swelling and hematomas. For these reasons, and even if autologous onlay block grafts are still the gold standard, new techniques and biomaterials have favored the development of potentially less invasive approaches. The present work evaluates the most recent strategies in vertical ridge augmentation to reduce invasiveness and complications, including diagnostic/treatment planning considerations, surgical techniques, digital tools (eg, customized titanium meshes/membranes or bone blocks), and future trends in the field of tissue engineering and cell therapy.

Facial masculinization surgery

Facial masculinization surgery

The Use of A Buccal Free Fat Tissue Graft to Enhance Primary Soft Tissue Closure during Socket Preservation and Improve Ridge Contour at the extraction site: Presentation of the Technique, and Report of Case Series

The Use of A Buccal Free Fat Tissue Graft to Enhance Primary Soft Tissue Closure during Socket Preservation and Improve Ridge Contour at the extraction site: Presentation of the Technique, and Report of Case Series