Soft Tissue Padding Research Articles

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While the incidence of sacral pressure ulcers has remained constant over the last ten years, the prevalence of heel pressure ulcers has increased. Heel ulcers can delay mobilisation and prolong hospital stay. They also contribute, either directly or indirectly, to other more serious complications such as cellulitis, osteomyelitis and deep vein thrombosis. Pressure ulcers on the heel are among the most difficult to heal as this area of the body has no appreciable soft tissue pad so, once damage occurs, the progression of the ulcer is quick. High risk patients should be nursed on a pressure relieving mattress but should also wear a heel protection devise.

Implant Breast Reconstruction Using Acellular Dermal Matrix

Thirteen breast reconstructions in 11 patients, averaging 58 years of age, underwent mastectomies. The technique uses a saline implant either totally or partially covered with a human acellular dermal matrix. The mean postoperative follow-up time was 14 months. Ninety percent of the patients were considered high risk; the thickness of the human acellular dermal matrix was an average of 1.3 mm, with an average area per breast of 121 cm. There were 12 successful breast reconstructions (92%) that provided stability, increased soft tissue padding, which allowed a greater resemblance to normal breast shape and decreased rippling and implant visibility. The graft was used in an onlay fashion or as an extension of the pectoralis major muscle that covers the implant. A representative histologic cross-section of well-integrated human acellular dermal matrix is presented. The use of a human acellular dermal matrix in breast reconstruction is an alternative protocol in high-risk patients, resulting in a minimal increase in operative time and a decrease in morbidity compared with more extensive procedures.

Shrinkage of the below-knee stump in leprosy.

The long-term progress of below-knee stumps was studied in 65 leprotic amputees. Thirty-seven patients underwent amputation with a long posterior flap (LP) and 28 patients with an equal anterior and posterior flap (EF) technique. Mean follow-up was for 6 and 7 years respectively. Shrinkage of the soft tissue and retraction of the posterior calf muscles caused the posterior skin flap of the stump to rotate posteriorly in all cases, with a mean 26 degrees of rotation in LP stumps and 42 degrees of rotation in EF stumps. The LP stumps remained thicker, with soft tissue padding at the bony ends, and had fewer stump complications than the EF stumps.

Reverse Osseofasciocutaneous Radial Forearm Flap for Thumb Reconstruction: A Flap Design and Case Series

To report the outcome of the modified design of the osseofasciocutaneous radial forearm flap. The flap was modified because of problems associated with the use in thumb reconstruction. We performed retrospective review of all patients who sustained nonreplantable thumb amputations who had this procedure between August 2000 and March 2005. The patients' ages ranged between 24 and 39 years. Demographic data and details of the level of amputation and alternative surgical procedures were reviewed. Eight male patients were identified and constituted the study cohort. The size of flap, length of the radius harvested, time to union, sensibility (moving 2-point discrimination test), grip and pinch strengths, complications, and patient outcome were determined. All patients who had the butterfly design of the reverse-flow osseofasciocutaneous radial forearm flap had an adequate and painless soft-tissue padding on the tip of the reconstructed thumb that provided good protection for the distal stump of the vascularized bone graft. Patients did not experience strictures at the bottom of the reconstructed tubes. The butterfly design is a useful modification of the skin paddle of the reverse osseofasciocutaneous radial forearm flap for thumb reconstruction. The design offers an easy way to reconstruct a tube shape with adequate padding on the tip and no terminal scar. In addition it prevents the constricting effect of the circumferential scar on the button of the reconstructed tube.

Free Toe Pulp Transfer for Digital Reconstruction

The problem of loss pulp substance of the fingers during an unanticipated event such as trauma, represents not only the deprivation of tactile perception, but also the loss of a solid, well-cushioned covering. The ultimate goals for the reconstruction of finger pulp are to maintain the original digital length, provide adequate soft tissue padding and to obtain near-normal sensations. Anatomically and functional speaking, the most suitable source for finger pulp reconstruction will be the toe pulp. A total of 15 free toe pulp transfers were done for finger pulp reconstruction between 1992 and 2001 which included 11 thumbs, 1 index finger, 2 middle fingers, and 1 ring finger. The pulp size varied from 2.5×2 cm^2 to 4.5×2.5 cm^2. All patients were followed-up for an average of 28 months (range: 10 to 64 months). All the toe donor sites were closed with split thickness skin grafts. The survival rate of the transferred toe pulp flap was 100% in all of the 15 flaps. Partial loss of skin graft in the donor site was noted in 2 of the 15 flaps, but secondary healing was accomplished later. No discomfort was identified during maneuvers such as walking. Satisfactory functional and cosmetic results were reported in 13 of the 15 flaps. One patient had complained about the bulkiness of the transferred pulp flap. Cold intolerance of the injured digit was noted in 2 patients and two complains were about hypoesthesia of the transferred pulps. S2-PD ranged from 6 to 15 mm with an average of 9.9 mm. We believe that the free toe pulp transfer is an excellent option for the finger pulp reconstruction with minimal donor site morbidity.

PATHOPHYSIOLOGY OF OSTEOPOROSIS

As with many chronic diseases that express themselves late in life, osteoporosis is distinctly multifactorial, both in etiology and pathophysiology. Osteoporotic fractures occur because of a combination of injury and intrinsic bony fragility. Injury comes most often from a combination of falls, falling to the side, poor postural reflexes that fail to protect bony parts from impact, and reduced soft-tissue padding over bony prominences. The bony fragility itself is a composite of geometry, low mass density, severance of microarchitectural connections in trabecular structures, and altered bone material quality. The latter is primarily the result of accumulated fatigue damage, but reduced collagen cross-links and other intrinsic material defects may play a role as well. Reduced bone mass, in turn, is the result of varying combinations of gonadal hormone deficiency, inadequate intakes of calcium and vitamin D, decreased physical activity, comorbidity, and the effects of drugs used to treat various unrelated medical conditions. Finally, the often poor outcome from hip fracture in the elderly is partly due to associated protein-calorie malnutrition. An adequate preventive program for osteoporotic fracture must address as many of these factors as possible and be as multifaceted as the disease is multifactorial.

Pathophysiology of Osteoporosis

<h2>ABSTRACT:</h2> As with many chronic diseases that express themselves late in life, osteoporosis is distinctly multifactorial both in etiology and in pathophysiology. Osteoporotic fractures occur because of a combination of injury and intrinsic bony fragility. The injury comes most often from a combination of falls, poor postural reflexes that fail to protect bony parts from impact, and reduced soft tissue padding over bony prominences. The bony fragility itself is a composite of geometry, low mass density, severance of microarchitectural connections in trabecular structures, and accumulated fatigue damage. Reduced bone mass, in turn, is caused by varying combinations of gonadal hormone deficiency, inadequate intakes of calcium and vitamin D, decreased physical activity, comorbidity, and the effects of drugs used to treat various unrelated medical conditions. Finally, the often poor outcome from hip fracture in the elderly is partly caused by associated protein-calorie malnutrition. An adequate preventive program for osteoporotic fracture must address as many of these factors as possible, ie, it must be as multifaceted as the disease is multifactorial.

Pathophysiology of osteoporosis.

As with many chronic diseases that express themselves late in life, osteoporosis is distinctly multifactorial both in etiology and in pathophysiology. Osteoporotic fractures occur because of a combination of injury and intrinsic bony fragility. The injury comes most often from a combination of falls, poor postural reflexes that fail to protect bony parts from impact, and reduced soft tissue padding over bony prominences. The bony fragility itself is a composite of geometry, low mass density, severance of microarchitectural connections in trabecular structures, and accumulated fatigue damage. Reduced bone mass, in turn, is caused by varying combinations of gonadal hormone deficiency, inadequate intakes of calcium and vitamin D, decreased physical activity, comorbidity, and the effects of drugs used to treat various unrelated medical conditions. Finally, the often poor outcome from hip fracture in the elderly is partly caused by associated protein-calorie malnutrition. An adequate preventive program for osteoporotic fracture must address as many of these factors as possible, ie, it must be as multifaceted as the disease is multifactorial.

Local composite neurovascular island flap for skin cover in pulp loss of the thumb

A local composite neurovascular island flap to provide stable skin cover with good soft tissue padding and sensibility for extensive pulp loss of the thumb was used in five patients. The island flap included the dorsoradial branches of the radial digital neurovascular bundle of the thumb.

Problems of digital amputations: a clinical review of 260 patients and 301 amputations.

Three hundred and one digital amputations have been reviewed. There was a high complication rate, including poor pad, neuroma, joint stiffness, nail remnant, osteomyelitis, retracted tendon stump and stiff shotdder. In 20% of patients a second operation, usually reamputation, was necessary because of neuroma or poor pad. Fifty per cent of patients were away from work for more than two months, and prolonged disability often followed when the amputation stump was covered by a skin graft or flap, because of impaired sensation. Reference is made to five digits which were reimplanted and subsequently amputated. It is recommended that when amputating through the digit, the surgeon should not aim at preserving length at all costs, but at covering the amputation stump with a satisfactory soft‐tissue pad and maintaining full finger function.

A simple plastic procedure of the fingers for conserving bony tissue and forming a soft tissue pad

gested that this method has appeared in the literature. The writer has been unable to find it. In America’s Iarge industria1 pIants, amputation is approaching a rarity. In the smaIIer jobbing shops, where safety departments are Iess efficient, this injury is stiI1 sadIy common. The writer has had rather discouraging results with the free graft in industry. NeedIess to say, a11 digit amputations wiI1 not submit to this pIastic operation. GeneraIIy speaking, an amputation through a nai1, if the proxima1 part of the nai1 or its bed, remains and if the transverse Iine of amputation is not too obhque with the long axis of the finger, the operation has a good chance for success.