Soft Tissue Reduction Research Articles

Changes in soft tissue dimensions following horizontal guided bone regeneration with a split-thickness flap design – evaluation of 8 cases with a digital method

BackgroundPeri-implant soft tissue corrections are often indicated following alveolar ridge augmentation, due to the distortion of the keratinized mucosa at the area of augmentation. The objective of the current study was to evaluate the dimensional soft tissue changes following horizontal guided bone regeneration (GBR) utilizing 3D digital data.Methods8 mandibular surgical sites with horizontal alveolar ridge deficiencies were treated utilizing a resorbable collagen membrane and a split-thickness flap design. Baseline and 6-month follow-up cone-beam computed tomography (CBCT) scans were reconstructed as 3D virtual models and were superimposed with the corresponding intraoral scan. Linear changes of supracrestal vertical- horizontal soft tissue alterations were measured in relation to the alveolar crest at the mesial- middle- and distal aspect of the surgical area. Soft tissue dimensions were measured at baseline and at 6-month follow-up.ResultsPreoperative supracrestal soft tissue height measured midcrestally averaged at 2.37 mm ± 0.68 mm, 2.37 mm ± 0.71 mm and 2.64 mm ± 0.87 mm at the mesial-, middle- and distal planes. Whereas postoperative supracrestal soft tissue height was measured at 2.62 mm ± 0.72 mm, 2.67 mm ± 0.67 mm and 3.69 mm ± 1.02 mm at the mesial, middle and distal planes, respectively. Supracrestal soft tissue width changed from 2.14 mm ± 0.72 mm to 2.47 mm ± 0.46 mm at the mesial, from 1.72 mm ± 0.44 mm to 2.07 mm ± 0.67 mm and from 2.15 mm ± 0.36 mm to 2.36 mm ± 0.59 mm at the mesial, middle and distal planes, respectively. Additionally the buccal horizontal displacement of supracrestal soft tissues could be observed.ConclusionsThe current study did not report significant supracrestal soft tissue reduction following horizontal GBR with a split-thickness flap. Even though there was a slight increase in both vertical and horizontal dimensions, differences are clinically negligible.Trail registrationThe trail was approved by the U.S. National Library of Medicine (www.clinicaltrials.gov); trial registration number: NCT05538715; registration date: 09/09/2022.

LASER-ASSISTED CROWN LENGTHENING: CLINICAL EFFICACY AND ADVANTAGES OVER CONVENTIONAL TECHNIQUES (SYSTEMATIC REVIEW)

Introduction: Crown lengthening is a widely recognized dental procedure with both aesthetic and functional purposes. It involves the reduction of periodontal hard and soft tissues to obtain supracrestal tooth length, resulting in longer clinical crowns and adequate supracrestal tissue attachment. Laser therapy has emerged as a promising alternative that is currently developing in the field of periodontics and offers several advantages. This review aims to synthesize the current research on the clinical efficacy of laser-assisted crown lengthening procedures and highlight their advantages over conventional methods. Review: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted in electronic databases PubMed, Scopus, Embase, and Google Scholar for human studies published from 2017 to April 2023. Out of 213 identified and screened studies, three original articles were included in the analysis. Two clinical trial studies used Er,Cr:YSGG while one study used Er:YAG for crown lengthening procedures involving gingiva and alveolar bone reduction, with a 3-month follow-up period. Compared to conventional crown lengthening, the laser-assisted approach showed comparable increases in clinical crown length. However, the laser-assisted group demonstrated better gingival margin stability, improved soft tissue healing, and minimal damage to adjacent tissues. Furthermore, there was a statistically significant lower bacterial load and less post-surgery pain with laser-assisted crown lengthening compared to the conventional method. Conclusion: In cases where both gingival and bone reduction are required, laser-assisted crown lengthening using Er,Cr:YSGG and Er:YAG can be considered a minimally invasive alternative with several advantages over conventional procedures.

Surgical Intervention in Allergic Rhinitis: Stuffy Versus Sneezy Runny Nose.

To detect proportion and surgical outcome of adult patients with allergic rhinitis non-responsive to medical treatment. To identify clinical candidacy for submucous turbinoplasty of inferior turbinate resection or soft tissue reduction. A prospective descriptive study of adults with clinical allergic rhinitis was done. Non-responders to medical therapy were identified and outcome of surgical intervention analyzed.There were 393 patients. Eighty-one patients (21%) were refractory to medical therapy. Presenting symptoms were sneezing with watery rhinorrhea among 72% and nasal obstruction in 28% patients All patients in the latter group had hypertrophied inferior turbinates with associated deviated nasal septum in 36.6%. Bony and mucosal inferior turbinate hypertrophy among 73.3% and mucosal hypertrophy among 26.7% were identified by a negative or positive response to on-table local vasoconstrictor application respectively. Submucosal inferior turbinoplasty with turbinate resection in the former and soft tissue reduction in the latter group were done, along with septoplasty among 36%. All patients revealed significant reduction in postoperative SNOT score. Crusting was more during early postoperative period among those with soft tissue reduction and simultaneous septoplasty, necessitating meticulous endoscopic follow-up.Adult allergic rhinitis presenting predominantly with nasal obstruction ('stuffy nose'), could be non-responsive to medical therapy unlike sneezy, runny nose, especially when obstructive symptoms are more than two years among older patients, suggesting presence of hypertrophied inferior turbinates. On-table response to vasoconstrictors is a reliable clinical indicator for submucous inferior turbinoplasty: negative and positive response suggesting turbinate resection among majority and soft tissue reduction among minority respectively.

The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-arch Implant Restoration.

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3D printed guide according to the future gingival margin of the planned dentition. A 61-year-old female with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of re-contouring of the alveolar ridge and gingiva and placement of six implants and a FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully-digitally-guided surgery was planned. This consisted of utilizing three surgical guides. Starting with the fixation pin guide and continuing with the scalloped hard and soft tissue reduction guide and finally, the implant placement template. Following the surgery, the patient received a temporary restoration and on the 4-month follow-up, a new poly-methyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the paper. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

A pilot study on the association between soft tissue volumetric changes and non-surgical periodontal treatment in stage III periodontitis patients. A case series study

ObjectivesThis study investigates the correlation between soft tissue volumetric changes and clinical periodontal parameters for patients suffering from Stage III periodontitis after non-surgical periodontal treatment (NSPT) via intraoral scanning. MethodologyThe following study is a case series pilot study involving twenty-eight Stage III Periodontitis patients. All subjects received full-mouth periodontal examination and intra-oral scanning cat baseline and re-evaluation. NSPT with bi-weekly oral hygiene reviews were carried out, and re-evaluation was performed after 10–12 weeks. Baseline scanned data of all subjects would be superimposed with the corresponding scanned data obtained during re-evaluation to ensure the teeth are in the correct alignment. Boolean subtraction would be performed with the 3D scanned data after superimposition and transformation into a 3D solid. The association of baseline clinical parameters and changes after NSPT with soft tissue volumetric changes up to tooth surface level would be evaluated. Results and conclusionMean volumetric reduction after NSPT was 153.45 mm3 ± 185.30 mm3 and 124.06 mm3 ± 124.17 mm3 for the maxillary and mandibular arch, respectively. A statistically significant correlation was detected between soft tissue volumetric reduction to baseline and post-treatment clinical periodontal parameters. Posterior teeth were found to have the highest reduction in soft tissue volume.According to this pilot study, baseline clinical periodontal parameters (PPD, CAL, BOP) correlate with the soft tissue volumetric reduction after NSPT. Further studies on a larger scale and utilization of digital means on tooth sites would be necessary to strengthen the proof of concept. Clinical significanceIntraoral scanning can be a valid non-invasive method to assess soft tissue volumetric changes after initial periodontal treatment, which are correlated to changes in the baseline clinical periodontal parameters.

Interproximal Soft Tissue Height Changes After Unassisted Socket Healing vs Alveolar Ridge Preservation Therapy.

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) ther- apy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult patients who underwent maxillary single-tooth extraction with or without ARP therapy were included. Surface scans were obtained and CBCT was performed to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regres- sion models were conducted to investigate the individual effect of demographic and clinical vari- ables. Ninety-six subjects (USH &#61; 49; ARP &#61; 47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P < .0001). ARP therapy significantly attenuated interproximal soft tissue height re- duction compared to USH: -2.0 ± 0.9 mm mesially for USH vs -1.0 ± 0.5 mm mesially for ARP; -1.9 ± 0.7 mm distally for USH vs -1.1 ± 0.5 mm distally for ARP (P < .0001). Thin (≤ 1 mm) facial bone thick- ness (FBT) upon extraction was associated with greater interproximal soft tissue atrophy compared to thick FBT (> 1 mm), independent of the treatment received (P < .0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height, especially in thin bone phenotype, by a factor of 2 for the mesial site (&#43;1.3 mm) and by a factor of 1.6 for the distal site (&#43;0.9 mm). This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional re- duction after maxillary single-tooth extraction compared to USH.

LBSAT238 Teprotumumab Reduces Orbital Fat And Muscle Volume In Patients With Thyroid Eye Disease

Abstract Teprotumumab, a novel IGF-1R antibody has been shown to reduce proptosis in patients with thyroid eye disease (TED) in 2 randomized controlled trials. At present, it is unclear whether the reduction in proptosis is related to a decrease in extraocular muscle or orbital fat tissue. In this prospective longitudinal study, we reviewed the changes to orbital fat and muscle, and compared them, in consecutive patients with TED, who had completed treatment with teprotumumab (8 infusions). The primary outcome was change in orbital fat and muscle volume within 6 weeks of starting and completing therapy. Secondary outcome measures included change in proptosis and the clinical activity score (CAS). All patients had either CT or MRI with ≤ 1 mm slice thickness. Three-dimensional volumetric analysis of the orbital fat and muscle volume was performed using the previously validated 3D image analysis software, MIMICS (Materialise, Leuven, Belgium). Hounsfield units of fat and muscle were defined manually. All extraocular muscle tissue and fat between the orbital septum (eyelid) and the orbital outlet of the optic canal was included. A 3D model created by voxel addition was expressed in millimeters cubed. Segmentation and measurements were performed independently by two graders to review repeatability and observer variability. In line with previous clinical trials, the orbit with the most proptosis was defined as the study orbit and the contralateral orbit was designated the fellow orbit. Twenty-one patients (15 females and 6 males) met the inclusion criteria. Mean (SD) age was 55 (16), while mean (SD) duration of TED was 71 (46) months. There was a reduction of 3 mm in both; study and fellow orbits following treatment (p &amp;lt; 0. 01 for both). Compared to baseline, there was a mean (SD) CAS reduction of 4 (1) in the study orbit and 2.4 (1.1) in the fellow orbit (p &amp;lt; 0. 01 for both). Following therapy, mean (SD) reduction in muscle tissue was 1691 mm3 (1358) in the study orbit and 1714 mm3 (1927) in the fellow orbit (p &amp;lt; 0. 01 when compared to baseline for each). The mean (SD) reduction of fat volume was 1382 mm3 (1318) in the study orbit and 933 mm3 (1699) in the fellow orbit (p &amp;lt; 0. 01 when compared to baseline for each). There was no difference between fat and muscle reduction for the study orbit (p = 0.4) or fellow orbit (p = 0.2). There was a significant correlation between a reduction in proptosis and reduction in orbital soft tissue (fat and muscle) volume. The results of this study suggest that following treatment with teprotumumab, there is a significant decrease in orbital fat and muscle volume. This reduction in soft tissue volume likely drives the reduction in proptosis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Metal artifact reduction in ultra-high-resolution cone-beam CT imaging with a twin robotic X-ray system

Cone-beam computed tomography (CBCT) has been shown to be a powerful tool for 3D imaging of the appendicular skeleton, allowing for detailed visualization of bone microarchitecture. This study was designed to compare artifacts in the presence of osteosynthetic implants between CBCT and multidetector computed tomography (MDCT) in cadaveric wrist scans. A total of 32 scan protocols with varying tube potential and current were employed: both conventional CBCT and MDCT studies were included with tube voltage ranging from 60 to 140 kVp as well as additional MDCT protocols with dedicated spectral shaping via tin prefiltration. Irrespective of scanner type, all examinations were conducted in ultra-high-resolution (UHR) scan mode. For reconstruction of UHR-CBCT scans an additional iterative metal artifact reduction algorithm was employed, an image correction tool which cannot be used in combination with UHR-MDCT. To compare applied radiation doses between both scanners, the volume computed tomography dose index for a 16 cm phantom (CTDIvol) was evaluated. Images were assessed regarding subjective and objective image quality. Without automatic tube current modulation or tube potential control, radiation doses ranged between 1.3 mGy (with 70 kVp and 50.0 effective mAs) and 75.2 mGy (with 140 kVp and 383.0 effective mAs) in UHR-MDCT. Using the pulsed image acquisition method of the CBCT scanner, CTDIvol ranged between 2.3 mGy (with 60 kVp and 0.6 mean mAs per pulse) and 61.0 mGy (with 133 kVp and 2.5 mean mAs per pulse). In essence, all UHR-CBCT protocols employing a tube potential of 80 kVp or more were found to provide superior overall image quality and artifact reduction compared to UHR-MDCT (all p < .050). Interrater reliability of seven radiologists regarding image quality was substantial for tissue assessment and moderate for artifact assessment with Fleiss kappa of 0.652 (95% confidence interval 0.618–0.686; p < 0.001) and 0.570 (95% confidence interval 0.535–0.606; p < 0.001), respectively. Our results demonstrate that the UHR-CBCT scan mode of a twin robotic X-ray system facilitates excellent visualization of the appendicular skeleton in the presence of metal implants. Achievable image quality and artifact reduction are superior to dose-comparable UHR-MDCT and even MDCT protocols employing spectral shaping with tin prefiltration do not achieve the same level of artifact reduction in adjacent soft tissue.

Liporeduction: A Faster and Safer Breast Remodeling Technique.

Breast reduction is a time-consuming procedure with a relatively high complication rate. Furthermore, recurrent breast enlargement can occur in case of postoperative weight gain. The authors describe a breast reduction technique based on liposuction, followed mostly by skin resection alone, which makes this operation easier, faster, and safer, with more stable results. Two hundred thirty-three patients were treated by breast liporeduction between 2006 and 2017, with an age range of 18 to 70 years (average age, 42 years). The patients were selected after careful clinical and instrumental assessment among those in whose breasts the fat component was prevalent over the gland. Most of the soft-tissue reduction consisted of fat aspiration. The follow-up ranged from 12 months to 9 years (average, 4.5 years). The results of this study have been extremely satisfactory. Most of the patients healed uneventfully and were happy with the final outcome. Very few complications were encountered, among which were small steatonecroses and partial nipple-areola complex necroses. For the past 15 years, all four authors have preferred this breast reduction technique over others. Fat only is selectively removed by aspiration with a blunt cannula, sparing the vascular network and easily mobilizing the nipple-areola complex. Liporeduction provides a good stable result because any postoperative weight variation will not change the volume of a breast consisting mainly of glandular and fibrous tissue. Therapeutic, IV.

The septal tubercle: the state of the problem

The septal tubercle is considered to be a thickened area of the nasal septum, which is located above the lower nasal concha and in front of the middle nasal concha. Taking into account its histological structure and location in the distal segment of the internal nasal valve, it is located and structured for secretory function and vasoactive regulation of the respiratory air flow. These histologically rich tissues with glandular elements are well adapted to the possible dryness that occurs under the influence of intense air flow during breathing, and the existence of a certain number of venous sinusoids of the blood confirms the connection with part of the extensive vascular tissues in the nasal cavity. It is believed that the tubercle of the nasal septum is more pronounced in patients with chronic inflammation of the sinonasal region, for example, with chronic allergic rhinitis or chronic rhinosinusitis. There is currently no consensus on the issue of surgery of the nasal septum body. Due to the lack of consensus among practitioners, many surgeons do not routinely perform operations on this structure and consider the surgical intervention too aggressive, and the effect on nasal obstruction is insignificant. However, according to the presented studies, the results of surgical reduction of soft tissues of the enlarged septal tubercle in the treatment of nasal obstruction using radiofrequency ablation, coblation or microdebrider seem promising, which requires additional study of this issue during long-term follow-up.

New CBCT Indications in Musculoskeletal Imaging

Cone-beam computed tomography (CBCT) has become increasingly important as a low-radiation imaging technique with high resolution. The current new generation CBCT’s aim to optimize the benefits of CBCT while limiting the traditional disadvantages with features such as a larger gantry, higher tube voltage and a moveable table. Very promising is the current development of dual energy CBCT for detecting bone marrow edema, a better soft tissue visualization and reduction of beam hardening artifact. implementation of iterative reconstructions and artificial intelligence in high-end CBCT is a potential tool in a further very substantial dose reduction.

Stump-plasty: An Operation Born of Necessity in Gaza

Aim and objectiveThe most recent wave of lower limb amputees in Gaza arises from ballistic injuries sustained during protests. This study evaluates the requirement for surgical revision of these mature stumps to allow prosthetic fit and mobility.Materials and methodsA multidisciplinary team (MDT) comprising a prosthetist, orthopaedic and plastic surgeons and a physiotherapist screened 104 amputee stumps (103 cases). The 27 cases selected for surgical revision (stump-plasty) are the subject of this study.The MDT prescriptions of care issued at screening were compared to surgical procedures performed at stump-plasty and the findings. Compliance with the MDT prescription was recorded. Stump issues are identified to propose modifications of primary amputation technique to mitigate future revisions.Patients’ healthcare status was assessed by questionnaire (EQ-5D-L5) at screening, then subsequently post-stump-plasty.ResultsMore below-knee amputees (BKAs) than above-knee amputees (AKAs) required stump-plasty. Revisions varied according to the quality of tissue present at the amputation level. AKA revisions addressed bulk and contour issues whereas BKA revisions related to bone prominence, neuroma formation and lack of soft tissue cover. Despite many variations in tissue-targeted procedures being possible, the MDT prescription was followed accurately at surgery.Suggested modifications at primary amputation to decrease revisions include improved bone tip bevelling at BKA and greater soft tissue reduction at AKA. Severed nerve management needs to be rationalised to reduce primary neuroma formation and neuroma revision at stump-plasty requires consideration to attempt to reduce the recurrent risk. Removal of the fibular remnant in short BKA stumps at primary amputation could mitigate common peroneal nerve hypersensitivity later.Following stump-plasty, amputees recorded a significantly improved score in three of five dimensions of the EQ-5D-L5 questionnaire: activities, anxiety levels and pain.Conclusion and clinical significancePrimary ballistic injury dictates the level of amputation and the resultant stump quality. Issues arising in these complex amputee stumps benefited from measured decisions and specialist care delivered by the MDT. Stump-plasty aims to improve the amputees’ prosthetic fit, mobility and health.How to cite this articleGodwin Y, Almaqadma A, Abukhoussa H, et al. Stump-plasty: An Operation Born of Necessity in Gaza. Strategies Trauma Limb Reconstr 2021;16(2):102–109.

Factor Influencing Postoperative Enophthalmos After Reconstruction of Orbital Wall Fracture.

To determine factors influencing postoperative enophthalmos after reconstruction of orbital wall fracture. Data of consecutive patients who were diagnosed with unilateral medial or inferior orbital wall fracture from March 2013 to February 2020 were retrospectively reviewed. Forty-three patients were included in this study (24 with medial orbital wall fracture and 19 with inferior orbital wall fracture). Their medical records including Hertel exophthalmometry, preoperative computed tomography (CT) scan, and postoperative CT scan were reviewed. The degree of enophthalmos developed was calculated by measuring exophthalmos before surgery and at 6 months after surgery. Patients were classified into 2 groups depending on whether reduction was good after surgery or not. Data (eg, age, gender, onset, fracture size, and so on) were then compared between these 2 groups. A total of 43 patients were included in the study. Their mean age was 40.1 years. There were 34 (79.1%) males. The mean onset from trauma to surgery was 8.1 days. Insufficient soft tissue reduction was found in 9 patients through postoperative CT scan. Preoperative mean enophthalmos was - 1.70 mm. Postoperative mean enophthalmos was -0.45 mm after 6 months. The mean fracture size was 213.74 mm2. There was no statistically significant difference in enophthalmos at 6 months after surgery regardless whether the reduction was good or not. Enophthalmos at 6 months after surgery was associated with preoperative fracture size and onset. Postoperative enophthalmos development might be associated with preoperative fracture size and onset. Delayed operation in case of large orbital wall fracture might lead to undesired result. Thus, surgeons should keep that in mind.

Surgical Considerations for an Osseointegrated Steady State Implant (OSIA2®) in Children.

Surgical Considerations for an Osseointegrated Steady State Implant (OSIA2®) in Children.

Functional and radiological outcome of closed talus neck fractures managed by open reduction and internal fixation: A case series study

Background and Objectives: Displaced talar fractures remain a therapeutic challenge for orthopaedic surgeons. According to the literature, these fractures are often associated with high complication rates, including malunion, osteonecrosis, osteoarthritis. The operative treatment of such fractures seems to require a balance between an aggressive treatment with a strict anatomical reduction and essential respect of soft tissues to limit skin complications or osteonecrosis. Fractures of the talus are known to be relatively uncommon. Talus fractures comprise approximately 0.1 to 0.85 percent of all fractures. Most occur as a result of high-energy trauma, such as motor vehicle accidents. As a result, talus fractures are often accompanied by other injuries, including dislocation of adjacent joints and fracture of neighboring bones. However, due to the relatively better diagnostic methods introduced more talar fractures have been recognized and it remains the second most common tarsal bone to get fractured after calcaneum. Methods: 30 patients were selected in an age group of 15-60 years who suffered from closed talus fractures either by road traffic accidents or fall injuries. After clinical evaluation and investigations, Xray and CT scan of ankle of patients were done. The patients underwent operative fixation of talus fracture by cancellous screw fixation and post-operative immobilization was given. Following discharge, patients were followed up at 3rd month, 6th month, 1 year, and during each follow up serial Xrays were taken anteroposterior, lateral, mortise view of the ankle joint. Clinical assessment of the ankle was done using Baird Jackson score, Olerud Molander, AOFAS scoring. clinical complaints of pain and inability to walk and undergo daily activities along with gait abnormalities.8 out of these 10 cases had joint incongruity and ankle joint pain and restriction of movement signifying arthritic changes. 2 cases had non-union seen at 3rd month post-op Xray and were advised and put on below-knee cast and immobilization for 8 weeks. In all cases, cancellous screws were used as the implant of choice and no implant-related complications were found in any of the patients. There was no post-operative skin infection or skin necrosis seen in any patients. Conclusion: Open reduction and internal fixation are recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis, rather the type of fractures that might be indirectly influenced by the mechanism of injury provides a statistical significance.

Development of a multiscale testing method for the reduction of soft biological tissues waste during mechanical characterization

Two biaxial mechanical test methods were devised to compare their suitability for the mechanical characterization of soft biological tissues with the least possible tissue waste. Nanoindentation was used to explore the microscopic properties of the tissue and to overcome the macroscopic test limitations.

K-wire Made Easy by Premarking Wire Trajectory on the Skin in Management of Finger Fractures.

Background:Hand injury in general and fractures in particular are among the most common complaints of hand trauma patients presenting to our emergency department. Depending on fracture types, geometry, locations, and stability, treatment options may vary from close reduction and splinting to close reduction and K-wire fixation, and finally, to open reduction and internal fixation. The aim of the study was to prove that premarking of K-wire trajectory helps reduce procedure and fluoroscopy time, as well as the number of wire-insertion attempts, and minimize bone and soft tissue injury in the management of phalangeal finger fractures.Methods:This is a prospective descriptive study aimed to describe a surgical technique. Patients who underwent close reduction and K-wire fixation of phalangeal digital fractures were enrolled. A total of 20 cases were included.Results:The total number of K-wires was 37, and the total number of successful attempts was 40; average fluoroscopy time was 22.75 seconds; and average total operative time was 14.25 minutes. Surgeries of all cases were supervised by a consultant physician, but some were performed by a junior resident in the team. The inaccuracy index was measured for the group.Conclusions:Marking of the trajectory before placing K-wires for the management of digital fractures is not described in the literature. Our study describes an innovative operative technique that, when combined with the classic K-wire fixation technique, produces beneficial outcomes in the form of reduction in operative time and number of wire introduction attempts, with overall reduction in fluoroscopy time and soft tissue and bone damage (including false passages).

Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series.

Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.

Staged modified Charles procedure on stage III lymphedema of lower limb: safe and effective: a case report

Introduction: Lymphedema of lower limb or elephantiasis is debilitating condition causes quality of life impairment, physical, mental, and social burdens. Surgical techniques of lymphedema are physiologic therapy and excisional procedure, one of them is Charles procedure. Currently, surgical approach controversies remain. This case report aims to present Staged Modified Charles Procedure on stage III lymphedema of lower limb, other excisional procedure techniques. Case description: A Male, 43 years old, complain enlargement of left leg since 18 years ago, his leg was bigger and heavier gradually with intermittent pain until he got difficult to walk. History of trauma, or previous surgery was denied. There were lymphostatic elephantiasis, non-pitting edema with skin changes (acanthosis, increase in thickness, fat deposition, and fibrosis) on physical examination. The patient was diagnosed as lymphedema stage III. Modified Charles's procedure consisted of two-stage tissue excision, negative pressure wound therapy, and delayed skin graft. There were no fluid or blood loss, and infection, obtained 95% of skin graft take, good wound healing, and maximum soft tissue reduction. Histomorphologically supports the diagnosis of elephantiasis. Conclusion: Staged modified Charles procedure on stage III lymphedema of lower limb are safe and effective treatment, provide maximum tissue reduction, with excellent skin graft and wound healing, without fluid and blood loss, or infection.

Does the pre-operative buccal soft tissue level at teeth or gingival phenotype dictate the aesthetic outcome after flapless immediate implant placement and provisionalization? Analysis of a prospective clinical case series

BackgroundImmediate implant placement (IIP) often is related to mid-buccal recession in literature. To draw conclusions about the behavior of the soft tissues following IIP, pre-operative aesthetic measurements have to be taken into account. The aim of analysis of these prospective clinical case series data was to elucidate whether the pre-operative buccal soft tissue level (STL) or gingival phenotype influence the 1-year pink aesthetic outcome after performing flapless immediate implant placement and provisionalization (FIIPP) maxillary incisor cases.Materials and methodsIn 97 patients, a maxillary incisor was replaced performing FIIPP. STL and phenotype were analyzed on light-photographs made pre-operatively (T0), direct post-operatively (T1), after placement of the permanent crown (T2), and 1 year post-operatively (T3). To investigate if a pre-operative buccal soft tissue deficiency or excess influenced the total pink esthetic score (total-PES) per patient at T3, PES-3 was modified by adding a minus (“−”) or plus (“+”) in case of a STL-deficiency or excess, respectively.ResultsPre-operatively, 40% of the cases showed a mid-buccal recession (STL-deficiency), 19% STL-excess, while in 41% an equal level in comparison with the contra-lateral tooth was observed (STL-neutral). One year post-operatively, 79% (31/39) of the recession cases showed soft tissue gain, while STL-excess cases showed the highest rate of soft tissue reduction (94%; 17/18). This resulted in a decrease of soft tissue recessions and excesses (to 26% and 4%, respectively), and an increase of ideal STL (PES-3-score 2) to 70%. The 1-year aesthetic outcome was not statistically different (p = 0.577) between patients with a pre-operative soft tissue recession (mean T3 total-PES = 12.18) or STL excess (mean T3 total-PES = 11.94). Of the total population, 71 patients with a thin, and 26 with a thick phenotype were evaluated. No statistical difference (p = 0.08) was present in aesthetic outcome between the two phenotypes (thin mean T3 total-PES = 12.30, thick mean T3 total-PES = 11.65).ConclusionRegardless of phenotype, preoperative soft tissue recession, or excess, comparable high aesthetic outcomes were achieved 1 year post-operatively.Trial registrationEthical approval was obtained and registered on 20 October 2015 (NTR5583/NL4170).