Reconstruction Of Surgical Defects Research Articles

Reconstruction of plantar surgical defects with synthetic dermal matrix and split-thickness skin grafts: A case series and functional podiatry outcomes.

Reconstruction of surgical defects after wide local excision of acral melanoma on the sole should allow patients to walk and bear weight. Moreover, certain options such as local transposition flaps can compromise follow-up. We present a case series of surgical defects on weight-bearing areas of the sole reconstructed using a synthetic dermal matrix and a split-thickness skin graft. This approach prevents surrounding tissue displacement and results in good functional outcomes assessed by baropodometry and computer-based podoscopy.

Reconstruction of Partial Glossectomy Defects in Patients with Squamous Cell Carcinoma of Oral Tongue: A Prospective Clinical Study on the Assessment and Comparison of Intraoperative and Postoperative Outcomes of Islanded Nasolabial Flap Tunneled Under the Mandible and Radial Forearm Free Flap

Background: Reconstruction of the glossectomy defect following surgery plays a pivotal role in a patient’s quality of life. Reconstruction of surgical defects following glossectomy has evolved greatly from locoregional flaps such as nasolabial, submental, infrahyoid, and pectoralis major myocutaneous flaps to microvascular free flaps (radial forearm free flap [RAFF], anterolateral thigh flap). Due to certain drawbacks, microvascular-free flaps are avoided; instead, local/regional flaps are preferred. Islanded Nasolabial Flap Tunneled Under the Mandible (INFTUM) is a modification of the conventional nasolabial flap based on the facial artery. The flap is raised by dissecting to a certain length to adequately reach a significant distance for reconstruction of the glossectomy defects of mild-to-moderate size. This flap provides adequate bulk and pliable tissue to the remaining tongue, which aids in better functional outcomes. Aim: The aim is to assess and compare the intraoperative and postoperative outcomes of INFTUM and RAFF for the reconstruction of partial glossectomy defects in patients with squamous cell carcinoma of the oral tongue. Materials and Methods: This prospective study was conducted on 20 patients equally divided into two groups, Group A – Islanded Nasolabial Flap Tunnelled Under the Mandible and Group B – RAFF conducted in SGM Cancer Hospital, Sawangi. Intraoperative and postoperative outcomes were evaluated, and statistical analysis was performed using independent sample t-test and Chi-square test where values less than P = 0.05 were found significant. Results: INFTUM flap displayed better intraoperative and postoperative outcomes, especially functional outcomes, in shorter duration as it is locally available with minimum cosmetic deformity to the donor site. In this study, the flap is done in a single stage by tunneling under the mandible. It has a good reach to any aspect of the oral cavity, including the contralateral side, if ipsilateral level Ib nodes are compromised. Conclusion: INFTUM is a simple, effective, and safe flap that can be used for the reconstruction of T2-T3 lesions or partial glossectomy defects. It provides better intraoperative and postoperative outcomes and comparable functional outcomes to RAFF, especially when patients have anesthesia risk for prolonged surgical procedures in a limited-resource setting. Furthermore, it has comparatively less postoperative complications as it has less learning curve.

Surgical Use of Supraclavicular Artery Flap for Head and Neck Cancer Defects Repair: Personal Experience.

Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those "fragile" patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those "fragile" patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.

Examination of Suprahyoid Muscle Resection and Other Factors Affecting Swallowing Function in Patients With Advanced Oral Cancer After Surgical Resection and Reconstruction.

Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03-2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.

Surgical Techniques Following Free Cartilage Grafting.

Reconstruction of surgical defects with free cartilage grafts poses unique challenges. To characterize surgical techniques following free cartilage grafting. A literature review was performed using the Embase, PubMed Medline, Cochrane Library, ClinicalTrials.gov , and Web of Science databases from inception to May 21, 2021. Studies describing free cartilage grafts harvested from the ear or nose under local anesthesia, specifically for reconstruction of facial surgical defects, were selected for inclusion. Only surgical defects resulting from tumor resection were included. In total, 34 studies involving 713 patients with 723 surgical defects met inclusion criteria. The mean age of patients was 63.3 ± 10.4 years. Free cartilage grafts were most commonly harvested from the ear (93.1%). The most common recipient site was the nose (90.3%), followed by the lower eyelid (6.7%) and ear (3.0%). Free cartilage grafts are an effective reconstructive option for patients with deep or cartilaginous defects that have compromised structural support on the nose, ear, or eyelid.

Reconstruction of cutaneous dorsal finger defects.

Reconstruction of surgical defects on the dorsal finger can be challenging because of a lack of adjacent tissue reservoirs, poor laxity, and often thin, atrophic skin surrounding the defect. To present reconstructive options for cutaneous dorsal finger defects. We describe our five preferred approaches to reconstructing cutaneous dorsal finger defects based on the amount of available underlying tissue and location of the defect on the finger. In the authors' opinion, for smaller defects between and including the metacarpophalangeal joint extending to the proximal interphalangeal joint, a transposition flap or unilateral advancement flap is preferable. For proximal finger defects that are wider, a unilateral rotation flap is appropriate. A Burow full-thickness skin graft can be used for any proximal defect with underlying soft tissue present. For defects with underlying bone or tendon present, a reverse cross-finger interpolation flap can be utilized. The unilateral advancement flap, unilateral rotation flap, transposition flap, full-thickness skin grafts, or the reverse cross-finger interpolation flap can be used to reconstruct the majority of cutaneous dorsal finger defects.

The use of a pedicled buccal fat pad for reconstruction of posterior mandibular defects

BackgroundThe pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible.Case presentationThis study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area.ConclusionIn conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.

Reconstruction of Surgical Defect in Mandible Using Patient Specific Implant - A Case Report

Reconstruction of Surgical Defect in Mandible Using Patient Specific Implant - A Case Report

Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws.

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

Nasal vestibule and columella cancer: a therapeutic and reconstructive conundrum.

Nasal vestibular cancers are rare entities among the head and neck cancers. The treatment options are varied. Although surgical treatment plays an important role, postablative defects are difficult to reconstruct. This review aims to discuss the current views in the management of these cancers and issues related to the reconstruction of the complex surgical defects. Nasal vestibular cancers are a distinct rare entity of head and neck cancers. These cancers are staged using the AJCC-TNM system for nonmelanoma cutaneous cancers of head and neck or the Wang classification. Early lesions are best treated by either surgery or radiation giving excellent cure rates. Advanced stages tumours need combined treatment with surgery and adjuvant radiation therapy. Primary radiation therapy can be offered by external beam or interstitial brachytherapy. Surgical treatment varies from endonasal resections, Mohs' chemosurgery to open excisions. Even though the Wang system of classification is used by majority of reports due its clinical utility, it has a drawback of not taking into account the tumour size as done by the AJCC system. Brachytherapy has been reported to be offering excellent cure rates with low morbidity in early tumours. Surgical treatment is also effective in early lesions, but its role is more established in advanced lesions. Reconstruction of the surgical defects is often a challenge, to preserve functional integrity and cosmesis. Various techniques, including skin grafts, local flaps, free flaps and prosthetics, form part of the reconstructive armamentarium.

Reconstrucción auricular mediante fenestras y curación por segunda intención con apósitos hidrocoloides después de una cirugía micrográfica de Mohs

IntroductionMohs micrographic surgery plays a prominent role in cutaneous carcinomas treatment allowing 100% control of surgical margins. Reconstruction of surgical defects is quite a challenge for the dermatological surgeon. There are particularly complex anatomical regions such as the auricule. Auricular fenestration with subsequent secondary-intention healing is a simple, economical technique, with few complications, that is useful when the defect involves the cartilage and its perichondrium. Materials and methodsA descriptive study of auricular defects after Mohs micrographic surgery was carried out using the auricular fenestration technique and healing by second-intention healing assisted with hydrocolloid dressing. ResultsWe present four patients with an average age of 68.5 years, three of them presented basal cell carcinoma and one presented squamous cell carcinoma. The average size of repaired defects was 2.45 cm. ConclusionThe procedure was well tolerated and none of the cases presented complications such as bleeding or infection.

Management of Intraoral Surgical Defects Using Sublingual Gland Flap.

The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. The age range was 45-71-70 years. All defects were present in the posterior mandible. All patients' undergone sequestrectomy, debridement, and reconstruction with sublingual gland flap under local anesthesia. Postoperatively patients were followed up at 1, 3, and 6 months. Patients were monitored for complete epithelization of defect, infection, pain, and recurrence of the lesion. Complete epithelization with closure of the defect was achieved in all cases. None of the patients had residual pain or inflammation at the surgical site. None of our patients experienced any donor site morbidities. There was no case of postoperative infection. Reconstruction of intraoral defects using sublingual gland flap is an effective treatment modality to reconstruct small to medium sized defect of oral cavity.

A Peculiar Way of Reconstruction for Surgical Defects of the Upper Lip: A Case Report

Cutaneous neoformations of the upper lip, especially non melanoma skin cancers (NMSC), are very common. The upper lip is composed of multiple cosmetic subunits and it is divided into a philtral subunit and two lateral ones. For what concerns philtral subunit, Cupid’s bow can be particularly difficult to be recreated after a surgical excision. The vermillion border, that has the function to separate the inner surface of the lip (oral mucosa) from the surrounding skin, lies directly on a circumoral band of orbicularis oris. This is a circumferential muscle with a rich vascular supply that gives the lips their shape, definition and function. Any surgical wound of the lip can be repaired successfully in a variety of ways and the goal is always to maintain the integrity of the philtrum and the Cupid’s bow. We present the case of a 63 year-old woman with a pinkish nodule of the central portion of the upper lip, focusing on surgical reconstruction.

Surgical management of skin cancer and trauma involving the middle third of the auricle.

The main causes of acquired auricular defects are surgical treatment of skin tumors and trauma. Due to the complex anatomy of the external ear, surgical reconstruction of defects in this area is challenging for surgeons, especially in case of midhelix-antihelix involvement with significant loss of soft tissue and cartilage. Our purpose is to illustrate the main reconstructive techniques of large midhelix and antihelix defects, as well as the advantages or disadvantages associated with each surgical procedure. Primary closure/wedge technique is mainly used in elderly, multimorbid subjects where single-stage procedures are desirable, but several complex chondrocutaneous, retroauricular, temporoparietal full-thickness flap procedures can also be used to recreate an ear with normal appearance. Auricular reconstruction of large midhelix-antihelix defects requires a good knowledge of auricular anatomy and the various surgical procedures available for such defects.

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience.

Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T1N0M0 category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44years. Intraoperative mouth opening was achieved up to 48mm in OSMF followed by 42.5mm postoperatively after 2years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed. The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4cm2 of the oral cavity.

Potential Effect of Leukocyte-Platelet-Rich Fibrin in Bone Healing of Skull Base: A Pilot Study.

Background Reconstruction of surgical defects following cranial base surgery is challenging. Others have demonstrated that leukocyte-platelet-rich fibrin (L-PRF) stimulates tissue healing and bone regeneration. However, these studies have addressed mostly maxillofacial surgical wounds. Objective The objective of this study was to assess the possible adjuvant role of L-PRF in inducing neoossification of the surgical bone defect in anterior skull base surgery. Methods We identified patients who had undergone an endoscopic endonasal surgery of the anterior skull base in which L-PRF membranes were used for the reconstruction of the bone defect and who were followed up with postoperative CT scans. CT findings were then correlated with baseline scans and with the CT scans of a patient who had undergone imaging and histologic analysis after maxillofacial surgery in which L-PRF was used and in which we demonstrated bone formation. Results Five patients fulfilled the inclusion criteria. In four patients, the CT scan demonstrated closure of the bony defect by neoosteogenesis; however, the bone appeared less dense than the surrounding normal bone. A comparison with the control patient yielded similar radiological features. Conclusion This case series suggests that L-PRF may induce bone healing and regeneration at the surgical site defect. Multi-institutional studies with a larger series of patients are required to confirm this possibility.

Reconstruction of surgical defects following Cancer surgery

Reconstruction of surgical defects following Cancer surgery

Toward a skin-material interface with vacuum-integrated capped macroporous scaffolds.

Avulsion, epidermal marsupialization, and infection cause failure at the skin-material interface. A robust interface would permit implantable robotics, prosthetics, and other medical devices; reconstruction of surgical defects, and long-term access to blood vessels and body cavities. Torus-shaped cap-scaffold structures were designed to work in conjunction with negative pressure to address the three causes of failure. Six wounds were made on the backs of each of four 3-month old pigs. Four unmodified (no caps) scaffolds were implanted along with 20 cap-scaffolds. Collagen type 4 was attached to 21 implants. Negative pressure then was applied. Structures were explanted and assessed histologically at day 7 and day 28. At day 28, there was close tissue apposition to scaffolds, without detectable reactions from defensive or interfering cells. Three cap-scaffolds explanted at day 28 showed likely attachment of epidermis to the cap or cap-scaffold junction, without deeper marsupialization. The combination of toric-shaped cap-scaffolds with negative pressure appears to be an intrinsically biocompatible system, enabling a robust skin-material interface. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1307-1318, 2017.

The surface proteomic signature of a biomaterial determines its interaction with epithelial

Event Abstract Back to Event The surface proteomic signature of a biomaterial determines its interaction with epithelial Mohamed Nur Abdallah1, Sara Abdollahi2, Ghada Abughanam3, Marco Laurenti1, Yizhi Xiao4, Walter Siqueira4, Simon Tran3, Marta Cerruti2 and Faleh Tamimi1 1 McGill University, Faculty of Dentistry, Canada 2 McGill University, Department of Mining and Materials Engineering, Canada 3 McGill University, Craniofacial Tissue Engineering - Faculty of Dentistry, Canada 4 Western University, Department of Biochemistry and School of Dentistry, Canada Introduction: Surgical reconstruction of defects caused by infection, trauma or cancer relies heavily on the regeneration of the overlying epithelium and soft tissues, since they prevent bacterial penetration to deeper tissues. In fact, a main reason for the failure of craniofacial reconstructions is the lack of soft tissue regeneration. Several materials have been used for soft tissue reconstruction; however, most of them present unpredictable results and it is not well understood why some of them promote better soft tissue attachment than others. Basement membrane (BM) proteins are crucial for the interaction of epithelial cells with underlying tissues. Thus, we hypothesized that the adsorption of BM proteins on the surface of a biomaterial determines its interaction with epithelial cells. We investigated the interaction of biodegradable polymers with BM proteins and soft tissue cells (epithelial cells and fibroblasts), and optimized this interaction by surface functionalzation. Also, we developed a method to fabricate scaffolds of the optimized polymer with customized shape and porosity for epithelial and soft tissue regeneration. Materials and methods: The interaction of three biodegradable polymers (poly-DL-lactic-acid (PDLLA), alginate (ALG) and polycaprolactone (PCL)) with BM proteins was assessed using proteomic techniques such as bicinchoninic acid protein assay and liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS). Human gingival epithelial cells and dermal fibroblasts were cultured on the polymers to evaluate cell viability. The most biocompatible polymer was functionalized with amine or phosphate groups using diazonium chemistry and was assessed using the previous methods. Next, we developed a process to customize the shape and porosity of the optimized polymer. We investigated the use of flexible elastomeric materials (silicone, polyurethane and polyether) to create molds for casting the polymer. The precision and porosity of the scaffolds were enhanced using the particulate-leaching method and were assessed using micro-computed tomography.Data was analyzed using ANOVA, and Student’s t-test. Non-parametric data was evaluated using non-parametric tests. Statistical significance was set at P<0.05. Results and discussion: PDLLA adsorbed the highest amount of BM proteins, and presented the highest epithelial cell viability, while PCL showed the lowest adsorption and worst cell viability (Fig.1). Compared to PCL, both PDLLA and ALG adsorbed high amounts of proteins and demonstrated high fibroblast viability (Fig.1). Surface functionalization affected protein adsorption and cell behaviour on PDLLA. Both amination and phosphonation of PDLLA surfaces adsorbed similar amounts of BM proteins and improved the fibroblast viability; however, only aminated-PDLLA increased the concentration of adhesive proteins and enhanced the viability of epithelial cells (Fig.1). These results suggest that the adsorption of BM proteins, particularly adhesive proteins (e.g. laminin), is important for epithelial cell but not for fibroblasts. Polyether was found to be compatible with the PDLLA solvent and was used to create molds for casting scaffolds with customizable shape and porosity (Fig.2). These scaffolds could be used for soft tissue reconstruction. Conclusion: The adsorption of basement membrane proteins is critical for epithelial cell interaction with biomaterials. Surface amination promotes epithelial cell attachment by the enhancing the adsorption of adhesive basement membrane proteins. Aminated-PDLLA is a good candidate for soft tissue regeneration and can be customized using polyether molds. The Canadian Institutes of Health Research; The Natural Sciences and Engineering Research Council of Canada; The Canada Foundation for Innovation; The Network for Oral and Bone Health Research; The Canadian Imperial Bank of Commerce; The Faculty of Dentistry of McGill University

Microvascular anastomosis in oral and maxillofacial surgery

In maxillofacial surgery, head and neck reconstruction of surgical defects caused by oral cancer is considered a challenging problem. Till recently, most oral and pharyngeal defects were closed primarily using skin flaps or tubed-pedicle flaps of skin from the trunk such as forehead flap, deltopectoral flap, pectoralis major myocutaneous flap; however, these were associated with compromised aesthetic and functional results. The advent of microvascular free tissue transfer over the past two decades has helped us overcome these disadvantages and has enabled the ablative surgeon to undertake surgical procedures that could not have been attempted in the past. Innovations in the field of microsurgery have resulted in better techniques, microscopes, and microinstruments, which have made free flap harvesting much easier. This article will review the various techniques of microvascular anastomosis used in head and neck reconstruction and analyze the newer techniques and methods employed today. It also attempts to provide a brief gist of the various free flaps used in head and neck reconstruction and the ones most expedient in the surgeons' arsenal.