Technique For Repair Of Defects Research Articles

Spondylolysis and pars repair technique: A comprehensive literature review of the current concepts

Spondylolysis is an important cause of low back pain in children and adolescents, especially in those involved in athletic activities. Spondylolysis is caused either by a fracture or by a defect in the pars inter-articularis and can be unilateral or bilateral. Among the various hypotheses regarding the etiopathogenesis of pars lysis, the occurrence of chronic micro-fractures secondary to repetitive extension and rotational stresses across pars remains the most convincing explanation to date. The majority of these patients remain asymptomatic. Imaging contributes to the staging and prognostication of the lesions, planning the line of management, and monitoring the response to treatment. Nonoperative treatment with activity restriction, braces, graded physiotherapy, and rehabilitation forms the cornerstone of management. Surgery is indicated in a specific cohort of patients whose symptoms persist despite an adequate conservative trial and includes spinal fusion and pars defect repair techniques. Patients who demonstrate good pain relief after diagnostic pars infiltration can be considered for pars repair. Patients aged ≤25 years, those with an athletic background, unilateral pathologies, and those without associated spondylolisthesis, instability, or disc degeneration are ideal candidates for pars repair. The overall outcome in spondylolysis is good, and 85% to 90% of athletes return to sports at 6 months following conservative or surgical line of treatment. In this current narrative review, we comprehensively discuss the etiology, patho-anatomy, natural history, clinical features, diagnostic modalities, and management of spondylolysis with special emphasis on direct repair techniques of pars.

Ultraviolet laser ablation as technique for defect repair of GaN-based light-emitting diodes

Defect repair of GaN-based light-emitting diodes (LEDs) by ultraviolet laser micromachining is reported. Percussion and helical drilling in GaN by laser ablation were investigated using 248 nm nanosecond and 355 nm picosecond pulses. The influence of laser ablation including different laser parameters on electrical and optical properties of GaN-based LED chips was evaluated. The results for LEDs on sapphire with transparent conductive oxide p-type contact on top as well as for thin-film LEDs are reported. A reduction of leakage current by up to six orders in magnitude and homogeneous luminance distribution after proper laser defect treatment were achieved.

Defect size analysis approach combined with silicate gel/ceramic particles for defect repair of Pd composite membranes

Pd composite membranes show great potential in several important fields, such as high-purity H2 separation and production, due to unique permeability to hydrogen and its isotopes. However, the significant defect formation on palladium membranes and following decline in H2 selectivity resulted from either preparation process or thermal/chemical stability issues exist as a great challenge for their commercial applications. The currently existing techniques for defect repair of Pd composite membranes show either high complexity or limited effect thus limiting their practical applications. In this study, we presented a novel approach, i.e., strongly adhesive and high temperature resistant silicate gel (HTRSG)/ceramic particles, in combination with home-developed “modified” liquid–liquid displacement porometry (MLLDP) for defect size distribution analysis, where the latter can provide important guidance for the selection of appropriate particles sizes. The experimental results with thin Pd membranes indicated significant improvement in H2 permselectivity without decreasing H2 permeance after defect repair treatment. Moreover, silicate gel exhibits great durability under high temperature conditions. This approach features high simplicity, effectiveness and low cost, and is especially suitable for on-site repair of spent membranes in future applications. In addition, it is universal for defect repair of other inorganic membranes, and can also be used for the sealing of membrane modules.

The Wave Flap

Reconstruction of defects straddling the alar groove presents the dual challenges of resurfacing the nasal sidewall and alar subunits while simultaneously recreating the alar groove. The wave flap (WF) is a modified, medially based, nasal sidewall rotation flap that uses locally recruited tissue from the nasal sidewall to facilitate color and texture match and permit camouflage of scars. To detail a surgical repair for defects in the horizontally oriented middle third of the alar groove. This retrospective case series describes a technique for repair of defects involving the alar groove. Using postoperative photographs, outcomes were assessed by blinded noninvestigator dermatologist raters using the Observer Scar Assessment Scale. Between February 2012 and June 2013, 10 patients were reconstructed using a WF design. Subjective assessment of scar vascularity, pigment, pliability, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 11.1 (out of 50). No complications were noted. The WF provides an excellent reconstructive option for Mohs defects of the middle third of the alar groove by recruiting local tissue and permitting maximum scar camouflage. A well-designed and executed WF provides cosmetically exceptional results for defects of the alar groove.

Stein's Double Cross-Lip Flaps Combined with Johanson's Step Technique for Subtotal Lower Lip Reconstruction.

In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson's step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster-related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson's step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction.

312: Initial results of a novel fetoscopic neural tube defect repair technique versus open fetal surgery

312: Initial results of a novel fetoscopic neural tube defect repair technique versus open fetal surgery

Design of an Endonasal Graft Placement Tool for Repair of Skull Base Defects

Poor tools lead to dropped gra7s, decreased surgeon confidence, increased opera<ng <me Forceps: • cannot reliably open and close in 6ght spaces • good grip • poor force applica6on Blunt Tools: • good force applica6on • poor grip • difficulty handling varying gra: size, shape, rigidity Endonasal Approach • Minimally invasive • Limited tool manipulability • Gra: placement can add up to 30 minutes Inadequate Gra7 Placement Complica<ons • CSF leaks that lead to meningi6s, brain hemorrhage, neurological deficits, or death1

The War of Jenkins’ Ear

In 1731, Spanish sailors boarded the British brig Rebecca off the coast of Cuba and sliced off the left ear of its captain, Robert Jenkins. This traumatic auriculectomy was used as a pretext by the British to declare war on Spain in 1739, a conflict that is now known as the War of Jenkins' Ear. Here, we examine the techniques available for auricular repair at the time of Jenkins' injury and relate them to the historical events surrounding the incident. Review of relevant original published manuscripts and monographs. Surgeons in the mid-18th century did not have experience with repair of traumatic total auriculectomies. Some contemporary surgeons favored auricular prostheses over surgical treatment. METHODS for the reconstruction of partial defects were available, and most authors advocated a local post-auricular flap instead of a free tissue transfer. Techniques for repair of defects of the auricle lagged behind those for repair of the nose. Limitations in care of traumatic auricular defects may have intensified the significance of Jenkins' injury and helped lead to the War of Jenkins' Ear, but conflict between Britain and Spain was probably unavoidable because of their conflicting commercial interests in the Caribbean.

Fusiform Elliptical Burow's Graft: A Simple and Practical Esthetic Approach for Nasal Tip Reconstruction

Reconstruction of cutaneous nasal tip and supratip defects presents a common challenge in which esthetic outcomes are dependent on appropriate flap or graft selection and execution. We describe the fusiform elliptical Burow's graft, a modified full-thickness skin graft, for repair of moderately sized nasal tip and supratip defects. It has the advantage of being a one-stage procedure with incisions and undermining similar to a primary closure. This technique allows the defect to become smaller in size and shallower in depth while taking the shape of a fusiform ellipse confined to a single cosmetic subunit. The color and texture match of the adjacent Burow's skin graft combined with its fusiform elliptical shape allow it to blend in more naturally with the nasal tip contour compared with the traditional circular-shaped Burow's graft, which is typically used on the nose. The fusiform elliptical Burow's graft is a simple, reliable, easily reproducible, and esthetically pleasing technique for repair of defects on the nasal tip and supratip.

Fusiform Elliptical Burowʼs Graft

BACKGROUND Reconstruction of cutaneous nasal tip and supratip defects presents a common challenge in which esthetic outcomes are dependent on appropriate flap or graft selection and execution. OBSERVATION We describe the fusiform elliptical Burow's graft, a modified full-thickness skin graft, for repair of moderately sized nasal tip and supratip defects. It has the advantage of being a one-stage procedure with incisions and undermining similar to a primary closure. This technique allows the defect to become smaller in size and shallower in depth while taking the shape of a fusiform ellipse confined to a single cosmetic subunit. The color and texture match of the adjacent Burow's skin graft combined with its fusiform elliptical shape allow it to blend in more naturally with the nasal tip contour compared with the traditional circular-shaped Burow's graft, which is typically used on the nose. CONCLUSION The fusiform elliptical Burow's graft is a simple, reliable, easily reproducible, and esthetically pleasing technique for repair of defects on the nasal tip and supratip.

Biomechanical Testing of Pars Defect Repairs

Human lumbar vertebral bodies were used to biomechanically test three different pars interarticularis defect repair techniques. A posteriorly directed force was applied to the inferior facets so that a bending moment was created across the pars. The stiffness and strength of each type of repair was measured and compared with the intact values. The Buck screw provided both the stiffest and strongest repair overall and within each group of cadaveric specimens. This was followed by the Morscher hook screw. Both the screw and hook repair were statistically significantly stronger and stiffer than the wire repair. There was no statistical difference between the screw and hook repairs regarding strength or stiffness. Using the intact L1 vertebral body as a control for each cadaver, the three surgical techniques for pars repair could be evaluated. The screw repair provided 64% of the intact stiffness and 58% of the intact strength. The hook repair provided an average of 52% of the intact stiffness and 40% of the intact strength. The wire provided only 3.5% of the intact stiffness and 12% of the intact strength. The screw repair technique is the stiffest and strongest pars repair method. The wire technique restores the least stiffness and strength.

Biomechanical Testing of Pars Defect Repairs

Study Design Human lumbar vertebral bodies were used to biomechanically test three different pars interarticularis defect repair techniques. A posteriorly directed force was applied to the inferior facets so that a bending moment was created across teh pars. Objectives The stiffness and strength of each type of repair was measured and compared with the intact values. Summary of Background Data The Buck screw provided both the stiffest and strongest repair overall and within each group of cadaveric specimens. This was followed by the Morscher hook screw. Both the screw and hook repair were statistically significantly stronger and stiffer than the wire repair. There was no statistical difference between the screw and hook repairs regarding strength or stiffness. Methods Using the intact L1 vertebral body as a control for each cadaver, the three surgical techniques for pars repair could be evaluated. Results The screw repair provided 64% of the intact stiffness and 58% of the intact strength. The hook repair provided an average of 52% of the intact stiffness and 40% of the intact strength. The wire provided only 3.5% of the intact stiffness and 12% of the intact strength. Conclusions The screw repair technique is the stiffest and strongest pars repair method. The wire technique restores the least stiffness and strength.

Use of skin flaps in dermatologic surgery of the face.

Different flap techniques for plastic repair of defects are described, namely, local flaps (advancement, transposition and rotation flaps) and regional flaps. Such use of skin of similar structure and pigmentation gives excellent cosmetic results. The indications for using local or regional flaps depends on size and location of the defect. Total extirpation of cutaneous malignancy particularly by microscopically monitored serial excision is a prerequisite to reconstruction.