Temporary Prosthesis Research Articles

Técnica de fechamento progressivo na laparostomia e descompressão abdominal

É apresentada uma técnica de controle da evisceração, empregada nos casos com indicação formal de laparostomia. Através da combinação de dupla prótese temporária (tela de polipropileno e película de poliamida), realizamos o "fechamento progressivo", o qual permite a síntese primária tardia da parede abdominal, sem o risco de fístula entérica. Os resultados da primeira série de 23 pacientes (1990-1994) são comparados a outro grupo (outras técnicas de laparostomia) do mesmo hospital. A mortalidade global foi de 39,1% em nossa série, contra 55,9% quando utilizadas outras técnicas (p = 0,003), não havendo diferença entre seus índices prognósticos (Apache II). Em todos os casos em que o fechamento progressivo foi concluído (22 pacientes), a síntese primária tardia da parede abdominal foi possível, mesmo que com longos períodos de laparostomia. O emprego da técnica não aumentou o tempo de internação. A reoperação programada e o controle dos focos sépticos foram mais efetivos, com uma média de revisões de cavidade igual a 6,8 contra 1,8 no outro grupo. Nenhuma fístula e nenhuma eventração decorreram do emprego da técnica. O recente emprego da técnica na Síndrome Compartimental do Abdome tem demonstrado grande benefício para estes pacientes críticos. Os novos conceitos sobre a laparostomia trouxeram importantes mudanças quanto aos seus critérios de indicação e novas exigências quanto ao seu refinamento técnico.

Prosthetic reconstruction of the edentulous maxilla.

Presurgical planning for the treatment of the maxillary edentulous patient is followed with an entire step-by-step construction of the maxillary prosthesis. I emphasize prosthetic try-ins that ensure proper abutment placement to maximize superior aesthetics and occlusion. Techniques demonstrated will reduce both chair time and stress to the dentist and patient. Also, proper coordination with the laboratory technician frees the doctor from doing time-consuming procedures intraorally. A temporary prosthesis is constructed and used as a guide for the final prosthesis. The efficiency of the following indirect technique allows this service to reach a greater number of patients.

Healing of open stump wounds after vascular below-knee amputation: Plaster cast socket with silicone sleeve versus elastic compression

Objective: To assess the effect of a plaster cast socket on the healing of open wounds and on temporary prosthesis fitting after below-knee amputation because of arterial occlusive disease. Design: Randomized controlled trial. Setting: Rehabilitation center, university hospital. Patients: All included patients had undergone recent (in the previous 3 months) below-knee amputation because of arterial disease and initially had an open stump. Patients were randomly assigned to two groups of 28 subjects each. The sizes of the amputation scars were 8 to 24cm 2. Ischemia of the stump was eliminated as a probable cause of delayed wound healing by the inclusion criterion of transcutaneous oxygen tension (TcPo 2) of >35mmHg. The average age in group I (the experimental group) was 65.2 ± 12.4 (SD) years and in group II (the control group) 66.8 ± 10.8 years (not significant). Intervention: A plaster cast (supracondylar-type) socket was fitted on the stumps of group I patients, interposed with a silicone sleeve. The patients were gradually trained to wear this cast for up to 5 hours a day. They were provided with elastic compression bandages for the remainder of the time. Patients in group II wore elastic compression bandages, which were only removed for dressing changes. Main Outcome Measures: Time required for stump healing, length of time between amputation and ability to walk wearing a contact socket, and length of hospital stay. Results: Group I had a quicker average healing time (71.2 ± 31.7 [SD] days compared to the control group's 96.8 ± 54.9 days) and a shorter average length of hospital stay (99.8 ± 22.4 days compared to the control group's 129.9 ± 48.3 days). Conclusion: Use of a plaster cast socket leads to more rapid healing of the open stump and to a shorter hospitalization. If there is no stump ischemia, this plaster cast technique is safe.

Ecce Homo Prostheticus

In 1919 the editors of a German medical text on orthopedics allowed a glint of dark humor to sneak into an otherwise sober scientific publication. The book, published by Germany's foremost testing center for artificial limbs, is a comprehensive volume of essays on the latest developments in prosthetic technology, entitled Artificial Limbs and Work Aids for War Cripples and Accident Victims.1 It is profusely illustrated with photographs depicting new surgical procedures (such as Ferdinand Sauerbruch's painstaking method of reconstructing the musculature of a stump), the latest designs in lightweight metal prosthetic limbs, and the practical application and manipulation of these devices, dispassionately demonstrated by recent amputees. Page after page, the mutilated bodies of the human models appear all the more fragile and pliable next to the machine-like hardness and precision of their state-of-the-art prosthetic attachments. Two small photographs inconspicuously buried among the technical diagrams, however, give the therapeutic fusion of flesh and metal a strange new twist. The model here is a classical statue, a modem plaster confection with a tilted Praxitelean head, missing both arms and one leg, his genitals discreetly covered by a fig leaf. In place of the missing right leg, the figure is equipped with a temporary metal prosthesis attached to the bandaged plaster stump, leather straps around the waist and shoulder.

KONUS KURON TUTUCULU HİBRİD PROTEZ UYGULAMASI-HYBRID PROSTHESIS APPLICATION WITH CONICAL CROWN

Ozet Sunulan makalede; dikey boyut kaybi, ortulu kapanis, oligodonti, kucuk boyutlu disler, tam olarak sekillenmemis dissiz alveol kretleri ile karekterize olan ekto-dermal displazil hastaya uygulanan protetik tedavi ve iki yillik takibi aktarilmistir. Tedavi uygulamasinda oncelikle gecici bir protez araciligi ile dikey boyut saglanmistir. Vak'ada nihai protez, konus kuronlu hibrid protez olarak planlanmis ve protetik restorasyonun yapimi esnasinda uygulanan yontemler ayrintili olarak anlatilmistir. Iki yillik takip sonucu, konus kuronlu kombine protezin; uygulanan vak'ada basarili oldugu, hastaya eksik olan fonasyon fonksiyon ve estetigi sagladigi, kalan dis ve cevre dokularin devamliligini korudugu gorulmustur. Anahtar sozcukler: hibrid protez, konus kuron, ekto-dermal displazi. Abstract A patient with ectodermal dysplasia who were characterized with vertical dimension loss, over bite, oligodontia small teeth in volume and unformed alveol crests without teeth were reported in this article. The patient have undergone prosthetic therapy and the follow up period was for two years. The first step of the treatment was to regain the lost vertical dimension using a temporary prosthesis. The final prosthesis for this case has been planned as a hybrid prosthesis with conical crowns and all the methods of prosthesis fabrication were explained in detail in this case report. At the end of Uie two years follow up period we have concluded that the hybrid prosthesis with conical crowns had been successfulfor the above mentioned case and the missing phonetic, function and esthetic were regained and the protection of the left teeth and (he surrounding tissues were provided. Key words: hybrid prosthesis, conical crown, ectodermal dysplasia.

Rehabilitation of patients after hip disarticulation.

We review rehabilitation of patients after hip disarticulation operated on over the past 5 years. Sixty-two patients underwent 63 hip disarticulations: 24 had malignancies, 23 arteriosclerosis, 11 Buerger's disease, 3 diabetes and 1 uncontrollable infections. The mean age of tumour patients was 39 years (range 6-69 years), that of the vascular patients was 55 years (range 33-78 years). The postoperative mortality rate of the vascular patients was 16/37, and 0/24 of those with malignancies. There was one bilaterally operated patient with bilateral purulent coxitis from decubitus ulcers, who died on the 32nd post-operative day. Complicated wound healing was observed in 5 of the 24 tumour patients, and in 24 of the 37 vascular patients. The strategy of prostheses fitting has a two-stage concept: temporary prostheses in the 1st or 2nd month, permanent prostheses in the 6th month. All 24 tumour patients were fitted and could walk, while only 2 of 37 vascular patients were able to walk with prostheses. In our experience the outcome is significantly dependent upon the primary illness: in vascular cases it is poor, while in malignancies it is fairly good.

Impacted maxillary central incisor in mixed dentition treatment

The impacted maxillary central incisor in a child poses a disturbing esthetic dilemma to parents, by virtue of its location. Neither the orthodontist nor the parents prefer to wait for the fully erupted permanent dentition and comprehensive orthodontics to resolve this problem. This challenge can be met in the early mixed dentition stage, as described with these two cases. The response to the technique was excellent. The patients now possess confidence to smile and have enhanced self-esteem, which is critical even in early life. Just as important is that the newly positioned maxillary central incisor is the natural tooth, not a temporary prosthesis that can loosen or break. Gingival contour is a consideration, however.

Temporary prosthesis for laryngotracheal stenosis: A clinical report

Clinical and laboratory procedures to fabricate a transitional prosthesis for patients treated with laryngofissure surgery have been described. Hard resin promoted healing of the surgical area and maintained the opening because of its stiffness. The prosthesis, which can be highly polished, was easily removed by the patient for proper hygiene and was fabricated to accurately fit the inside margins of the wound. All these factors were important for a good clinical result.

Proper Time for Definitive Transtibial Prosthetic Fitting

The authors examined postoperative volume changes of residual limbs to identify the proper time for definitive transtibial prosthetic fitting (the point in time at which the residual-limb volume has stabilized). The number of stockings in the socket was used as a criterion for good or bad prosthetic fitting. Residual-limb volume changes of 11 transtibial amputees were followed for approximately 160 days. The volume was determined by laser scanning with the CAPOD® system. The authors found the volume changes could be characterized by a simple power function. The range of volume reduction after 160 days was 17 percent to 35 percent. Using a two-stocking criterion (10-percent reduction of volume), the criterion was fulfilled by all patients at 100 days postamputation; with a one-stocking criterion (5-percent reduction of volume), the criterion was fulfilled by 120 days postamputation. From these data, the authors recommend fitting with a temporary prosthesis as early as possible, and the change to a definitive prosthesis should occur four months postoperatively.

Historical review of temporary prostheses

Historical review of temporary prostheses

Temporary prostheses distribution system

Temporary prostheses distribution system

Problems regarding the present Japanese pricing system for temporary prostheses

Problems regarding the present Japanese pricing system for temporary prostheses

Standard pricing of temporary prostheses and technical aids

Standard pricing of temporary prostheses and technical aids

Urethral prostheses. An overview

The first report in Literature dealing with an endourethral prosthesis in the treatment of recurrent bulbar strictures dates back to 1988. Since then other prostheses with different design and materials have been proposed. The Urolume by A.M.S., the first ever, is used worldwide and its indications are better known due to a longer follow-up time. In 6 months epithelium covers the prosthesis and it is generally well tolerated, but some Authors do not agree with its use in the treatment of traumatic strictures. Titanium prostheses have been used in few cases. A temporary steel alloy prosthesis, the Urocoil, has been proposed recently. Not enough follow-up data are available about this and the new “thermic memory” prosthesis. The bigdegradable prosthesis, used till now only on rabbits, actually represents the new frontier in the treatment of urethral strictures.

Orbitaimplantate aus korallinem Hydroxylapatit als Bulbusersatz nach Enukleation

BACKGROUND During the last two decades, hydroxyapatite has become popular as alloplastic material for bone replacement in orthopedic and dental surgery. We investigated prospectively the feasibility of hydroxyapatite spheres as replacement of enucleated eyes. PATIENTS AND METHODS Thirty-three consecutive patients entered a prospective study designed to evaluate the results obtained after either primary (n = 26) or secondary (n = 7) implantation of a hydroxyapatite sphere as replacement of the enucleated eyeball. Each patient was examined preoperatively, 1, 2, and 4 months after surgery, as well as every 6 months thereafter. At each examination time the motility of both coralline sphere and overlying cosmetic prosthesis was evaluated and the conjunctival sac was carefully examined at the slit-lamp. RESULTS The postoperative follow-up averaged 10.5 months for the primary implantations and 7.2 months for the secondary implantations. Two implants had to be removed because of infection unresponsive to antibiotic treatment. Defects in the conjunctiva overlying the implant necessitated wound revision in two cases. A buccal mucosal graft was performed in two additional ones. A temporary cosmetic prosthesis could be fitted in all but two of the remaining patients as early as 3 weeks after surgery. Motility of at least 3 mm in all directions could be obtained in 31 cases. CONCLUSION Our study demonstrated that satisfactory motility and good biocompatibility can be achieved, at least in the medium term, with implantation of coralline hydroxyapatite spheres.

EFFECT OF AGE ON PROGRESSION THROUGH TEMPORARY PROSTHESES AFTER BELOW-KNEE AMPUTATION1

Forty six patients that underwent below knee amputation for diabetes, trauma/osteomyelitis or peripheral vascular disease were studied. Healing was estimated by the rate of progression through temporary prostheses as determined weekly by the amputee rehabilitation team (physiatrist, orthopedist, physical therapist, nurse, and prosthetist). For all groups combined, mean days +/- standard error from amputation to above knee cast with pylon and foot (AKPy) were 22.9 +/- 1.9, to below knee cast with pylon and foot (BKPy) 41.6 +/- 2.8 and to laminated temporary prostheses 66.5 +/- 4.5. A regression analysis of these variables on age (range: 29 to 84 yr) showed significant positive correlations for AKPy (r = 0.34, P = 0.0214) and BKPy (r = 0.40, P = 0.0056). An analysis of variance with contrasts (Tukey's protected t) showed significant lower values (P < 0.05) for amputation to BKPy in the trauma/osteomyelitis group when compared to diabetes or peripheral vascular disease and no difference among the last two groups. However, when variables were adjusted for age (analysis of covariance with age as a covariate), the differences among groups disappeared (covariance F(2,44) = 0.9, P > 0.4). In conclusion, age, not the cause of the amputation, correlated with healing after below knee amputation as estimated by the rate of progression through temporary prostheses.

Conversion of an Existing Complete Denture to a Temporary Obturator Prosthesis

With the advent of light-cured materials, many new opportunities for reconstruction present themselves. This brief article describes the technique for converting an existing complete denture into a temporary obturator prosthesis. This can be done chairside with minimal patient discomfort and anxiety.

Updating upper extremity temporary prosthesis: thermoplastics.

Since 1989 amputees with upper-extremity burns have been fitted with a temporary prosthesis fabricated from low-temperature thermoplastic. Before 1989 conventional temporary prostheses were fabricated with plaster. The use of the thermoplastic material has produced a lightweight, cost-effective, modular system. No patients exhibited skin breakdown with the thermoplastic material. It appears that thermoplastics may be the next major breakthrough in terms of a design for a temporary upper-extremity prosthesis.

Delivery system of Temporary Prosthesis

Delivery system of Temporary Prosthesis

Use of Immediate Postoperative Mastectomy Prostheses

From materials readily available in the operating room, a temporary breast prosthesis can be fashioned for use in the immediate postoperative period. These materials yield a prosthesis with good shape and form, filling a brassiere cup and providing the general pressure needed on skin flaps in the immediate postoperative period. Psychologically, filling the absent breast cup helps patients adjust to their new body image and eliminates the shock of gross asymmetry.