Tissue Thickness Research Articles

Impact of saflufenacil and glyphosate-based herbicides on the morphoanatomical and development of Enterolobium contortisiliquum (Vell.) Morong (Fabaceae): new insights into a non-target tropical tree species.

The unregulated use and improper management of herbicides can cause negative effects on non-target species and promote changes in biological communities. Therefore, the current study is aimed at understanding morphoanatomical responses and effects on seedling development induced by the herbicides glyphosate and saflufenacil in Enterolobium contortisiliquum, a non-target tropical species. The plants were cultivated in a greenhouse and subjected to herbicides at doses of 0, 160, 480, and 1440g a.e ha-1 for glyphosate, and 0, 25, 50, and 100g a.i ha-1 for saflufenacil. We conducted visual and morphological assessments over 90days post-application. Leaf samples were collected 12days after the application for anatomical analysis, and we also performed a micromorphometric analysis of the leaf tissues. Biomarkers of phytotoxicity were identified in plants exposed to both herbicides, even at the lowest doses, including in leaves without visual symptoms. The main morphological alterations were the decrease in growth, stem diameter, and dry mass. Furthermore, the leaves and stems visually exhibited chlorosis and necrosis. Both herbicides triggered anatomical modifications such as significant changes (p < 0.05) in the thickness of leaf tissues, hypertrophy, cell collapse, and changes in epicuticular waxes. However, the alterations induced by glyphosate were more widespread compared to saflufenacil, encompassing alterations in the root system. We confirmed that the different mechanisms of action of each herbicide and the existence of an underground reserve system in this species are intrinsically linked to the morphological and developmental responses described. Our findings suggest that E. contortisiliquum could be a potential bioindicator species for these herbicides in the environment, even at concentrations lower than those typically recommended for field application.

GRHL2 regulates keratinocyte EMT-MET dynamics and scar formation during cutaneous wound healing

After cutaneous wounds successfully heal, keratinocytes that underwent the epithelial-mesenchymal transition (EMT) regain their epithelial characteristics, while in scar tissue, epidermal cells persist in a mesenchymal state. However, the regulatory mechanisms governing this reversion are poorly understood, and the impact of persistent mesenchymal-like epidermal cells in scar tissue remains unclear. In the present study, we found that during wound healing, the regulatory factor GRHL2 is highly expressed in normal epidermal cells, downregulated in EMT epidermal cells, and upregulated again during the process of mesenchymal-epithelial transition (MET). We further demonstrated that interfering with GRHL2 expression in epidermal cells can effectively induce the EMT. Conversely, the overexpression of GRHL2 in EMT epidermal cells resulted in partial reversion of the EMT to an epithelial state. To investigate the effects of failed MET in epidermal cells on skin wound healing, we interfered with GRHL2 expression in epidermal cells surrounding the cutaneous wound. The results demonstrated that the persistence of epidermal cells in the mesenchymal state promoted fibrosis in scar tissue, manifested by increased thickness of scar tissue, deposition of collagen and fibronectin, as well as the activation of myofibroblasts. Furthermore, the miR-200s/Zeb1 axis was perturbed in GRHL2 knockdown keratinocytes, and transfection with miR-200s analogs promoted the reversion of EMT in epidermal cells, which indicates that they mediate the EMT process in keratinocytes. These results suggest that restoration of the epithelial state in epidermal cells following the EMT is essential to wound healing, providing potential therapeutic targets for preventing scar formation.

Fabrication of endothelialized capillary-like microchannel networks using sacrificial thermoresponsive microfibers.

In the body, capillary beds fulfill the metabolic needs of cells by acting as the sites of diffusive transport for vital gasses and nutrients. In artificial tissues, replicating the scale and complexity of these capillary vessels has proved challenging, especially in a three-dimensional context. In order to better develop thick artificial tissues, it will be necessary to recreate both the form and function of capillaries. Here we demonstrate a top-down method of patterning hydrogels using sacrificial templates formed from thermoresponsive microfibers whose size and architecture approach those of natural capillaries. Within the resulting microchannels, we cultured endothelial monolayers that remain viable for over three weeks and exhibited functional barrier properties. Additionally, we cultured endothelialized microchannels within hydrogels containing fibroblasts and characterized the viability of the co-cultures to demonstrate this approach's potential to when applied to cell-laden hydrogels. This method represents a step forward in the evolution of artificial tissues and a path towards producing viable capillary-scale microvasculature for engineered organs.

The Effect of Platelet Fibrin Plasma (PFP) on Postoperative Refractory Wounds: Physiologically Concentrated Platelet Plasma in Wound Repair.

Surgical wounds that can't complete primary healing three weeks after surgery are called postoperative refractory wounds. Postoperative refractory wounds would bring great physical and life burdens to the patients and seriously affect their quality of life. To investigate the effect of platelet fibrin plasma (PFP) on postoperative refractory wound healing. The composition of PFP was analyzed using blood routine and blood biochemicals. Clinical data were collected that met the inclusion criteria after treatment with PFP, and the efficacy of PFP was evaluated by wound healing rate and days to healing. Next, growth factor content in PFP, PRP, and PPP was analyzed using ELISA, and PFP-treated cells were applied to investigate the effect of PFP on fibroblast and endothelial cell function. PFP component analysis revealed no statistical difference between platelet concentration in PFP and physiological concentration. Clinical statistics showed that PFP treatment was effective in the postoperative refractory wound (four-week wound healing rate > 90%), significantly better than continuous wound dressing. Meanwhile, our result also proved that PFP treatment significantly enhanced vascularization by upregulated the expression level of CD31 and improved granulation tissue thickness. Activated PFP, PRP, and PPP could continuously release growth factors in vitro and the amount of growth factors released by PRP and PFP was significantly higher than PPP. In vitro studies demonstrated that active PFP could improve cell proliferation, migration, adhesion, and angiogenesis in fibroblasts and endothelial cells. Physiologically concentrated platelet plasma promoted wound healing and improved related cellular functions. The modified PFP (responsible for accelerating wound healing and enhancing the migration and proliferation of fibroblasts and endothelial cells) was prepared and analyzed for its clinical effectiveness in postoperative refractory wounds. Physiologically concentrated platelet plasma promoted wound healing and improved related cellular functions. The preparation of PFP could significantly reduce the amount of prepared blood, with a good application value for postoperative wounds. PFP can be considered a treatment option, especially for postoperative refractory wounds.

Relationship between soft tissue envelope thickness of the lower extremity and acute periprosthetic joint infection of the knee.

The prevalence of obesity is increasing worldwide and it is known to be associated with many postoperative complications, including infection. Patients' body fat distribution may vary and body mass index (BMI) does not provide sufficient information about adipose tissue thickness of the lower extremities. The aim of this study is to investigate the relationship between thigh diameters and early postoperative prosthesis-related joint infections (PJI) in patients who underwent arthroplasty. The study included 76 patients and 114 knees who were operated on by a single surgeon and underwent total knee arthroplasty (TKA) due to primary knee osteoarthritis between May 2022 and September 2023 in a tertiary reference hospital. Circumference of the thickest part of the operated thigh (cm), preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, height, weight, BMI and the presence of early postoperative prosthesis-related joint infections were evaluated. The mean BMI was 32.6 ± 4.2 (kg/m2). Two (2.6%) were normal weight, 14 (18.5%) were overweight, 58 (76.3%) were obese and 2 (2.6%) were morbidly obese. The mean circumference of the thickest part of the thigh was 57.56 ± 6.38 (cm). 6 patients were diagnosed with PJI in the acute phase. The mean circumference of the thickest part of the thigh was statistically significantly greater in the group with acute PJI compared to the group without PJI (p = 0.048). The incidence of acute PJI was found to be significantly higher in patients with larger thigh diameters, whereas no such relationship was observed for BMI. The incorporation of preoperative soft tissue envelope measurements into routine clinical examination may prove beneficial in reducing the risk of PJI.

3D Bioprinting of Thick Adipose Tissues with Integrated Vascular Hierarchies

AbstractEngineering functional, thick tissues with integrated vascular architectures is crucial for advancing regenerative medicine. This study applied a novel 3D bioprinting strategy to construct thick adipose tissues featuring complex, hierarchical vascular networks. Mature adipocytes and endothelial cells are encapsulated within a collagen matrix, with structural integrity and vascular functionality ensured through a combination of bioinks. An innovative approach is utilized to establish millimetric vascular channels that connect to microvascular networks, forming a fully perfusable, hierarchical vasculature throughout the 3D bioprinted tissue. The structural stability and endothelial functionality of the vascularized constructs are assessed under continuous flow. In‐vitro analyses confirmed the integrity of the vascular networks and demonstrated the functional characteristics of the printed mature adipose cells. Direct anastomosis of the bioprinted tissue to a rat femoral artery resulted in effective vascular integration and tissue viability, as evidenced by efficient blood perfusion and significant host vascular ingrowth within the implanted tissues. The findings highlighted the potential of the presented bioprinting technique in the development of fully functional, vascularized adipose tissues suitable for surgical reconstruction and regenerative medicine applications.

Ex vivo fluorescence-guided resection margin assessment in breast cancer surgery using a topically applied, cathepsin-activatable imaging agent

Up to 40 % of breast cancer patients have a tumor-positive resection margin (TPRM) – defined as cancer cells at the surface of the resected specimen – after breast-conserving surgery (BCS), necessitating re-resection or boost radiation. To prevent these additional treatments, intraoperative near-infrared (NIR) fluorescence imaging with the topically applied, cathepsin-activatable imaging agent AKRO-6qcICG might be used to detect TPRMs and guide additional resection. Here, to validate its performance, the agent is topically applied to all surfaces of freshly resected breast cancer specimens (n = 11 patients) and to 3–5 mm thick tissue slices of the specimens (n = 26 patients). NIR fluorescence images of the resection surfaces and tissue slices are acquired and correlated to final histopathology. AKRO-6qcICG detects TPRMs with a sensitivity, specificity, PVV, and NPV of 100 %, 67 %, 10 %, and 100 %, respectively. On the tissue slices, the fluorescence signal has a median tumor-to-background ratio of 1.8. These findings indicate that topically applied AKRO-6qcICG can visualize TPRMs ex vivo with a high sensitivity and NPV, with sufficient contrast to adjacent healthy breast tissue.

Palette‐based colour normalization for histopathology images

AbstractWith the emergence of computer‐aided diagnostic (CAD) systems, the speed of histopathological image analysis and the accuracy of cancer detection have considerably improved. However, the appearance of histopathological slides can vary depending on the consistency of tissue thickness, stain concentrations, and equipment, thus affecting the judgment of CAD systems. This study proposes a palette‐based colour normalization method for histopathology images is proposed to solve the problem of colour differences between histopathology images. The method builds a graphical user interface based on an improved palette generation algorithm and colour transfer definitions, through which the user can complete the corresponding colour modification to achieve colour normalization. The evaluation of the metrics on histopathological images shows that our method is able to achieve higher image quality and better preservation of structural information of the source image compared with four other colour normalization algorithms. The peak signal‐to‐noise ratio values obtained by the proposed method on two publicly available datasets were 24.1914 and 21.3666, and the structural similarity index matrix values were 0.9871 and 0.9760. The proposed method provides new ideas for the development and design of CAD systems.

Anthropological and forensic significance of facial soft tissue thickness in Montenegrin population

A lack of soft tissue leads to difficulties in facial reconstruction and further identification in the absence of DNA (deoxyribonucleic acid), finger print and dental data. If these data are not available, then identification based on facial soft tissue thickness (FSTT) is the next reliable method. There is no data in the literature about facial soft tissue thickness in Montenegrin population. Once the measurement is performed, a software algorithm based on the multidetector computerized tomography (MDCT) imaged bone structures and use of FSTT would be able to provide a useful picture of the face for identification purposes. This prospective research was performed by MDCT head examinations of 83 adults aged 18–85, living in Montenegro. The FSTT was measured at eight central points (glabella (GL), nasion (NA), rhinion (RHI), mid-philtrum (MID), upper lip (UL), lower lip (LL), mental eminence (ME), and the point beneath the chin (BC)), and five bilateral points (frontal tubers (FT), supraorbital (SO), external orbital marginal point (EX), zygomatic arch (ZY), and middle masseter (MST)). It was observed that the points RHI, MID, UL, LL, ME, FT, SO and MST are thicker in men compared to women. With an increase in BMI, FSTT in the central points also increases, as well as bilaterally at the ZY, FT, SO and MST points. With aging, there is an increase of the thickness of the FSTT at the RHI and bilaterally at the EX and ZY, while at the MID, LL and MST, the thickness decreases with aging, in both sexes.

New Insight for Enhanced Topical Targeting of Caffeine for Effective Cellulite Treatment: In Vitro Characterization, Permeation Studies, and Histological Evaluation in Rats

Cellulite (CLT) is one of the commonly known lipodystrophy syndromes affecting post-adolescent women worldwide. It is topographically characterized by an orange-peel, dimpled skin appearance hence, it is an unacceptable cosmetic problem. CLT can be modulated by surgical procedures such as; liposuction and mesotherapy. But, these options are invasive, expensive and risky. For these reasons, topical CLT treatments are more preferred. Caffeine (CA), is a natural alkaloid that is well-known for its prominent anti-cellulite effects. However, its hydrophilicity hinders its cutaneous permeation. Therefore, in the present study CA was loaded into solid lipid nanoparticles (SLNs) by high shear homogenization/ultrasonication. CA-SLNs were prepared using Compritol® 888 ATO and stearic acid as solid lipids, and span 60 and brij™35, as lipid dispersion stabilizing agents. Formulation variables were adjusted to obtain entrapment efficiency (EE > 75%), particle size (PS < 350 nm), zeta potential (ZP < −25 mV) and polydispersity index (PDI < 0.5). CA-SLN-4 was selected and showed maximized EE (92.03 ± 0.16%), minimized PS (232.7 ± 1.90 nm), and optimum ZP (−25.15 ± 0.65 mV) and PDI values (0.24 ± 0.02). CA-SLN-4 showed superior CA release (99.44 ± 0.36%) compared to the rest CA-SLNs at 1 h. TEM analysis showed spherical, nanosized CA-SLN-4 vesicles. Con-LSM analysis showed successful CA-SLN-4 permeation transepidermally and via shunt diffusion. CA-SLN-4 incorporated into Noveon AA−1® hydrogel (CA-SLN-Ngel) showed accepted physical/rheological properties, and in vitro release profile. Histological studies showed that CA-SLN-Ngel significantly reduced mean subcutaneous fat tissue (SFT) thickness with 4.66 fold (p = 0.035) and 4.16 fold (p = 0.0001) compared to CA-gel, at 7th and 21st days, respectively. Also, significant mean SFT thickness reduction was observed compared to untreated group with 4.83 fold (p = 0.0005) and 3.83 fold (p = 0.0043), at 7th and 21st days, respectively. This study opened new avenue for CA skin delivery via advocating the importance of skin appendages. Hence, CA-SLN-Ngel could be a promising nanocosmeceutical gel for effective CLT treatment.Graphical

Examining the Safety of Dorsogluteal and Ventrogluteal Sites for Intramuscular Injection in Older Adults.

Muscle, subcutaneous tissue and total tissue thicknesses are important factors in successful intramuscular injection. Muscle mass decreases and subcutaneous tissue increases with age. This may negatively affect the safety and effectiveness of intramuscular injection in older adults by increasing the risk of bone contact and subcutaneous drug administration. Intramuscular injection sites should be evaluated in this respect, but no previous study has evaluated the most appropriate sites for safe and effective intramuscular injection in older adults. This study aimed to examine the safety of dorsogluteal and ventrogluteal injection sites in older adults. This cross-sectional study included 171 older adults who presented to the radiology clinic of a hospital between November 2022 and February 2023. We collected the study data using a descriptive characteristics form and an ultrasonographic measurement form. To complete the descriptive characteristics form, we interviewed the participants and measured their waist circumference, hip circumference, weight and height. Muscle, subcutaneous tissue and total tissue thicknesses at the ventrogluteal and dorsogluteal sites were determined by ultrasonography. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. At the ventrogluteal and dorsogluteal sites, respectively, total tissue thicknesses were 59.43 ± 11.21 and 48.78 ± 9.68 mm, subcutaneous tissue thicknesses were 20.07 ± 6.64 and 22.97 ± 7.40 mm and muscle thicknesses were 40.13 ± 5.59 and 25.61 ± 4.30 mm. Tissue thicknesses at both sites differed according to sex, weight, hip circumference and waist circumference (p < 0.05). Although both sites were acceptable according to the tissue thickness thresholds for intramuscular injection given in the literature (subcutaneous tissue < 25 mm, total tissue > 35 mm), the ventrogluteal site was more advantageous in terms of greater muscle thickness and lower subcutaneous tissue thickness. The results of this study indicated that both the ventrogluteal and dorsogluteal sites are safe for intramuscular injections in older adults in terms of tissue thickness. However, the ventrogluteal site may be safer for older adults because of the lower risk of bone contact and subcutaneous injection. Further studies are needed on this subject. This study is important in terms of determining the safe and effective gluteal site for IM injection in older people aged 65 and over, preventing complications that may arise from site selection, and developing nursing policies that consider older people as a special group in the selection of IM injection sites.

Temporal Augmentation Effect of Reduction Malarplasty: Application of our Bracing Technique with Zygomatic Arch Elevation.

A broad midface is usually accompanied by temporal depression. Traditional reduction malarplasty may visually improve the temporal depression by the inward reduction of zygomatic arch, but also has a high risk of soft tissue sagging. Our bracing technique has been reported to have an anti-sagging effect and may have a temporal augmentation effect as observed during our long-term clinical practice. Data of patients who received reduction malarplasty with our bracing technique from September 2015 to July 2023 were retrospectively collected. The pre-op and post-op CT images of those who met the inclusion criteria were used for three-dimensional reconstruction and measurements of the thickness and volume of the temporal soft tissue as well as the elevation distance of zygomatic arch. Fifty-eight patients with an average follow-up of 18.4 ± 9.1months were included. Despite mild thinning of the temporalis muscle after reduction malarplasty, the overall thickness of the temporal soft tissue significantly increased due to the significant thickening of the temporal adipose-fascial layer. There was a 0.5ml-increase in the temporal volume although without statistical difference. No significant correlation was detected between the elevation distance of zygomatic arch and the temporal thickness or volume change. The bracing technique of reduction malarplasty not only plays an anti-sagging role, but also has a temporal augmentation effect through the superior bracing by the elevation and rigid fixation of the zygomatic arch. It adds brilliance to the traditional technique and can be suggested especially when the patients are disturbed by temporal depression. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical Responses of Two Species under Controlled Water Restriction.

Quillay (Quillaja saponaria Molina) and peumo (Cryptocarya alba [Molina] Looser) are two tree species endemic to Chile that grow in Mediterranean climate zones, characterized by a summer season with high temperatures, high solar radiation, and low soil water availability. A study was conducted with 2-year-old Q. saponaria and C. alba plants and two substrate water conditions: well-watered and controlled water restriction. At the end of the study, anatomical leaf modifications were analyzed. The tissues were anatomically described in transverse sections of juvenile and adult leaves, measuring leaf thickness, cuticle thickness, and cell density of the mesophyll parenchymal tissues. In the young leaves of Q. saponaria plants undergoing water restriction treatment, an increase in cuticle and leaf thickness and a decrease in the density of the palisade and spongy parenchyma were observed. In contrast, a significant reduction in leaf thickness was observed in adult leaves of both species with water restriction treatment. The anatomical changes in the leaves of Q. saponaria and C. alba suggest an adaptation to adverse environmental conditions, such as water restriction.

The Efficacy of Leukocyte-Platelet-Rich Fibrin in Combination with Sub-Epithelial Connective Tissue Graft in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial

Aims and Background The aim of the current study is to assess and compare the efficacy of the leukocyte-platelet-rich fibrin [L-PRF] in combination with sub-epithelial connective tissue graft [SCTG] and SCTG only in promoting aesthetic results and strengthening the state of the soft tissue surrounding implants. Materials and Methods A parallel-arm randomized controlled clinical trial was used for this investigation. A total of 120 patients who had missing teeth with a thin gingival biotype [less than 1.5 mm] were included in this study. The patients of Group I were treated with PRF and SCTG during second-stage implant surgery, while the patients of Group II were treated with SCTG only. Treatment outcomes included the assessment of the width and thickness of the keratinized tissue at the baseline, 3 and 6 months postoperatively; pro- and anti-inflammatory cytokines [IL-1β, TNF-α, and IL-4] in the peri-implant crevicular fluid on the 1st, 7th and 30th days after surgical procedure; swabs from the surface of postoperative wounds of the mucous membrane on days 3, 5, 7, and 10; Pink aesthetic score [PES] 6 months after prosthesis placement; and laser Doppler flowmetry on days 1, 7, and 14 after augmentation. Results and Discussion Patients who received L-PRF+SCTG had a significant increase in keratinized tissue thickness [KTT] [p = 0.08] than those who received SCTG only [KTT 1.86 ± 0.17 Vs 1.48 ± 0.15] 6 months after surgery. The mean [±SD] of PES was found to be 13.1 [±0.02] for Group I and 11.3 [±0.08] for Group II. The cytology, LDF, and local immunoassay analysis demonstrated faster epithelialization and better revascularization in Group I. Conclusion The use of L-PRF and SCTG is an effective method in augmenting peri-implant soft tissue and improving gingival biotype and aesthetic outcomes, which would help overcome complications and increase patients’ satisfaction.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BackgroundImmediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.MethodsWe included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann–Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.ResultsAll implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26–1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39–1.47 mm in groups I and N, respectively.ConclusionWithin the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.Trial registrationThe protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Superthin Anterolateral Thigh Flap for Head and Neck Reconstruction.

This study was performed to clarify whether the superthin anterolateral thigh (ALT) flap is an appropriate choice for head and neck reconstructions requiring thinner and more pliable flaps. Data of patients who underwent head and neck reconstruction from January 2020 to December 2022 were retrospectively collected. Nine patients (4.2%) underwent reconstruction with a superthin ALT flap. All the flaps survived with no cases of total or partial necrosis. Six patients treated with superthin ALT flaps and 15 patients treated with conventional ALT flaps who underwent oral cavity reconstruction were compared. The mean body mass index was significantly higher in the superthin flap group than in the conventional ALT flap group (25.2 vs 21.2kg/m2, respectively; P = 0.04). The rate of postoperative complications requiring debridement was 0% and 13% (P = 0.37). The mean postoperative Hirose score was 9.7 and 8.7 (P = 0.17). The mean postoperative Functional Oral Intake Scale score was 6.7 and 5.9 (P = 0.12). Secondary flap refinement surgery after facial skin reconstruction was performed in 0 of 2 patients (0.0%) in the superthin flap group and 4 of 52 patients (7.7%) in the conventional ALT flap group (P = 0.04). Oral cavity reconstruction with superthin ALT flaps did not increase the incidence of postoperative flap necrosis and resulted in comparable postoperative function. In addition, superthin ALT flaps did not require additional flap refinement surgeries after facial skin reconstruction. The superthin ALT flap is a safe and reliable choice for obese patients with thick thigh subcutaneous tissue.

An anatomical study of thenar and hypothenar soft tissue thickness in men and women.

We hypothesized that reduced thenar soft tissue thickness may be a risk factor for distal radial fractures. We assessed MRI scans of the wrist in 78 adults. The 51 men had significantly higher palmar soft tissue thickness compared to the 27 women, even after adjusting for hand size.Level of evidence: IV.

The lumbar artery perforator free flap as an alternative option for breast reconstruction in low BMI patients: analysis of CT Angiography of donor sites across BMI.

In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition persists in the lumbar region compared to the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) free flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI. A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive DIEP flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI <22, normal BMI 22-24 and high BMI >30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the lumbar artery perforator. A statistically significant difference was identified between the ratio of lumbar to abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7cm lateral to the spinous process (range 6.4 - 9.5cm), with no significant difference between BMI groups, highlighting this consistent anatomical position. This study confirms a greater lumbar to abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 - 9.5cm lateral to the spinous process. The lumbar artery perforator flap should therefore be strongly considered for autologous breast reconstruction in this patients with a low BMI.

Mapping optimal orthodontic implant sites in the palate using cone-beam computed tomography.

To measure the palatal soft tissue thickness and cortical bone density to determine safe regions for the placement of orthodontic mini-implants and to examine the influence of sex and age on soft tissue thickness and cortical bone density. Cone-beam computed tomography images of 42 patients (22 males and 20 females), including 21 adults and 21 adolescents, were examined in this study. The palatal soft tissue thickness and cortical bone density were measured at the coronal planes between the premolars (P4-5), between the second premolars and first molars (P5-6), and between the first molars and second molars (P6-7). The thickness of the soft tissue revealed similar coronal planes, but the bone density varied. The mean thickness was 3.8 mm at 0°-60° and 1.5 mm at 60°-90°. P4-5 had the highest bone density (>600 HU), decreasing toward P6-7 (<600 HU). Bone density decreased from 90° to 0° coronally, whereas the soft tissue thickness increased. Age, sex, and their interaction affected bone and soft tissues. In general, areas with a high bone density tended to have thin soft tissue coronally, thus the preferred implant site tends to be more anterior to the P4-5 plane and closer to 60°-90°. Considering individual variances, mapping of the recommended regions for palatal mini-implants is suggested.

Comparing Small Buccal Dehiscence Defects Treated with or without Guided Bone Regeneration. A Sub-Analysis of a RCT.

to assess clinical and radiographical outcomes of single tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR). In a randomized clinical trial of 59 patients, single-tooth posterior implants were placed. For the subanalysis of 16 patients with a buccal dehiscence defect (≤ 5mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone (Native bone). A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at one year (1y). Measurements included: soft tissue thickness (STT), bone tissue thickness (BTT) and buccal contour, based on cone-beam computed tomography (CBCT), optical scans, clinical parameters. All data were analyzed descriptively. The mean STT at implant shoulder (IS) showed a gain of 0.15 mm (Q1: - 0.16, Q3: 0.49) for the GBR group and 0.03 mm (Q1: -0.49, Q3: 0.13) for the SH group. The mean BBT 1 mm below IS showed a loss of 0.25 mm (Q1: -0.85, Q3: -0.09) for the GBR group and 0.04 mm (Q1: -0.14, Q3: 0.17) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinically relevant differences between the groups. Patient-reported outcomes regarding pain one day after surgery were similar among the study groups. The present sub-analysis resulted in a similar buccal contour and similar radiographic outcomes as well as peri-implant health for sites treated with or without GBR.