Unilateral Defects Research Articles

Biomechanical evaluation of implant options for unilateral maxillary defects: a finite element analysis

ObjectiveThis study aimed to evaluate stress distribution in unilateral maxillary defects using finite element analysis (FEA) to compare subperiosteal (SI) and zygomatic implants (ZI).Materials and methodsA 3D model of a unilaterally atrophied maxilla was reconstructed from CT scans. Five scenarios were simulated: (1) quad zygoma implants (SC1), (2) zygoma and conventional implants (SC2), (3) two-piece SI and conventional implants (SC3), (4) one-piece SI and conventional implants (SC4) and (5) one-piece SI implant (SC5). Mechanical properties were assigned based on data in the literature; a 450 N force for occlusal loading and a 93 N force for oblique loads were applied.ResultsUnder vertical loading, SC2 exhibited the highest tensile stress (Pmax) in the atrophic region (R-AM), while SC4 showed the lowest Pmax across the entire maxilla, indicating better stress distribution. Under oblique forces, SC2 also showed the highest Pmax in R-AM, while SC5 had the lowest Pmax overall. Minimum principal stress (Pmin) followed similar patterns, with SC4 and SC5 demonstrating lower stress levels than the other scenarios. Abutment stresses were highest in SC2 and lowest in SC4. Overall, the SI scenarios (SC3–SC5) exhibited lower stress transmission to the alveolar bone than the ZI scenarios (SC1 and SC2), with SC4 providing the most balanced stress distribution across all regions.ConclusionsSI implants, mainly the one-piece SI (SC4), offered a more favourable stress distribution than ZI implants in unilateral maxillary defects, reducing the risk of excessive bone stress. This finding suggests that SI implants may be superior for such cases, although individual patient anatomy should guide implant selection. Further clinical studies are necessary to confirm these biomechanical findings in vivo.Clinical relevanceThis study underscores the crucial role of implant selection in minimising stress on the alveolar bone in unilateral maxillary defects. Based on these findings, we recommend personalised implant strategies based on biomechanical insights to enhance outcomes in maxillofacial reconstruction.

Biomechanical evaluation of six zygomatic implants versus four zygomatic implants combined with dental implants in the treatment of different maxillary defects

BackgroundThis study aims to compare the biomechanics of six zygomatic implants (ZIs) and dental implants (DIs) combined with four ZIs with different maxilla defects.MethodsThree-dimensional constructs of the ZIs, DIs human skulls, and maxillary prostheses were created using SolidWorks Software (Version 2015, Dassault Systems SolidWorks Corporation, Waltham, MA, USA). Eight finite element models of the skull with four different alveolar defect types (0–4) were constructed. Type 0: No defect; Type 1: Bilateral posterior defects; Type 2: Right posterior defect; Type 3: Anterior and left posterior defects; Type 4: Bilateral posterior and anterior defects. In two models with the same defect type (for defect types 0–2), six ZIs or two DIs combined with four ZIs were inserted into the maxilla. Six ZIs were inserted in the maxilla models with defect types 3 and 4. Vertical (150 N) and masseteric (300 N) loads were simulated on the prosthesis. The maximum Von Mises stress in the implants/surrounding bone and bone deformation were evaluated.ResultsThe maximum Von Mises stresses in bone/implant were found highest in the defect type 2 model with four ZIs combined with two DIs. The lowest maximum Von Mises stress for bone was detected in the model with defect type 0 and with six ZIs.ConclusionAmong the four types of defects, the posterior unilateral defect caused the highest stress value.

Outcome of posterior lamellar replacement with oral mucous membrane graft in lid margin sequalae of Steven Johnson syndrome

: to address common lid margin sequalae presented in steven Johnson syndrome and to assess the outcome of posterior lamellar replacement with oral mucous membrane graft. : This single center longitudinal study was conducted in Ispahani Islamia Eye Institute and Hospital. 56 diagnosed cases of Steven Johnson syndrome with lid margin sequalae during the period of July 2020 to June 2023 were included in the study. Patients with ocular cicatrizing pemphigoid and chemical burn were excluded from the study. Demographic profile, presenting lid margin sequalae, outcome of surgery and complication after intervention and its management were properly evaluated and recorded. : A total of 98 eyelids (upper and lower) in 56 patients were evaluated. The Mean age was 38.33 ± 15.22 years (range 6 – 70 years). 21 patients were male and 35 were female (male: female=1:1.66). 14 patients had unilateral defect and 42 patients have bilateral defect. Most common lid margin sequalae was lid margin keratinization (85.71%), distichiasis (62.5%), trichiasis (21.42%) and entropion (8.92%). All lid margin defect were successfully corrected by posterior lamellar replacement with oral mucous membrane graft. During 6 months post-operative follow up, significant symptomatic relief from epiphora, foreign body sensation, pain and photophobia were achieved in all patients. There was remarkable reduction of conjunctival inflammation (88.63%) and persistent corneal epithelial defect (71.42%). Mean visual acuity was significantly improved. Common complications of the surgery were misdirected lashes (7.14%), dislodgement of graft (2.04%%), and recurrent entropion (2.04%). All complication was successfully managed through appropriate second procedure.Posterior lamellar resection with an oral mucous membrane graft for modifying lid margin defects in Steven-Johnson syndrome shows promising results.

Severe dental malocclusion in a case of repaired unilateral cleft palate managed by orthodontic mechanotherapy alone

Cleft palate is a developmental abnormality that perforates the palate, and divides the arch segments producing grave malocclusion. Crossbites, labiolingual displacements, rotations, archform distortion and incompatibility are a few facets characterizing the problem. Teeth may be congenitally missing or periodontally infirm in the vicinity of the breakdown. If the skeletal jaw base discrepancy is not major, orthognathic surgery may be omitted and orthodontic mechanics alone can suffice to manipulate the teeth into a decent occlusion. Restorative work for esthetic embellishment can enhance the overall result, particularly if teeth are malformed. This case report describes how severe dental malocclusion arising from a repaired unilateral cleft palate defect was corrected with a fixed preadjusted edgewise appliance, adorning smile esthetics and boosting the patient’s self-confidence.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study

ObjectiveTo compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methodsPelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. ResultsPuborectal hiatus distance was higher in the HD group (59.2 ​± ​8.7 ​mm vs. 55.5 ​± ​7.1 ​mm, p ​= ​0.03). Similarly, the distance to the M line was greater in the HD group (18.3 ​± ​4.8 ​mm vs. 16 ​± ​4.6 ​mm, p ​= ​0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 ​± ​291.4 ​mm2 vs. 1897.5 ​± ​352.5 ​mm2, p ​= ​0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p ​= ​0.03). There was a negative correlation between birthweight and obturator internus muscle area (r ​= ​−0.388, p ​= ​0.02), and a positive correlation with M line distance (r ​= ​0.344, p ​= ​0.04). ConclusionLevator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.

Design, In Vitro Evaluation and In Vivo Biocompatibility of Additive Manufacturing Three-Dimensional Printing of β beta-Tricalcium Phosphate Scaffolds for Bone Regeneration

The reconstruction of bone deficiencies remains a challenge due to the limitations of autologous bone grafting. The objective of this study is to evaluate the bone regeneration efficacy of additive manufacturing of tricalcium phosphate (TCP) implants using lithography-based ceramic manufacturing (LCM). LCM uses LithaBone TCP 300 slurry for 3D printing, producing cylindrical scaffolds. Four models of internal scaffold geometry were developed and compared. The in vitro studies included cell culture, differentiation, seeding, morphological studies and detection of early osteogenesis. The in vivo studies involved 42 Wistar rats divided into four groups (control, membrane, scaffold (TCP) and membrane with TCP). In each animal, unilateral right mandibular defects with a total thickness of 5 mm were surgically performed. The animals were sacrificed 3 and 6 months after surgery. Bone neoformation was evaluated by conventional histology, radiology, and micro-CT. Model A (spheres with intersecting and aligned arrays) showed higher penetration and interconnection. Histological and radiological analysis by micro-CT revealed increased bone formation in the grafted groups, especially when combined with a membrane. Our innovative 3D printing technology, combined with precise scaffold design and efficient cleaning, shows potential for bone regeneration. However, further refinement of the technique and long-term clinical studies are crucial to establish the safety and efficacy of these advanced 3D printed scaffolds in human patients.

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

A rare case of unilateral double Stafne bone defects and literature review.

Stafne bone defect (SBD) is a rare developmental bone defect characterized by an asymptomatic focal concavity of the cortical bone, typically on the lingual aspect of the mandibular body, which generally contains salivary gland tissue. It can be detected during routine dental examinations and typically appears as an ovoid, well-defined, well-corticated, radiolucent depression in the posterior mandibular region below the inferior alveolar nerve (IAN) (in: Neville et al, Oral and maxillofacial pathology, Elsevier, Inc, St. Louis, MO, 2016).An 80-year-old male presented to our clinic for a routine dental examination. Panoramic radiography and cone-beam computed tomography (CBCT) displayed two well-defined, well-corticated, ovoid radiolucencies inferior to the IAN canal on the left mandibular molar region. The working diagnosis was SBD, and the patient was informed of the findings. Irregular margins on the superior aspect of the anterior defect were noted on CBCT imaging; therefore, follow-up with panoramic images at 6months, 1 and 5years was recommended.

Dermoscopy of Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects Nevus with Unilateral Limb Defects

Here, we report the dermoscopic findings of congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) nevus with left-sided ichthyosiform erythroderma and left upper-limb aplasia in a 4-month-old baby. The presence of ptychotropism and strict midline demarcation are unique features described in CHILD nevus. Dermoscopy of the CHILD nevus showed linear and dotted vessels with yellowish waxy scales on a pink background. These characteristic dermoscopic findings would also help us to differentiate it from inflammatory linear verrucous epidermal nevus.

Evaluation of Optic Nerve Head Microcirculation in Open-Angle Glaucoma Patients with Unilateral Visual Field Defect

Introduction: Microcirculation of optic nerve head (ONH) in open-angle glaucoma (OAG) patients with unilateral visual field (VF) loss has yet to be fully investigated, especially the perimetrically unaffected fellow eyes. Methods: Thirty-eight OAG patients with VF defect in one eye and normal VF in the other eye, and thirty-one healthy participants were analyzed. All participants underwent laser speckle flowgraphy (LSFG), spectral-domain optical coherence tomography (SD-OCT) imaging, and VF test for further analyses. LSFG measurements included mean blur rate in all area of ONH (MA), big vessel area of ONH (MV), and tissue area of ONH (MT). SD-OCT parameters included circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macula thicknesses. The difference of LSFG and SD-OCT indices between glaucoma patients and healthy controls were compared. The diagnostic accuracy was analyzed with the areas under the receiver operating characteristic curves (AROCs). Results: Global cpRNFL thickness and macular thickness in unaffected eyes of OAG patients were higher than their fellow eyes and lower than healthy eyes. MA and MV in healthy eyes and unaffected eyes were significantly higher than in affected eyes. MT in unaffected eyes of OAG patients was higher than in their fellow affected eyes but lower than in healthy eyes. The AROCs were highest for cpRNFL (0.925), followed by macular thickness (0.838), and MT (0.834). Conclusions: ONH microcirculation in perimetrically unaffected fellow eyes was decreased in OAG patients with unilateral VF loss. LSFG can detect changes of ONH in high-risk eyes before detectable VF damage, which may reflect the vascular pathophysiology for glaucoma.

Thickness and design features of clinical cranial implants-what should automated methods strive to replicate?

New deep learning and statistical shape modelling approaches aim to automate the design process for patient-specific cranial implants, as highlighted by the MICCAI AutoImplant Challenges. To ensure applicability, it is important to determine if the training data used in developing these algorithms represent the geometry of implants designed for clinical use. Calavera Surgical Design provided a dataset of 206 post-craniectomy skull geometries and their clinically used implants. The MUG500+ dataset includes 29 post-craniectomy skull geometries and implants designed for automating design. For both implant and skull shapes, the inner and outer cortical surfaces were segmented, and the thickness between them was measured. For the implants, a 'rim' was defined that transitions from the repaired defect to the surrounding skull. For unilateral defect cases, skull implants were mirrored to the contra-lateral side and thickness differences were quantified. The average thickness of the clinically used implants was 6.0 ± 0.5mm, which approximates the thickness on the contra-lateral side of the skull (relative difference of -0.3 ± 1.4mm). The average thickness of the MUG500+ implants was 2.9 ± 1.0mm, significantly thinner than the intact skull thickness (relative difference of 2.9 ± 1.2mm). Rim transitions in the clinical implants (average width of 8.3 ± 3.4mm) were used to cap and create a smooth boundary with the skull. For implant modelers or manufacturers, this shape analysis quantified differences of cranial implants (thickness, rim width, surface area, and volume) to help guide future automated design algorithms. After skull completion, a thicker implant can be more versatile for cases involving muscle hollowing or thin skulls, and wider rims can smooth over the defect margins to provide more stability. For clinicians, the differing measurements and implant designs can help inform the options available for their patient specific treatment.

Analysis of the Management of Cleft Lip Surgery with the Characteristics of Patients with Cleft Lips or Without Cleft Palatum in Nort Sumatra

Clefts are the most common type of congenital abnormality on the face. This condition can cause medical, psychological, and social problems in individuals and&#x0D; families. Several previous studies have yielded results in the form of a large number&#x0D; of cleft sufferers who come for treatment at a late age. This can affect the outcomeof the management given. The characteristics of cleft patients in Indonesia, especially in Medan City, are still very limited. Therefore, researchers have the desire to be able to do research in this field. patients with or without cleft palate who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra based on:(1) type of cleft, (2) location of the cleft defect, (3) Gender, (4) Treatment time, and (5) Type of operation. design. The sample for this study was secondary data on 193 cleft patients who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra in the 2017 – 2022 period. palate based on the type of cleft was labiognatopalatoschizis with a total of 115 patients (59.6%), based on the location of the defect was a unilateral defect (left side) of 98 patients (50.8%), based on gender was male with a total of 130 patients (67.4%), based on the time of treatment category was the late labioplasty category with a total of 54 patients (28%), and based on the type of surgery the most was the type of primary cleft palate repair surgery with a total of 56 people (29%). from previous studies.

Prosthetic rehabilitation of unilateral midfacial defect resulting from flap related complication: A case report of clinical challenges and their solutions.

Composite defects of the head and neck region after oncologic resection are challenging and require reconstruction of several layers, including the intraoral lining, osseous reconstruction of the mandible or maxilla and soft tissue/skin coverage. Management of complications resulting from flap failure is a challenging task from a technical and aesthetic perspective that can have a substantial social and psychological impact on those affected. This clinical report describes prosthetic rehabilitation of a lateral midfacial defect and the clinical challenges encountered and their solutions in a patient with carcinoma of gingivobuccal complex who underwent composite bite resection, reconstruction and adjuvant radiation therapy. A conventional approach that employed an acrylic substructure and silicone (one-piece) prosthesis was implemented to address the cutaneous cheek defect taking into account history of recent radiotherapy and comprehensive medical history. The delivered prosthesis effectively restored the lost facial contour and concealed the facial defect, contributing to aesthetics and improving the patient's quality of life.

Bone regeneration using activin A/BMP2 chimera (AB204) with collagen membrane in rats with calvarial defects.

Collagen has long been recognized as an excellent carrier for growth factors, and membrane-type collagen has been widely applied in dentistry for guided bone regeneration. This study was conducted to examine the effects of an activin A/BMP2 chimera (AB204) combined with a collagen membrane (CM) on bone repair in a rat calvarial defect model. A unilateral calvarial defect measuring 5.0 mm was surgically created in 32 Sprague-Dawley rats. The rats were then randomly assigned to 1 of 4 groups, each consisting of 8 animals: control (untreated), CM (treated with a CM only), CM/bone morphogenetic protein 2 (BMP2) (treated with a CM and 1.0 μg of BMP2), and CM/AB204 (treated with a CM and 1.0 μg of AB204). Bone regeneration was evaluated using micro-computed tomography (CT) and histological analysis at 2 and 4 weeks following surgery. Micro-CT analysis revealed that bone formation in the CM/BMP2 and CM/AB204 groups was superior to that observed in the control and CM groups at both 2 and 4 weeks postoperatively. BMP2 induced greater bone regeneration than AB204 at 2 weeks; however, AB204 resulted in a greater bone volume at 4 weeks, achieving the highest values recorded. No significant differences were found between the CM/BMP2 and CM/AB204 groups at either time point (P>0.05). On histological examination, new bone formation was evident in both CM/BMP2 and CM/AB204 groups. Within the limitations of this study, the findings indicate that AB204 may enhance osteogenic potential when used in combination with CM for bone regeneration.

A successful thoracoscopic treatment of bilateral congenital false diaphragmal hernia in a newborn

Introduction. Congenital diaphragmatic hernia (CDH) occurs with frequency of 1:2000 to 1:4000 live births. False CDH are more common. Out of unilateral diaphragm defects, left-sided ones predominate (9–24 times more often depending on hernia type). Bilateral diaphragmatic hernia is an extremely rare malformation which accounts for no more than 1% of all diaphragmatic hernias.&#x0D; Description of observation. The authors present their own experience in treating a rare clinical case of bilateral false diaphragmatic hernia in a newborn with the left-sided component manifested immediately after the birth and with the right-sided one – in 2 weeks after the correction of the first one, as well as its successful thoracoscopic treatment.&#x0D; Conclusion. The authors consider that one of the possible reasons for not detecting this pathology at ultrasound examination is translocation of the abdominal organs to the chest (which can occur antenatally, intra- and postnatally).

Stacked fibula flap for unilateral total maxillectomy reconstruction with orbital preservation.

Unilateral total maxillectomy is indicated for locally advanced maxillary tumors that require complete removal of the midface bony structure and inferior orbital rim. Reconstruction of this defect is challenging due to aesthetic and functional concerns. A retrospective review of patients at two tertiary-care institutions undergoing unilateral total maxillectomy reconstruction with a stacked fibula flap from 2018 to 2022 was performed. Each patient's clinical course was reviewed, and attention was focused on the demonstration of surgical steps with photos. Twenty patients underwent stacked fibula flap reconstruction for unilateral total maxillectomy orbital preservation defects. Surgical extirpation was performed for malignancy (80%, 16/20) and for osteoradionecrosis or benign tumor in 20% (4/20). The complication rate was 30% (6/20). Most flaps survived (95%, 19/20). We present a modified, reproducible method of fibula flap reconstruction for unilateral total maxillectomy with orbital preservation that only requires two segments and maintains positive aesthetic and functional results.

Effects of glass-ceramic produced by the sol-gel route in macrophages recruitment and polarization into bone tissue regeneration.

Effective bone substitute biomaterials remain an important challenge in patients with large bone defects. Glass ceramics produced by different synthesis routes may result in changes in the material physicochemical properties and consequently affect the success or failure of the bone healing response. To investigate the differences in the orchestration of the inflammatory and healing process in bone grafting and repair using different glass-ceramic routes production. Thirty male Wistar rats underwent surgical unilateral parietal defects filled with silicate glass-ceramic produced by distinct routes: BS - particulate glass-ceramic produced via the fusion/solidification route, and BG - particulate glass-ceramic produced via the sol-gel route. After 7, 14, and 21 days from biomaterial grafting, parietal bones were removed to be analyzed under H&E and Massons' Trichome staining, and immunohistochemistry for CD206, iNOS, and TGF-β. Our findings demonstrated that the density of lymphocytes and plasma cells was significantly higher in the BS group at 45, and 7 days compared to the BG group, respectively. Furthermore, a significant increase of foreign body giant cells (FBGCs) in the BG group at day 7, compared to BS was found, demonstrating early efficient recruitment of FBGCs against sol-gel-derived glass-ceramic particulate (BS group). According to macrophage profiles, CD206+ macrophages enhanced at the final periods of both groups, being significantly higher at 45 days of BS compared to the BG group. On the other hand, the density of transformation growth factor beta (TGF-β) positive cells on 21 days were the highest in BG, and the lowest in the BS group, demonstrating a differential synergy among groups. Noteworthy, TGF-β+ cells were significantly higher at 21 days of BG compared to the BS group. Glass-ceramic biomaterials can act differently in the biological process of bone remodeling due to their route production, being the sol-gel route more efficient to activate M2 macrophages and specific FBGCs compared to the traditional route. Altogether, these features lead to a better understanding of the effectiveness of inflammatory response for biomaterial degradation and provide new insights for further preclinical and clinical studies involved in bone healing.

Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

Histological Evaluation of A unilateral Critical-Sized Mandibular Defect Reconstruction using human dental pulp stem cells by Light Microscope and Real-Time Quantitative PCR

Objective: To evaluate the osteogenic differentiation potential of human dental pulp stem cells (DPSCs) isolated from the dental pulp of third molar teeth in vitro cultures, and to evaluate the bone regenerative capacity of human dental pulp stem cells (DPSCs) when transplanted into a unilateral critical-sized bone defect in the mandibular bone in vivo after receiving a hydroxyapatite matrix and polylactic-polyglycolic acid (HA/PLGA) scaffold. Material and methods: A total of 18 mandibular defects were made, and three groups (each n = 6) were created. The first group: the transplanted DPSCs implanted in the critical-sized bone defect after receiving (HA/PLGA) scaffold. The second group received only (HA/PLGA) scaffold. The third group, which served as the control, had a critical-sized defect left empty. After characterization, Von Kossa [VK] and Alizarin red staining were employed to identify differentiated osteoblasts at the 14th and 21st days, and histological analyses, as well as polymerase chain reactions (PCR), were also used. Results: It showed that DPSCs had high proliferation potential and typical fibroblastic shape. Additionally, osteogenic differentiation of DPSCs was validated by morphological alterations, histological examination, and the expression of lineage-specific genes confirmed osteogenic differentiation of DPSCs. Conclusion: High proliferation potential and the capacity to differentiate into osteoblasts are two characteristics of DPSCs taken from impacted third molars.