Use Of Fascia Research Articles

MYRINGOPLASTY WITH APPLICATION XENOGRAFT FROM SHEEP PERICARDIA

To date, there is no consensus on the question of which tissues are more appropriate to use for tympanic membrane plastic surgery. We decided to study the use of xenograft from sheep pericardium in myringoplasty in rabbits in the experiment, and in patients with chronic dry mesotympanitis. Experimental morphological studies using a xenograft were carried out in 28 rabbits. In the experiment, a positive result was obtained in 25 (89.3%) rabbits. In addition, 77 patients with dry perforation of the tympanic membrane were examined. To compare the results of the study, these patients underwent myringoplasty: 54 patients with the use of a xenograft from the sheep pericardium, 23 patients with the use of the fascia of the temporal muscle. Reliable engraftment of a xenograft from sheep pericardium after surgery was observed in 48 patients (88.9%), and with the use of temporal muscle fascia in 20 patients (86.9%).

Cerebrospinal fluid composition after duraplasty with different substitutes in early and late postoperative periods (an experimental study)

Objective. To study cerebrospinal fluid (CSF) changes after the duraplasty with autologous fascia, collagen-based material and chitin-chitosan membrane in early and late postoperative periods. Materials and methods. Chitosan-based films were made out of 3 % solution of chitosan for the research. We used 200 kDa chitosan (deacetylation rate 80–90 %) to produce chitin-chitosan membrane by using solvent evaporation method. For enhancing mechanical properties and reducing the degradation, chitin particles were added to the chitosan solution. Chitosan and chitin ratio was 80/20. The chitin/chitosan solution in Petri dishes was being dried out during 3 days at room temperature. Cerebrospinal fluid composition has been studied after the duraplasty with autofascia, collagen-based material and innovative chitosan-based graft in early and late postoperative periods. The duraplasty was performed by applying these materials to 90 Chinchilla rabbits breed. Animals were divided into three groups: I group — duraplasty using the fascia lata autograft, II group — duraplasty with the collagen-based material, III group — duraplasty using the chitin-chitosan membrane. The animals in the II and III groups were divided into 2 subgroups: A — plasty without fixing the material, B — plasty with fixing the material using atraumatic suture. CSF composition was studied before and after the operation had been performed in 2 weeks, 2 and 6 months. Results. The results of our study demonstrated the increase in density and protein level, the decrease in рН and glucose level and the extreme increase of cells, mostly neutrophils after the use of fascia lata for dural closure. At the same time, there were no substantial changes after dural closure with artificial collagen- and chitosan-based materials, the CSF composition normalized in 2 months after operation. Conclusion. The use of autologous fascia for duraplasty leads to an acute response of the cerebrospinal fluid in the early postoperative period and to residual pleocytosis. The chitosan-based graft application was followed by no complications at 6 months after surgery and only slight CSF response in the early postoperative period. There wasn’t any significant difference in CSF composition in chitosan- and the collagen-based material usage. Given the lack of changes in SCF tests between suture and no suture graft fixation except for a slight increase in erythrocyte number in the early postoperative period, the choice of material fixation method is entirely dependent on the clinical situation and does not affect the cerebrospinal fluid state.

Cartilage reinforcement graft versus fascia graft in tympanoplasty*

Background/aim: The purpose of this study was to compare cartilage reinforcement graft results with temporalis fascia graft alone in terms of hearing and anatomical outcomes in tympanoplasty. Materials and methods: Patients who underwent tympanoplasty with/without ossiculoplasty and/or mastoidectomy at a university hospital from 2006 through 2013 were reviewed retrospectively. The patients were divided into those grafted with temporalis muscle fascia alone and with fascia reinforced with cartilage. The postoperative air bone gap, gain in hearing thresholds, and graft status were evaluated for each group. Results: The study subjects included 179 patients. There were 82 patients in the fascia group and 97 patients in the cartilage group. Successful hearing results were elicited in 79.2% of the fascia group and 85.5% of the cartilage group. There was no significant difference in overall graft success. The graft was intact in 82.9% of the fascia group and 86.5% of the cartilage group. Conclusion: In this comparative study the use of cartilage to reinforce the temporalis muscle fascia was analyzed, showing better hearing and anatomical results than sole use of fascia in tympanoplasty both for primary and revision cases. Thus, in the light of our results, when performing tympanoplasty we recommend the use of cartilage reinforcement grafting whenever needed and indicated.

Telocytes of Fascial Structures.

Currently, the exact role of telocytes within fascial structures is unknown. The morphology, distribution and behaviour of fascial telocytes as well as the mutual relationship between telocytes and other cellular fascia constituents should be definitely a subject of further studies. It will contribute to better understanding of the role of the fascial system in health and diseases, may shed light on the regeneration potential of these tissues and may help to find targets for future treatments for locomotor disorders, including fascial diseases. Last but not least, confirmation of the presence of telocytes within fascia may contribute to optimise the use of fascia as a graft material.

Surgical outcome and complications of nasal septal perforation repair with temporal fascia and periosteal grafts.

AIMSSurgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients.METHODSDuring the years 2007–2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland. We performed a retrospective review of closure rates and complications. Follow-up time ranged from 1 to 62 months.RESULTSBleeding was the most common early complication (9%), followed by postoperative infection (5%) in the whole series. Our main technique, bipedicled advancement flaps with fascia or fascia and periosteum, was performed for 81 patients. We obtained successful closure in 78% of these patients with this operative technique and the rate increased to 86% during the last 3 years of the study period.CONCLUSIONSPerforation repair with temporal fascia or fascia with periosteum requiring only one donor site seems to be a reliable option for nasal septal perforation repair.

Bilateral Myringoplasty in Chronic Otitis Media

A theoretical risk of iatrogenic sensorineural hearing loss (HL) during surgery has induced a reluctance to perform bilateral myringoplasty/tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 26 patients. Twenty-six patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral myringoplasty/tympanoplasty type I (52 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 13.3 years, and the male to female ratio was 1.36. All but one ear were operated through a transcanal approach, and the onlay technique was used most frequently (83%), with use of fascia (56%), tragal perichondrium (38%), or cartilage palisades (6%) as graft material. Follow-up examination and hearing tests (pure tone and speech audiometry) were performed at a mean of 13.8 months after surgery. Perforation closure was obtained in 49 (94%) of the 52 ears. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.

PR22 SKULL BASE RECONSTRUCTION WITH FREE FLAPS

Introduction & Aims Microsurgical reconstruction in skull base surgery is not universally practiced. Current evidence suggests improved outcomes allowing more aggressive management of skull base pathology. We present our experience of free flaps in skull base reconstruction.Material & Methods 17 patients (10 male, 7 female, aged 30–72 years) required microsurgical reconstruction of skull base defects from 2004–2006. The anterior cranial fossa was involved in 10/17. Indications for surgery included malignancy (12/17) and benign neoplasia (3/17).Results 18 free flaps included 10 rectus abdominis, 5 radial forearm and 5 latissimus dorsi. Complications included one complete flap loss, one anastomotic revision, one CSF leak, one case of meningitis and one subdural empyema. There were no deaths.Conclusions We recommend free flap reconstruction for significant skull base defects involving both skull and dura. Important factors determining outcome include adequate pedicle length, flap thickness, use of fascia and controlled lumbar drainage.

MP-18.20: Comparison of the results of tension-free vaginal tape and intra-vaginal sling in bladder neck suspension for patients with stress urinary incontinence

Stress Urinary Incontinency (SUI) is the most common cause of incontinency in women. The prevalence increases with aging. Sling procedure effectively treats SUI. Using artificial tapes are replacing the use of fascia with similar results and not significantly more complications.

Preliminary results with the use of AlloDerm in chronic otitis media.

AlloDerm, an acellular dermal graft, has been used successfully as a material for soft tissue implantation. The authors report their experience with the use of AlloDerm in the reconstruction of the tympanic membrane. Case review study. Charts were reviewed for all patients who underwent tympanoplasty with and without mastoidectomy between June 1999 and June 2002 in whom AlloDerm was used as a grafting material. There were 24 patients, 17 with simple perforations (8 revisions) and 7 with chronic otitis media with cholesteatoma (6 revisions). Success was defined as closure of the tympanic membrane perforation. Closure of the perforation using AlloDerm was achieved in 87.5% of the patients (ie, in all but three patients). Another patient developed serous otitis media and required a myringotomy tube in the postoperative period. The success rate for AlloDerm in tympanoplasty was similar to that of temporalis fascia in the authors' experience. AlloDerm can provide a suitable grafting material when fascia is not available or when the size of the defect precludes the use of fascia.

Use of Alloderm in the neurotologic setting

Purpose: To determine whether Alloderm (Life Cell Corporation, The Woodlands, TX) can be used to cover canal wall down mastoid defects, as well as repair dural defects from translabyrinthine and transpetrosal approaches to the skull base. Methods: A retrospective analysis was performed at an academic tertiary care medical center. Eighteen patients were operated on with canal wall down mastoidectomies, and Alloderm was used to reconstruct the tympanic membrane and line the mastoid cavity. Eleven patients had dural defects reconstructed after skull base approach surgery. We wanted to determine whether the Alloderm graft healed in canal wall down mastoidectomy procedures with good epithelialization. For the skull base approaches, we determined whether a cerebrospinal fluid leak had occurred. Results: The 18 patients who were reconstructed with an Alloderm graft after a canal wall down mastoidectomy all had good epithelialization. As with fascia reconstruction, some granulation tissue occurred, but this was easily controlled in the office setting. Of the 11 patients who underwent reconstruction for skull base surgery approaches, none developed a cerebrospinal fluid leak. Conclusion: Alloderm may provide a suitable grafting material when fascia is either not readily available, or the size of the defect precludes the use of fascia. (Am J Otolaryngol 2002;23:148-152. Copyright 2002, Elsevier Science (USA). All rights reserved.)

The Use Of Autogenous Fat, Fascia, And Nonvascularized Muscle Grafts In The Head And Neck

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

Cochlear implantation in children: labyrinthitis following pneumococcal otitis media in unimplanted and implanted cat cochleas.

Pneumococcal otitis media is frequent in young children and could lead to labyrinthitis post-implantation. To assess the risk, and methods of minimizing it by a graft to the round window around the electrode entry point, we have used a cat animal model of pneumococcal otitis media. Twenty-one kittens were used in the study. Thirty-two cochleas were implanted when the kittens were 2 months of age. Fourteen cochleas were implanted without using a graft (12 were available for study); 9 had a fascial graft, and 9 a Gelfoam graft (7 were available for study). The implanted kittens had their bullae inoculated with Streptococcus pneumoniae 2 months after implantation and were sacrificed 1 week later. There were also 9 unimplanted control ears which were inoculated when the animals were 4 months of age. Labyrinthitis occurred in 44% of unimplanted control, 50% of implanted ungrafted, and 6% of implanted grafted (fascia and Gelfoam) cochleas. There was no statistically significant difference between the unimplanted control and the implanted cochleas (p < 0.05). There was, however, a difference between the implanted-ungrafted and implanted grafted cochleas, but not between the use of fascia and Gelfoam to graft the round window entry point. As a result, the data indicates that cochlear implantation does not increase the risk of labyrinthitis following pneumococcal otitis media, but it is desirable to use fascia as a graft to the round window around the electrode entry point.

Vascularized Cranial Bone Grafts for Mandibular and Maxillary Reconstruction—The Parietal Osteofascial Flap

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.

Vascularized cranial bone grafts for mandibular and maxillary reconstruction: The parietal osteofascial flap

The authors have performed 13 cases of vascularized cranial bone grafts for reconstruction of maxillofacial defects since 1986. Two types of flaps were used: the parietal osteofascial flap pedicled to the parieto-temporal fascia based on the superficial temporal artery and the temporalis osteomuscular flap pedicled to the temporalis muscle based on the deep temporal artery. Zygomatico-orbital complex, maxilla and mandible were reconstructed and hemifacial microsomia was also treated. The results of vascularized cranial bone grafts pedicled to fascia were as good as those of grafts pedicled to muscle. There were no major complications. Two types of vascularized cranial bone grafts seem to be useful in reconstruction of maxillofacial defects with avascular recipient beds because of their good blood supply. The parietal osteofascial flap has additional advantages including easy rotation of the flap to the defect, particularly a mandibular defect, and versatile use of fascia without bulkiness for reconstruction of soft tissue defects. This flap can be designed as a full- or partial-thickness cranial bone graft with good vascularity. In this paper, our technique for mandibular and maxillary reconstruction using the parietal osteofascial flap is introduced, and the results compared with our temporalis osteomuscular flap technique are reported.

Loose areolar connective tissue: a graft for otologic surgery.

AbstractLoose connective tissue is available through a superior auricular incision, or through an endaural or postauricular approach. Storrs1 described use of fascia for tympanoplasty and stapedectomy. Goodman2,3 reported his experiences with areolar tissue grafts for tympanoplasty and stapedectomy. Farrior4 illustrates the use of loose connective tissue in the Atlases, Tympanoplasty in 3‐D, and in the movie “Modern Ear Surgery.” Moon5 reported on use of areolar connective tissue closure of the oval window in stapedectomy.Loose connective tissue originates from the mesenchyma. The histology and functions of loose connective tissue are such as to support its suitability for grafting in middle ear and mastoid surgery. The operative technique of obtaining this graft is described. Loose connective tissue has been used in stapedectomy, tympanoplasty, and mastoidectomy with satisfactory results.

The use of homograft aortic cusps in tympanoplasty

Tympanoplasty with the use of fascia, skin and other autogenous grafts can also be satisfactorily carried out by the use of homograft aortic cusps which if easily available, is equally effective, simple to use and time saving. No definite conclusion can be drawn from such a small series and without a long follow up. However, from the results of P.E. Moore, Cornish and Kosoy et al where myringoplasty with homograft aortic cusp were successfully followed up for 2 1/2 years, our efforts seem promising.

Preservation of the external ear canal in tympanoplasty

For the purpose of eliminating the troublesome mastoid cavity after tympanoplasty, some surgical procedures have been devised, which consist of preservation of the external ear canal, so that the operative mastoid cavity is primarily closed, with the use of fascia, periost or vein as a tympanic graft. Surgical procedures are as follows : At the first place, mastoidectomy is carried out without sacrifice of bony bridge using Shambaugh's endaural incision. Then, the meatal skin incision is made on the posterior canal skin and on it the window is made to see the drum and to prepare the vascular bed on the undersurface of the drum to receive the graft. Thereafter, the drum is separated from sulcus and elevated, but the anterior superior portion is preserved, which serves for reconstructive pro- cedure of the drum by giving the fixed point. After an adequate tympanoplastic procedure is used in accordance with middle ear condition, the drum is repaired with fascia or other tympanic graft on the undersurface of the drum and recon- structed. Such reconstructive procedures as de- scribed above are easily performed through the meatal window which is made on the early stage in operation. Finally the meatal skin is replaced and the window is closed. With these procedures, it seems that nearly normal ear canal and fully satisfactory results in hearing can he obtained. In Addition, healing process is more rapidly and less postoperative after care is needed than in classical tympanoplasty.

Fascia lata repair of massive ventral hernias

A series is reported of large ventral incisional hernias repaired with various technics involving the use of fascia. Good results were obtained with a reflected flap of abdominal aponeurosis, with a pedicle graft of fascia lata and with free transplants of fascia lata from the iliotibial tract. The latter method is the simplest and most satisfactory since it does not interfere with early mobilization of the patient. Wire sutures are preferred to fix the grafts, supplemented by fascia lata sutures when the tissues are of poor quality. Satisfactory repair of less severe incisional hernias may be accomplished with fascia lata sutures, but grafts are required to fill in the larger defects.

The use of fascia in jaw-surgery: K. Morgenroth. Deutsche zahnärztl. Ztschr. 4: 350, 1949

The use of fascia in jaw-surgery: K. Morgenroth. Deutsche zahnärztl. Ztschr. 4: 350, 1949

INGUINAL HERNIOPLASTY WITH FASCIA TRANSPLANT

Herniorrhaphy of any type has been found in all clinics to be an inadequate procedure for the treatment of some inguinal hernias. Recognition of this fact has led the most recent workers on this particular problem to seek some method that will effect a larger percentage of cures. Resulting methods in almost every instance comprise the use of fascia either as a suture material or for plication in the abdominal structures or in the form of a transplant. In a search for reasons for recurrent or postoperative inguinal hernia, it is well to recall some anatomic conditions of the inguinal region. An indirect inguinal hernia has its exit from the abdominal cavity through the internal ring—an opening in the transversalis fascia. A direct inguinal hernia protrudes through the floor of the canal or else bulges this structure. It then becomes the first covering of such a hernia. All inguinal hernias,