Use Of Soft Tissue Research Articles

Effect of suturing in root coverage via coronally advanced flaps: A systematic review.

To analyze the evidence about the influence of the suturing technique and material in terms of the percentage of mean root coverage (%MRC) following root coverage therapy in teeth diagnosed with single/localized gingival recession defects (GRD) via a monolaminar coronally advanced flap. The protocol of this systematic review was registered in PROSPERO (CRD42024514043). A literature search was conducted to identify investigations that fulfilled the eligibility criteria. Variables of interest were extracted, subsequently categorized, and qualitatively analyzed. A total of 15 randomized clinical trials, including 301 localized GRD in non-molar sites classified as Miller class I-II/RT1, in 253 patients were included. The studies reporting the combination of sling and single interrupted sutures, or interrupted sutures alone showed an MRC of 70.2%±16.6%, and 74.1%±0.75%, respectively. The highest MRC was observed in the studies using polyglactin 910 with a pooled value of 76.6% ± 15.3%, and monofilament materials, with a pooled MRC of 74.8%±7.1%. When the suturing diameter was evaluated, the highest pooled MRC with values of 79.1%±9.8% was observed with the use of 5-0. For the treatment of single/localized GRD in non-molar sites via a monolaminar coronally advanced flap, the use of a combination of sling and single interrupted sutures, or single interrupted sutures, polyglactin 910 or monofilament materials, and material diameter of 5-0 showed a higher MRC as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters. There were no differences in the percentage of root coverage achieved between the use of sling and single interrupted, versus single interrupted sutures alone on the treatment of single/localized GRD in non-molar sites. Polyglactin 910 and monofilament sutures resulted in a higher percentage of root coverage achieved as compared to expanded polytetrafluoroethylene, and silk with/without dressing. The use of 5-0 material diameter showed the highest percentage of root coverage achieved. This study was primarily aimed at evaluating how different suturing techniques and materials could affect the percentage of root coverage in single/localized recession defects, without the use of soft tissue substitutes or autogenous soft tissue grafts. After the pooled analyses of 15 randomized clinical trials that fulfilled the inclusion criteria, we observed that the adequate selection of suturing techniques, materials, and size could lead to a higher percentage of root coverage. Specifically, the use of single interrupted with or without sling sutures at the most coronal portion, Polyglactin 910 or monofilament materials, and size of 5-0 showed a higher percentage of root coverage as compared to the use of expanded polytetrafluoroethylene, and silk with/without dressing, and other suture diameters.

Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications?

This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients' functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer's exact test, and 2-sample t tests were used to analyze differences among variables. We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects (P < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P > .99) and late (9% vs 8%, P > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P = .52) and recovery of a 100% oral diet (67% vs 54%, P = .53). Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review.

Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Treatment of Intrathecal Drug Pump Flipping Using Fascial Flaps: A Technical Description and Case Series.

Intrathecal drug therapy is a common treatment for dystonia, pain, and spasticity using implanted pump and catheter systems. Standardized management of intrathecal drug pump (ITDP) migration and flipping has not been well established in the literature. This study reports the use of soft tissue to address less common pump complications such as pump flipping, migration, and difficulty in medication refill. A retrospective chart review of intrathecal pump cases performed by two surgeons between February 2020 and August 2022 was conducted. Patients with complications such as pump flipping, migration, or challenges in medication refill treated with soft tissue flaps were included. Patient demographics, comorbidities, and perioperative data were collected. A total of five patients with ITDP complicated by pump flipping, migration, malposition, or difficulty in medication refill that were treated using fascial flaps were included in the study. Three technical considerations when revising ITDP complications are secure pump anchoring, reliable wound closure, and ease of pump medication refill. Cases 1 and 2 demonstrate the technique of secure pump anchoring with a rectus fascial flap. Cases 3 and 4 show a technique to achieve reliable vascularized wound closure, and case 5 describes a technique to solve an uncommon problem of a thick subcutaneous abdominal tissue preventing the refill of the ITDP medication. Soft tissue flaps may serve as a treatment option for patients with uncommon ITDP complications. De-epithelialized dermal fasciocutaneous or fascial flaps may be developed to anchor the pump more securely. Cross-discipline collaboration may further delineate the technique, benefits, and outcomes of this approach.

Development of 3D Thermoplastic Polyurethane (TPU)/Maghemite (ϒ-Fe2O3) Using Ultra-Hard and Tough (UHT) Bio-Resin for Soft Tissue Engineering.

The use of soft tissue engineering scaffolds is an advanced approach to repairing damaged soft tissue. To ensure the success of this technique, proper mechanical and biocompatibility properties must be taken into consideration. In this study, a three-dimensional (3D) scaffold was developed using digital light processing (DLP) and ultra-hard and tough (UHT) bio-resin. The 3D scaffold structure consisted of thermoplastic polyurethane (TPU) and maghemite (ϒ-Fe2O3) nanoparticles mixed with UHT bio-resin. The solution sample for fabricating the scaffolds was varied with the concentration of the TPU (10, 12.5, and 15% wt/v) and the amount of ϒ-Fe2O3 (1, 3, and 5% v/v) added to 15% wt/v of TPU. Before developing the real geometry of the sample, a pre-run of the DLP 3D printing process was done to determine the optimum curing time of the structure to be perfectly cured, which resulted in 30 s of curing time. Then, this study proceeded with a tensile test to determine the mechanical properties of the developed structure in terms of elasticity. It was found that the highest Young’s Modulus of the scaffold was obtained with 15% wt/v TPU/UHT with 1% ϒ-Fe2O3. Furthermore, for the biocompatibility study, the degradation rate of the scaffold containing TPU/UHT was found to be higher compared to the TPU/UHT containing ϒ-Fe2O3 particles. However, the MTT assay results revealed that the existence of ϒ-Fe2O3 in the scaffold improved the proliferation rate of the cells.

Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review.

The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants. Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri-implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri-implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri-implant outcomes, incidence of biological complications, surgical time, or patient-reported outcome measures (PROMs) were collected. Meta-analyses were performed whenever possible. Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n=6; weighted mean difference (WMD)=-0.9mm; 95% confidence interval (CI) [-1.4; -0.3]; p=.001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n=5; WMD=-0.8mm; 95% CI [-1.6; 0.0]; p=.062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes. Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues.

Comparison of Fiducial Marker Implantation and Soft Tissue Registration Using Cone Beam CT in Image-Guided Radiation Therapy of the Prostate

With the advent of Cone Beam CT (CBCT) in Image Guided Radiation Therapy (IGRT) of prostate cancer, daily registration can now be achieved with aligning patient position based on their soft tissue (ST) as opposed to surgically-inserted radio-opaque fiducial markers (FM). There are a limited number of studies directly comparing the differences in registration based on CBCT FM versus CBCT ST, despite differing standards of practice with the use of FM in IGRT of prostate cancers. There is disagreement in the literature whether CBCT ST offers an equivalent means of patient registration. For this study, we retrospectively collected the radiation treatment plan and daily CBCT imaging for 25 patients treated for prostate cancer at our center from 2014-2015. All patients had 3 FM implanted in the apex, mid and base of prostate under ultrasound guidance, pre-simulation. Three radiation therapists (each >2 years of experience in the use of CBCT ST and FM registration) performed registration of CBCT scans, uniformly spread over the treatment, to the reference CT based on both FM and ST using a stand-alone XVI (X-ray Volume Imaging) system by Elekta™ (Crawley, UK). Shifts in the RL, SI, and AP direction were calculated for each of the 5 fractions for each patient. Average shifts across patients were calculated and the results between the FM- and ST-based matching were compared using a Bland and Altman analysis. In a sample set of 5 patients, average shifts in the RL, SI, and AP directions were 2.5, 2.5, and 4.2 mm with CBCT FM, and 2.6, 1.4, and 4.0 mm with CBCT ST. A Bland and Altman comparison between CBCT FM versus CBCT ST resulted in a 95% confidence intervals of -2.4 to 1.6mm for RL, -1.9 to 4.4mm for SI, and -2.1 to 3.5mm for AP. The percentage of shifts in agreement between ±3mm was 98% for RL, 88% for SI, and 94% for AP, while the percentage of shifts in agreement between ±5mm was 98% for RL, 98% for SI, and 100% for AP. Our experience with CBCT ST has shown that it is comparable to CBCT FM alignment, in a center with radiation therapists experienced in aligning based on CBCT ST.

Soft Tissue Envelope Preserving Technique for Computer Navigated Total Knee Arthroplasty

Objectives:Current techniques in Total Knee Arthroplasty(TKA) are utilitarian in that all patients are recommended to have the same alignment of neutral mechanical axis. It has been well established that the population has a varied natural alignment with less than 20% of patients naturally neutral. The ability to predictably individualise alignment for patients is hypothesised to result in greater patient satisfaction. This technique aims to modify mechanical axis technique to consider an individual’s soft tissue constraints.Methods:Soft Tissue Envelope Preserving (STEP) is an operative technique for performing TKA that utilises the soft tissue data obtained intra-operatively from computer navigation registration to determine the optimal alignment to provide balanced positioning of implants without the need for soft tissue releases. Hence balance is achieved through bone cuts rather than altering the patient’s soft tissue balance. The technique will be described in detail.Results:The last 100 patients performed with complete data sets including navigation files and both pre-op and one year post operative outcome measures were reviewed. The spread of overall alignments and bony resections have been compiled with no outliers outside 5 degrees of neutral. The clinical results were comparable with other series and patient satisfaction of greater than 90% was reported. There were no MCL or LCL releases performed. Ilio-tibial band partial releases were the only reported soft tissue releases made.Conclusions:This technique is a safe and effective method of performing TKA with good short term outcomes. It minimises the use of soft tissue releases by utilising the patient’s own soft tissue envelope to balance the knee whilst maintaining the basic principles of a measured resection mechanical axis technique. It has resulted in excellent patient satisfaction in the short term.

Significant correlation of Cd, Cu, Pb and Zn in sediments and oysters (Saccostrea cucullata) collected from Qeshm Island, Persian Gulf, Iran

The relationships are evaluated between the heavy metal species in sediments and the accumulation by the soft tissues of Saccostrea cucullata collected from the northern and southern coasts of Qeshm Island, Persian Gulf. The sequential extraction technique was employed to fractionate the sediment into non resistant and resistant fractions. Data from sequential extractions indicated that the metals were mainly associated with the residual fraction at the north coast and with non residual fractions at the south coast. The results showed that the best correlations were observed between heavy metals concentrations in soft tissues and the fractions in the southern sediment. Note that the bioavailability of trace metals is influenced by the chemical characteristics and properties of the sediment. Therefore, the present results generally supported the use of soft tissues of S. cucullata as a more accurate biomonitoring organism for Cu, Pb and Cd in sediments from the southern coast of Qeshm Island, Persian Gulf.

Spatial distribution and sources of polycyclic aromatic hydrocarbons (PAHs) in green mussels (Perna viridis) from coastal areas of Peninsular Malaysia: implications for source identification of perylene

Distribution of polycyclic aromatic hydrocarbons (PAHs) was determined in green mussels (Perna viridis) from various sites in coastal waters of Peninsular Malaysia between August 2004 and January 2007, in order to assess contamination by petroleum hydrocarbons. The range of ∑PAHs detected in mussels was from 766 to 110500 (ng/g lipid wt.). High concentrations of PAHs were found in mussel tissues collected near Penang Bridge. The ratios of methyl phenanthrenes to phenanthrene (∑MP/P ratio) for Penang, Kg. Pasir Puteh and Tebing Runtuh (Johore Straits) were greater than 2, indicating extensive input of petrogenic PAHs. The results indicated that male individuals elevated more considerable concentrations of PAHs in their soft tissues in comparison to female individuals. The results of independent sample T-test showed that there were no significant differences (p > 0.05) between male and female mussels analysed in the Pasir Panjang station. Negative significant correlations (r = −0.890, p < 0.01) and (r = −0.0655, p < 0.05), were found between weight and total of PAHs in female and male species, respectively. This indicated that body weight of each individual was not affected by the PAHs concentrations. The present study proposes the use of soft tissue of Perna viridis as a biomonitor of perylene bioavailability and contamination in coastal waters of Peninsular Malaysia.

Use of mollusc shells for DNA-based molecular analyses

Genetic approaches are increasingly being considered for investigations into the systematics and the conservation biology of molluscs. Here, we investigate the potential of using shell material for DNAbased analyses, using the example of endangered freshwater pearl mussels (Margaritifera margaritifera). Tissue and shells from 15 dead specimens were sampled. Their shells were split into four-quarters and re-exposed to original stream water for zero (unexposed), 1, 3 and 6 months. The influences of exposure time and resulting shell degradation, different grinding procedures and different DNA extraction methods on the quantity and quality of extractable DNA were assessed, using tissue samples as a reference. A combination of short shell-exposure time, medium grinding size and phenol–chloroform extraction procedures resulted in the most robust PCR and in lowest microsatellite genotyping errors. Amplification of nine microsatellite loci was successful in 89% of samples derived from fresh shell DNA. Genotyping errors were mostly the result of false alleles (7.8%), whereas allelic dropout only occurred at a rate of 5.7%. Shell material re-exposed to stream water for 1 month did not produce reliable genotyping results but amplification of mitochondrial COI was still successful. Real-time quantitative PCR of microsatellite-flanking DNA regions was shown to be an effective tool for pre-assessing DNA-quantity in shell material. These results suggest that fresh shell material may be a useful source of DNA for genetic analyses in mollusc species if the increased risk of errors compared to the use of soft tissues is adequately addressed.

Facial Sculpting and Tissue Augmentation

Until recently, deep facial sculpting was exclusively the domain of surgical interventions. Recent advances in the available array of dermal and subdermal fillers combined with an esthetic appreciation by both surgeons and nonsurgeons alike of the positive effect of filling the volume-depleted face have led to an expansion in the indications for the use of soft tissue augmenting agents. Subdermal support of the lateral two-thirds of the brow, the nasojugal fold, the malar and buccal fat pads, the lateral lip commissures, and the perioral region, including the pre-jowl sulcus, all restore youthful facial contour and harmony. An important advance in technique is the subdermal rather than the intradermal injection plane. "Instant" facial sculpting giving a brow-lift, cheek-lift, lip expansion, and perioral augmentation is possible using modern soft tissue augmenting agents. The softer, more relaxed appearance contrasts to the somewhat "pulled" appearance of subjects who have had surgical overcorrections. Treatments can be combined with botulinum toxin and other procedures if required. Newer advances in the use of fillers include the use of fillers injected in the subdermal plane for "lunchtime" facial sculpting. Using the modern esthetic filler compounds, which are biodegradable but longer lasting, subjects can have a "rehearsal" treatment or make it ongoing. Some individuals, such as those with human immunodeficiency virus (HIV)-related lipoatrophy or those who desire to obtain a longer-lasting effect, may elect to use a nonbiodegradable filling agent.

Computed tomography and cross-sectional anatomy of the thorax in clinically normal dogs

To provide a detailed anatomic description of the thorax in clinically normal dogs by means of computed tomography. 4 clinically normal adult German Shepherd Dogs weighing 28 to 37 kg. Dogs were anesthetized and positioned in ventral recumbency for computed tomographic (CT) examination of the thorax. A CT image from the thoracic inlet to the diaphragm was made by use of a third-generation scanner with a slice thickness of 5 mm. Individual images were reviewed by use of soft tissue (window width, 250 Hounsfield units; window level, 35 Hounsfield units) and lung (window width, 1,000 Hounsfield units; window level, -690 Hounsfield units) settings. One dog, weighing 28 kg, was euthanatized, bound on a wooden frame in the same position as used for CT examination, and frozen at -14 degrees C until solid. By use of an electric band saw, the frozen thorax was sectioned at 10-mm-thick intervals. Slab sections were immediately cleaned, photographed, and compared with corresponding CT images. Anatomic sections were studied, and identified anatomic structures were matched with structures on corresponding CT images. Except for some blood vessels and details of the heart, most of the bony and soft tissue structures of the thorax discerned on anatomic slices could be found on matched CT images. Because CT images provide detailed information on most structures of the canine thorax, results of our study could be used as a guide for evaluation of CT images of the thorax of dogs with thoracic diseases.

Compatibility of elastomeric impression materials for use as soft tissue casts

The communication of soft tissue contours from the clinical situation to the laboratory technician through the laboratory phases of the dental implant restoration is enhanced with the use of soft tissue casts. Modern elastomeric impression materials can function well as both the master impression and soft tissue cast materials. The purpose of this study was to test the compatibility of a variety of elastomeric impression materials and commercially available soft tissue cast materials with various matrix impression materials. Chemical interaction between the materials may result in adhesion or inhibition of the set of the soft tissue cast material. The results of this study indicated that consideration must be given to material compatibility if predictably successful results are to be achieved in soft tissue cast fabrication.

Long acting steroid injections are safe and effective if given correctly

EDITOR,—The article on pain in the neck, shoulder, and arm advises on the choice of steroid preparations for intra-articular and soft tissue use in the conditions mentioned.1 I disagree with the authors that the use of long acting depot preparations should be avoided. Several studies have shown that hydrocortisone acetate is the weakest and triamcinolone hexacetonide and triamcinolone acetonide are the most potent of the steroids …

A Technique for the Investigation of the Competitive Saprophytic Ability of Soil Fungi by the Use of Easily Decomposed Substrates

THE method commonly used to determine the competitive saprophytic ability of soil fungi consists of exposing suitable substrates to colonization by the fungus in non-sterile soil. A serious disadvantage of this method is that only relatively resistant substrates, for example, wheat straw, can be used effectively because of the manipulation to which the substrate has to be subjected after incubation. Less-resistant substrates such as portions of non-woody roots, rhizomes and cylinders or disks of storage parenchyma of carrots or potatoes, etc., are so softened by the action of soft-rotting organisms in the soil that it becomes difficult to cleanse them adequately of adhering soil, and hence to state with confidence that fungi isolated from them have actually colonized the substrate in competition with the general soil microflora. It is very important to test the suitability of any potential substrate, for, as Garrett1 has pointed out in the case of root-infecting fungi, one is usually trying to demonstrate a negative character, that is, inability to compete as a soil saprophyte, and to obtain the strongest circumstantial evidence the killed host must be used as the substrate. A substrate such as wheat straw can probably only yield evidence relevant to fungi pathogenic to wheat or at most to cereals; hence the need to be able to employ any substrate that suggests itself. Since the chief obstacle to the use of soft tissues as substrates is the difficulty of removing the unwanted soil, the present method has been designed to prevent all unnecessary contact with the soil.