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Yamasaki S, Hashimoto Y, Iida K, Han C, Kinoshita T, Nishino K, Nishida Y, Takigami J, Nakamura H. Quadriceps Tendon With Bone Autograft Has Better Stability and Magnetic Resonance Imaging Maturation Than Hamstring Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Patients With Knee Hyperextension. Arthroscopy 2024; 40:1234-1244. [PMID: 37597704 DOI: 10.1016/j.arthro.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/22/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction between methods using quadriceps tendon with bone (QTB) and hamstring tendon (HT) in patients with hyperextension of the knee. METHODS The medical records of patients with knee hyperextension greater than 8° who underwent arthroscopic ACL reconstruction between October 2010 and October 2020 with follow-up for at least 2 years (median, 3 years; interquartile range [IQR], 2.0-4.6 years) were retrospectively reviewed. Side-to-side difference in anterior translation, pivot-shift test grade, Lysholm score, and graft intensity using the Howell grade on magnetic resonance imaging at final follow-up were compared between the QTB and HT groups. RESULTS The HT and QTB groups consisted of 42 patients and 21 patients, respectively. The overall mean age was 21.5 years (range, 14-48 years), and the median Tegner Activity Scale score was 6 (range, 3-9). Postoperatively, the median side-to-side difference in anterior translation was 1.75 mm (IQR, 1-3 mm) in the HT group and 1.0 mm (IQR, 0-1.75 mm) in the QTB group (P = .01). Pivot-shift testing showed grade 0 in 74.7%, grade 1 in 18.7%, and grade 2 in 6.6% of patients in the HT group and grade 0 in 85.7% and grade 1 in 14.3% of those in the QTB group (P = .03). The median postoperative Lysholm score was 99 in both groups. Graft signal intensity showed a significant between-group difference: grade I in 52%, grade II in 36%, and grade III in 12% of patients in the HT group versus grade I in 85.7%, grade II in 9.5%, and grade III in 4.8% of those in the QTB group (P = .03). CONCLUSIONS In patients who underwent ACL reconstruction for hyperextension of the knee, QTB yielded better clinical outcomes than HT with respect to anterior stability, rotational stability, and graft signal intensity on median 2-year follow-up magnetic resonance imaging. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Changhun Han
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Broeren BO, Hundepool CA, Kumas AH, Duraku LS, Walbeehm ET, Hooijmans CR, Power DM, Zuidam JM, De Jong T. The effectiveness of acellular nerve allografts compared to autografts in animal models: A systematic review and meta-analysis. PLoS One 2024; 19:e0279324. [PMID: 38295088 PMCID: PMC10829984 DOI: 10.1371/journal.pone.0279324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/07/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. OBJECTIVE To systematically review the efficacy of the acellular nerve allograft, its difference from the gold standard (the nerve autograft) and to discuss its possible indications. MATERIAL AND METHODS PubMed, Embase and Web of Science were systematically searched until the 4th of January 2022. Original peer reviewed paper that presented 1) distinctive data; 2) a clear comparison between not immunologically processed acellular allografts and autologous nerve transfers; 3) was performed in laboratory animals of all species and sex. Meta analyses and subgroup analyses (for graft length and species) were conducted for muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count diameter, tetanic contraction and amplitude using a Random effects model. Subgroup analyses were conducted on graft length and species. RESULTS Fifty articles were included in this review and all were included in the meta-analyses. An acellular allograft resulted in a significantly lower muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count and smaller diameter, tetanic contraction compared to an autologous nerve graft. No difference was found in amplitude between acellular allografts and autologous nerve transfers. Post hoc subgroup analyses of graft length showed a significant reduced muscle weight in long grafts versus small and medium length grafts. All included studies showed a large variance in methodological design. CONCLUSION Our review shows that the included studies, investigating the use of acellular allografts, showed a large variance in methodological design and are as a consequence difficult to compare. Nevertheless, our results indicate that treating a nerve gap with an allograft results in an inferior nerve recovery compared to an autograft in seven out of eight outcomes assessed in experimental animals. In addition, based on our preliminary post hoc subgroup analyses we suggest that when an allograft is being used an allograft in short and medium (0-1cm, > 1-2cm) nerve gaps is preferred over an allograft in long (> 2cm) nerve gaps.
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Affiliation(s)
- Berend O. Broeren
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Ali H. Kumas
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liron S. Duraku
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erik T. Walbeehm
- Department of Plastic, Reconstructive & Hand Surgery, Haga Hospital and Xpert Clinic, Den Haag, The Netherlands
| | - Carlijn R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Anesthesiology, Pain and Palliative Care (Meta Research Team), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dominic M. Power
- Department of Hand & Peripheral Nerve Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Michiel Zuidam
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Tim De Jong
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Mathot F, Saffari TM, Rbia N, Nijhuis TH, Bishop AT, Hovius SE, Shin AY. Functional Outcomes of Nerve Allografts Seeded with Undifferentiated and Differentiated Mesenchymal Stem Cells in a Rat Sciatic Nerve Defect Model. Plast Reconstr Surg 2021; 148:354-365. [PMID: 34153019 PMCID: PMC8373640 DOI: 10.1097/prs.0000000000008191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mesenchymal stem cells have the potential to produce neurotrophic growth factors and establish a supportive microenvironment for neural regeneration. The purpose of this study was to determine the effect of undifferentiated and differentiated mesenchymal stem cells dynamically seeded onto decellularized nerve allografts on functional outcomes when used in peripheral nerve repair. METHODS In 80 Lewis rats, a 10-mm sciatic nerve defect was reconstructed with (1) autograft, (2) decellularized allograft, (3) decellularized allograft seeded with undifferentiated mesenchymal stem cells, or (4) decellularized allograft seeded with mesenchymal stem cells differentiated into Schwann cell-like cells. Nerve regeneration was evaluated over time by cross-sectional tibial muscle ultrasound measurements, and at 12 and 16 weeks by isometric tetanic force measurements, compound muscle action potentials, muscle mass, histology, and immunofluorescence analyses. RESULTS At 12 weeks, undifferentiated mesenchymal stem cells significantly improved isometric tetanic force measurement and compound muscle action potential outcomes compared to decellularized allograft alone, whereas differentiated mesenchymal stem cells significantly improved compound muscle action potential outcomes. The autografts outperformed both stem cell groups histologically at 12 weeks. At 16 weeks, functional outcomes normalized between groups. At both time points, the effect of undifferentiated versus differentiated mesenchymal stem cells was not significantly different. CONCLUSIONS Undifferentiated and differentiated mesenchymal stem cells significantly improved functional outcomes of decellularized allografts at 12 weeks and were similar to autograft results in the majority of measurements. At 16 weeks, outcomes normalized as expected. Although differences between both cell types were not statistically significant, undifferentiated mesenchymal stem cells improved functional outcomes of decellularized nerve allografts to a greater extent and had practical benefits for clinical translation by limiting preparation time and costs.
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Affiliation(s)
- Femke Mathot
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tiam M. Saffari
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nadia Rbia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tim H.J. Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Allen T. Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven E.R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Hsu KF, Chiu YL, Chiao HY, Chen CY, Chang CK, Wu CJ, Peng YJ, Wang CH, Dai NT, Chen SG, Tzeng YS. Negative-pressure wound therapy combined with artificial dermis (Terudermis) followed by split-thickness skin graft might be an effective treatment option for wounds exposing tendon and bone: A retrospective observation study. Medicine (Baltimore) 2021; 100:e25395. [PMID: 33832132 PMCID: PMC8036026 DOI: 10.1097/md.0000000000025395] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/14/2021] [Indexed: 01/05/2023] Open
Abstract
Skin grafts are not suitable for closing tendon- or bone-exposing wounds, which require flap surgery. Dermal regeneration templates have value for closing such wounds, but the disadvantages of the technique include implantation failures because of infection, hematoma formation, or inappropriate immobilization. Negative-pressure wound therapy was reported to increase graft acceptance in difficult wounds.This retrospective case series of 65 patients evaluated negative-pressure therapy combined with artificial dermis for the treatment of acute or chronic tendon- or bone-exposing wounds. The artificial dermis was placed after adequate wound-bed preparation, with simultaneous application of a vacuum-assisted closure system. Split-thickness skin grafting was performed after the implanted artificial dermis had become established.The overall success rate was 88.1% (59/67): 88.6% (39/44) in the chronic wounds group and 87% (20/23) in the acute-trauma group separately. The overall mean survival time of artificial dermis in success cases was 13.24 ± 7.14 days. In separately, the survival time of artificial dermis had no statistically difference in chronic wound group (13.64 ± 7.53 vs 12.60 ± 5.86. P = .943), but had significant statistical difference in acute trauma group (12.45 ± 6.44 days vs 23.33 ± 4.04 days, P = .018). Also, comorbidity of PAOD was found a strong risk factor of failure in chronic wound group (100% vs 23.1%, P < 0.001).We concluded that artificial dermis combined with negative-pressure therapy followed by split-thickness skin grafting might be a reliable and effective option for surgical reconstruction of tendon- or bone-exposing wounds, and could decreasing waiting periods of autologous skin graft.
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Affiliation(s)
- Kuo-Feng Hsu
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Hao Yu Chiao
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chun-Yu Chen
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chun-Kai Chang
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Chien-Ju Wu
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital
| | - Chih-Hsin Wang
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Niann-Tzyy Dai
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Shyi-gen Chen
- Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Yuan-Sheng Tzeng
- Department of Surgery, Division of Plastic and Reconstructive Surgery
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Amelot A, Nataloni A, François P, Cook AR, Lejeune JP, Baroncini M, Hénaux PL, Toussaint P, Peltier J, Buffenoir K, Hamel O, Hieu PD, Chibbaro S, Kehrli P, Lahlou MA, Menei P, Lonjon M, Mottolese C, Peruzzi P, Mahla K, Scarvada D, Le Guerinel C, Caillaud P, Nuti C, Pommier B, Faillot T, Iakovlev G, Goutagny S, Lonjon N, Cornu P, Bousquet P, Sabatier P, Debono B, Lescure JP, Vicaut E, Froelich S. Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study. Neurochirurgie 2021; 67:301-309. [PMID: 33667533 DOI: 10.1016/j.neuchi.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
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Affiliation(s)
- A Amelot
- Neurosurgery department, Hôpital de Bretonneau, Tours, France.
| | - A Nataloni
- Clinical research department, Finceramica Faenza S.p.A, Ravenna, Italy
| | - P François
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - A-R Cook
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - J-P Lejeune
- Neurosurgery department, CHRU Lille, Lille, France
| | - M Baroncini
- Neurosurgery department, CHRU Lille, Lille, France
| | - P-L Hénaux
- Neurosurgery department, CHU Rennes, Rennes, France
| | - P Toussaint
- Neurosurgery department, CHU Amiens, Amiens, France
| | - J Peltier
- Neurosurgery department, CHU Amiens, Amiens, France
| | - K Buffenoir
- Neurosurgery department, CHU Nantes, Nantes, France
| | - O Hamel
- Neurosurgery department, CHU Nantes, Nantes, France
| | - P Dam Hieu
- Neurosurgery department, CHU Brest, Brest, France
| | - S Chibbaro
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Kehrli
- Neurosurgery department, CHU Angers, Angers, France
| | - M A Lahlou
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Menei
- Neurosurgery department, CHU Angers, Angers, France
| | - M Lonjon
- Neurosurgery department, CHU Nice, Nice, France
| | - C Mottolese
- Neurosurgery department, CHU Neurologique Lyon, Lyon, France
| | - P Peruzzi
- Neurosurgery department, CHU Maison Blanche, Reims, France
| | - K Mahla
- Neurosurgery department, clinique du Tonkin, Villeurbanne, France
| | - D Scarvada
- Neurosurgery department, CHU La Timone, Marseille, France
| | - C Le Guerinel
- Neurosurgery department, CHU Henri Mondor, Creteil, France
| | - P Caillaud
- Neurosurgery department, CH de la Côte Basque, Bayonne, France
| | - C Nuti
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - B Pommier
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - T Faillot
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - G Iakovlev
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - S Goutagny
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - N Lonjon
- Neurosurgery department, CHU Gui de Chauliac, Montpellier, France
| | - P Cornu
- Neurosurgery department, CHU Pitié-Salpêtrière, Paris, France
| | - P Bousquet
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - P Sabatier
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - B Debono
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - J-P Lescure
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - E Vicaut
- Clinical research unit (URC), Hôpital de Lariboisière, APHP, Paris, France
| | - S Froelich
- Neurosurgery department, Hôpital de Lariboisière, APHP, Paris, France
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Parkes CW, Leland DP, Levy BA, Stuart MJ, Camp CL, Saris DBF, Krych AJ. Hamstring Autograft Anterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement. Arthroscopy 2021; 37:609-616. [PMID: 33144236 PMCID: PMC7867617 DOI: 10.1016/j.arthro.2020.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the (1) rates of complications and reoperations, (2) rate of anterior cruciate ligament (ACL) graft failure, and (3) patient-reported outcomes (PROs) among patients after hamstring autograft ACL reconstruction (ACLR) with and without independent suture tape reinforcement at a minimum 2-year clinical follow-up. METHODS We performed a 1:2 matched-cohort comparison of patients who underwent hamstring autograft ACLR with and without independent suture tape reinforcement between July 2011 and July 2017. Patients were matched according to age, sex, body mass index, preinjury Tegner activity score, and concomitant meniscal injury. Medical records were reviewed for demographic characteristics, additional injuries, and concomitant procedures. PRO scores (including Tegner activity, Lysholm, and International Knee Documentation Committee scores) and physical examination findings were collected both preoperatively and at a minimum of 2 years postoperatively. RESULTS Overall, 108 patients who underwent ACLR were included: 36 patients (mean age, 25.3 years; range, 13-44 years) with independent suture tape reinforcement and 72 patients (mean age, 24.9 years; range, 13-54 years) without suture tape reinforcement. Overall, 5 of 36 suture tape patients (14%) and 10 of 72 control patients (14%) underwent reoperations. At an average follow-up of 26.1 months in the suture tape cohort and 31.3 months in the control cohort, 1 patient in the suture tape cohort and 4 patients in the control cohort experienced graft failure. There were no statistically significant differences between the suture tape and control groups regarding return-to-sport rate (89% and 88%, respectively), postoperative International Knee Documentation Committee score (94.4 and 93.8, respectively), and postoperative Lysholm score (95.6 and 94, respectively). There was a statistically significant difference between the suture tape and control groups in postoperative Tegner activity score, at 7.1 (95% confidence interval, 6.5-7.6) and 6.4 (95% confidence interval, 6.2-6.6), respectively (P = .026). CONCLUSIONS ACLR with hamstring autograft and independent suture tape reinforcement was performed safely with low rates of complications, graft failure, and reoperations with similar PROs, function, and return-to-sport rates when compared with hamstring autograft ACLR without suture tape reinforcement at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Chad W Parkes
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Devin P Leland
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Abstract
The shortcomings of autografts and allografts in bone defect healing have prompted researchers to develop suitable alternatives. Numerous biomaterials have been developed as bone graft substitutes each with their own advantages and disadvantages. However, in order to test if these biomaterials provide an adequate replacement of the clinical standard, a clinically representative animal model is needed to test their efficacy. In this chapter, we describe a mouse model that establishes a critical sized defect in the mid-diaphysis of the femur to evaluate the performance of bone graft substitutes. This is achieved by performing a femoral ostectomy and stabilization utilizing a femoral plate and titanium screws. The resulting defect enables the bone regenerative potential of bone graft substitutes to be investigated. Lastly, we provide instruction on assessing the torsional strength of the healed femurs to quantitatively evaluate the degree of healing as a primary outcome measure.
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Affiliation(s)
- Ryan P Trombetta
- Orthopedic Trauma Department, US Army Institute for Surgical Research, San Antonio, TX, USA
| | - Emma K Knapp
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Hani A Awad
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA.
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8
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Marfil-Garza BA, Kim R, Shapiro AMJ, Kin T. Frequency of Obliteration of the Dorsal and Ventral Ducts of the Pancreas in Islet Transplantation. Dig Dis Sci 2021; 66:218-223. [PMID: 32086688 DOI: 10.1007/s10620-020-06145-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Islet isolation is an essential process in every human islet transplantation protocol. Intraductal enzyme delivery followed by adequate distention of the pancreas is the most critical step in islet isolation. Anomalies of the pancreatic duct system can significantly affect this process. Thus, identification and characterization of ductal patency is of paramount importance to achieve optimal islet isolation. AIMS To investigate the frequency of duct obliteration in the human pancreas and explore donor/patient characteristics associated with specific ductal variations. METHODS We examined ductal patency of pancreata allocated for islet allotransplantation (n = 597) and autotransplantation (n = 21) after removal of the duodenum during islet isolation procedure. Donor/patient factors were reviewed from the batch files. RESULTS Among 559 deceased donor pancreata without pancreas divisum (n = 38, 6.4%), both ducts were patent in 50.1%, only ventral duct was patent in 46.7%, and only dorsal duct was patent in 3.2%. Donor age was not associated with the frequency of obliterated dorsal duct. Black race tended to have the higher frequency of patent dorsal duct. As expected, pancreas divisum was more frequent in chronic pancreatitis cases (n = 6, 28.6%). Within 7 cases of chronic pancreatitis with unknown etiology, we encountered one case of ventral duct obliteration. CONCLUSIONS The minor duodenal papilla and aging do not likely play an important role in the occurrence of dorsal duct obliteration. Although frequency of obliterated ventral duct was low in our population, physicians, including gastroenterologists and endoscopists, as well as islet transplantation researchers should be aware of this possibility.
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Affiliation(s)
- Braulio A Marfil-Garza
- Clinical Islet Transplant Program, University of Alberta, 210 College Plaza 8215-112 St, Edmonton, AB, T6G2C8, Canada
| | - Ryekjang Kim
- Department of Pharmacology, University of Alberta, Edmonton, AB, Canada
| | - A M James Shapiro
- Clinical Islet Transplant Program, University of Alberta, 210 College Plaza 8215-112 St, Edmonton, AB, T6G2C8, Canada
| | - Tatsuya Kin
- Clinical Islet Transplant Program, University of Alberta, 210 College Plaza 8215-112 St, Edmonton, AB, T6G2C8, Canada.
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Haggerty EK, Marcaccio SE, Fadale PD, Hulstyn MJ, Owens BD. Bridge-Enhanced Anterior Cruciate Ligament Repair: The Next Step Forward in ACL Treatment. R I Med J (2013) 2020; 103:37-40. [PMID: 32872688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are common in young and active patients. In this patient population, surgical treatment with an autograft tendon is recommended to reconstruct a new ACL. ACL reconstruction has a high patient satisfaction, improved patient reported outcomes and allows young patients to return to an active lifestyle, including sports. However, long-term follow-up shows these patients are at higher risk for degenerative arthritis, frequently at a young age. Recent research has focused on re-investigating the utility of performing an ACL repair rather than a reconstruction in the hopes that maintaining a patient's native ligament may not only restore knee stability, but provide improved knee kinematics and lessen the risk of late osteoarthritis and also limit donor site morbidity from autograft harvests. Historically, patients undergoing ACL repair suffered poor outcomes due to issues with intra-articular healing of the ligament; but now, with new bioengineering techniques, bridge-enhanced ACL repairs may provide a feasible alternative in the treatment of ACL injuries.
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Affiliation(s)
- Erin K Haggerty
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Stephen E Marcaccio
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Paul D Fadale
- Professor of Orthopaedic Surgery; Chief, Division of Sports Medicine, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael J Hulstyn
- Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Brett D Owens
- Director, The Rhode Island Cartilage Repair Center; Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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Stefani RM, Lee AJ, Tan AR, Halder SS, Hu Y, Guo XE, Stoker AM, Ateshian GA, Marra KG, Cook JL, Hung CT. Sustained low-dose dexamethasone delivery via a PLGA microsphere-embedded agarose implant for enhanced osteochondral repair. Acta Biomater 2020; 102:326-340. [PMID: 31805408 PMCID: PMC6956850 DOI: 10.1016/j.actbio.2019.11.052] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/16/2022]
Abstract
Articular cartilage defects are a common source of joint pain and dysfunction. We hypothesized that sustained low-dose dexamethasone (DEX) delivery via an acellular osteochondral implant would have a dual pro-anabolic and anti-catabolic effect, both supporting the functional integrity of adjacent graft and host tissue while also attenuating inflammation caused by iatrogenic injury. An acellular agarose hydrogel carrier with embedded DEX-loaded poly(lactic-co-glycolic) acid (PLGA) microspheres (DLMS) was developed to provide sustained release for at least 99 days. The DLMS implant was first evaluated in an in vitro pro-inflammatory model of cartilage degradation. The implant was chondroprotective, as indicated by maintenance of Young's modulus (EY) (p = 0.92) and GAG content (p = 1.0) in the presence of interleukin-1β insult. In a subsequent preliminary in vivo experiment, an osteochondral autograft transfer was performed using a pre-clinical canine model. DLMS implants were press-fit into the autograft donor site and compared to intra-articular DEX injection (INJ) or no DEX (CTL). Functional scores for DLMS animals returned to baseline (p = 0.39), whereas CTL and INJ remained significantly worse at 6 months (p < 0.05). DLMS knees were significantly more likely to have improved OARSI scores for proteoglycan, chondrocyte, and collagen pathology (p < 0.05). However, no significant improvements in synovial fluid cytokine content were observed. In conclusion, utilizing a targeted DLMS implant, we observed in vitro chondroprotection in the presence of IL-1-induced degradation and improved in vivo functional outcomes. These improved outcomes were correlated with superior histological scores but not necessarily a dampened inflammatory response, suggesting a primarily pro-anabolic effect. STATEMENT OF SIGNIFICANCE: Articular cartilage defects are a common source of joint pain and dysfunction. Effective treatment of these injuries may prevent the progression of osteoarthritis and reduce the need for total joint replacement. Dexamethasone, a potent glucocorticoid with concomitant anti-catabolic and pro-anabolic effects on cartilage, may serve as an adjuvant for a variety of repair strategies. Utilizing a dexamethasone-loaded osteochondral implant with controlled release characteristics, we demonstrated in vitro chondroprotection in the presence of IL-1-induced degradation and improved in vivo functional outcomes following osteochondral repair. These improved outcomes were correlated with superior histological cartilage scores and minimal-to-no comorbidity, which is a risk with high dose dexamethasone injections. Using this model of cartilage restoration, we have for the first time shown the application of targeted, low-dose dexamethasone for improved healing in a preclinical model of focal defect repair.
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Affiliation(s)
- Robert M Stefani
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Andy J Lee
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Andrea R Tan
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Saiti S Halder
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Yizhong Hu
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - X Edward Guo
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Aaron M Stoker
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia 65212, MO, United States
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States; Department of Mechanical Engineering, Columbia University, 500 West 120th Street, 220 S.W. Mudd, New York 10027, NY, United States
| | - Kacey G Marra
- University of Pittsburgh, Biomedical Science Tower, 200 Lothrop Street, Pittsburgh 15213, PA, United States
| | - James L Cook
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia 65212, MO, United States
| | - Clark T Hung
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States.
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Beck JJ, Takamura K, Beck JM, Chang G, Bowen RE. Iliotibial band autograft: what size is the graft? A mathematical and cadaveric model : ITB single and double strand size. Arch Orthop Trauma Surg 2020; 140:19-23. [PMID: 31127410 DOI: 10.1007/s00402-019-03208-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The iliotibial band (ITB) is used in anterior cruciate ligament (ACL) reconstruction in skeletally immature patients as well as several other orthopedic reconstructions. The purpose of this study is to determine the size of the ITB as an autograft option in ACL reconstruction surgery or other orthopedic soft tissue reconstructions. METHODS Five adult cadavers resulting in nine ITB were used. Thickness and width of the ITB were determined. Using ITB width of 15-60 mm, single and doubled graft sizes were determined using standard surgical graft size technique. Geometric calculations based on average graft thickness were used to mathematically confirm the graft size of the ITB. RESULTS The ITB is less than 1 mm in thickness in males and females. Cadaveric measurements were less than 1 mm larger than mathematical measurements, in majority of measurements. ITB autograft can be harvested to a maximum 9 mm single-stranded graft or > 12 mm doubled graft. A minimum of 50 mm of ITB width is required to make a 8 mm graft. CONCLUSIONS ITB is a versatile graft that can be used for a graft size up to 9 mm single strand and over 12 mm double strand. A minimum of 50 mm width of ITB is required to obtain a 8 mm-diameter autograft. To ensure appropriate graft size, surgeons should consider harvesting the maximum amount of ITB when performing ACL reconstructions in skeletally immature patients. CLINICAL RELEVANCE Surgeons have a quick reference for the width of ITB they should harvest based on the size of graft they require for a successful surgery.
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Affiliation(s)
- Jennifer J Beck
- Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA.
| | - Karren Takamura
- Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA
| | - Jeanne M Beck
- Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA
| | - Grace Chang
- Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA
| | - Richard E Bowen
- Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA
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Wang CL, Luan SS, Panayi AC, Xin MQ, Luan J. Methods used for evaluation of volume retention rate in autologous fat grafting for breast augmentation: a systematic review. Chin Med J (Engl) 2019; 132:2223-2228. [PMID: 31490259 PMCID: PMC6797153 DOI: 10.1097/cm9.0000000000000415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate. METHODS Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria. RESULTS A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different. CONCLUSIONS Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.
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Affiliation(s)
- Cheng-Long Wang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Si-Si Luan
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Adriana C. Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Min-Qiang Xin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Jie Luan
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
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Syllaios A, Tsimpoukelis A, Vagios I, Kyros E, Davakis S. Breast reconstruction with autologous fat combined with platelet rich plasma: fighting between medical novelty and cancer biology. J BUON 2019; 24:1516-1520. [PMID: 31646801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The use of autologous fat transplantation for reconstruction purposes after mastectomy or Breast Conserving Treatment (BCT) for Breast Cancer (BC) has increased significantly the past twenty years. Adipose-derived stemm cells hold great tissue regenerative potential due to their established ability to improve the healing process through in situ differentiation and secretion of paracrine factors. Platelet-rich Plasma (PRP), contains high levels of diverse human growth factors for stem cells proliferation and differentiation in the course of tissue regeneration, and it has recently been accepted by many as a highly promising method for tissue regeneration. The molecular mechanisms mediating this effect are unclear and still remain under investigation. Major disadvantages on the use of PRP are not reported. Promising results in enhancing the survival of grafted fat has been shown with PRP with the potential of affecting patient's oncological outcome when applied on tumor excision sites.
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Affiliation(s)
- Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Pal M, Gupta K, Kumar S, Gopalkrishna P. Use of a mandibular torus for autogenous grafting: a case report. Gen Dent 2018; 66:73-76. [PMID: 30188861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Conventional treatment for the management of 2- to 3-walled intrabony defects is the use of allograft or alloplasts. Autogenous grafts are the gold standard because of their osteogenic potential. Mandibular tori are an ideal site for harvesting bone because their excision causes no structural, esthetic, or functional compromise to the patient. This case report describes the use of an autogenous graft obtained from a mandibular torus. The graft was utilized, in particulate form, to fill an intrabony defect at the mandibular right central incisor. The mandibular torus provided sufficient graft material and eliminated the need for a second surgical site. A follow-up at 1 year revealed reduction in clinical attachment loss and complete resolution of tooth mobility.
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Runer A, Wierer G, Herbst E, Hepperger C, Herbort M, Gföller P, Hoser C, Fink C. There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc 2018; 26:605-614. [PMID: 28477270 DOI: 10.1007/s00167-017-4554-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/19/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE Graft choice for anterior cruciate ligament (ACL) reconstruction is crucial, however the optimal graft source remains a topic of controversy. The purpose of this study is to compare subjective and functional patient-reported outcomes (PRO) after single-bundle ACL reconstruction using quadriceps tendon (QT) or hamstring tendon (HT) autografts for single-bundle ACL reconstruction. We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft. METHODS All data were extracted from a prospectively collected ACL registry. A total of 80 patients with at least 2-year follow-up were included in this study. A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex, age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts. Subjective and functional PRO scores including Lysholm score, Tegner activity level and visual analogue scale for pain were obtained at 6, 12 and 24 months after index surgery. RESULTS No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain. 24 months post-surgery the mean Tegner activity score of the HT group was significantly (p = 0.04) lower compared to the pre-injury status. At final follow-up, 27 patients (67.5%) in the QT group and 32 patients (80.0%) in the HT returned to their pre-injury activity level (n.s.). A total of 37 patients (92.5%) of the QT cohort and 35 patients (87.5%) of the HT cohort reported "good" or "excellent" results according to the Lysholm score (n.s.). "No pain" or "slight pain" during severe exertion was reported by 33 patients (82.5%) with QT autograft and 28 patients (82.4%) with HT autograft (n.s.). CONCLUSION There is no significant difference between PRO 2 years post-operative using either QT or HT autografts. Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Armin Runer
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
- Medical University of Innsbruck, Innsbruck, Austria
| | - Guido Wierer
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
- Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Elmar Herbst
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
- Department for Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Caroline Hepperger
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Peter Gföller
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria.
| | - Christian Hoser
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt, Sport- and Joint Surgery, Olympiastrasse 36, 6020, Innsbruck, Austria
- ISAG - Institute for Sports Medicine, Alpine Medicine and Health Tourism/UMIT, Hall in Tirol, Austria
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Sukop A, Tichá P, Molitor M. [Treatment Options for Inveterate Injuries of Deep Finger Flexors - Primary Transplantation with Tendon Graft]. Acta Chir Orthop Traumatol Cech 2018; 85:370-372. [PMID: 30383535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Injuries of the flexor finger apparatus are very common. Primarily, it is routinely treated by suture of the tendon. Isolated deep flexor injuries, when the flexion restriction only reaches the DIP joint, are sometimes overlooked by the surgeon or by the patients themselves, especially if the deep flexor is injured, after a closed rupture or cutaneous injury with a small skin wound. The patient is then sent to a department specializing in hand surgery after a few weeks. Subsequent shortening of the tendon apparatus makes flexor suture more difficult or sometimes even impossible. Many ways of suturing the tendons and subsequent treatment are described. The treatment results vary immensely. It depends on the mechanism of injury, injury zone, the suture suture technique used, time that has elapsed since primary treatment, surgeon experience and subsequent postoperative and rehabilitative care. One of them is reconstruction of the flexor apparatus by primary transplantation of an autologous tendon graft. Most commonly, the tendon graft is taken from the palmaris longusfrom the same hand. The tendon graft can subsitute the entire area of zones I and II. The tendon suture is made in the palm proximal to the A1 pulley outside the tendon sheath in the area where the muscular belly of thelumbricalis is located on the tendon of the deep flexor. The distal end is reinserted to the base of the distal phalanx. The primary use of the autologous tendon graft can be used in the reconstruction of obsolete deep-flexor injuries in Zone II, but also in primary treatments. This type of treatment has a number of advantages. Performing the reinforcement of the tendon at the base of the distal phalanxand the suture in the palm of the hand completely eliminates the complications caused by the tendon suture in zone II. There is no injury to the tendon sheath, or the need for intersection of the tendons. The transplanted tendon is smaller in diameter than the deep flexor, so it can also be used for older injuries when the tendon sheath is in partially missing. It removes painful palmar resistance by restoring the right position and a tension of tendon of lumbricalis and the tendon of the deep flexor. This type of reconstruction allows immediate active or semi-rehabilitation of the hand and fingers. Key words:tendon, injury, hand, transplantation, surgery, flexor, reconstruction, rupture, treatment.
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Affiliation(s)
- A Sukop
- Klinika plastické chirurgie 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha
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Ye F, Zeng Z, Wang J, Liu H, Wang H, Zheng Z. Comparison of the use of rhBMP-7 versus iliac crest autograft in single-level lumbar fusion: a meta-analysis of randomized controlled trials. J Bone Miner Metab 2018; 36:119-127. [PMID: 28342094 DOI: 10.1007/s00774-017-0821-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
Abstract
The aim of this study was to evaluate the safety and clinical effectiveness of rhBMP-7 (or osteogenic protein-1) versus that of autogenous iliac crest bone graft (ICBG) in single-level posterolateral fusion (PLF) of the lumbar spine. A systematic search of all articles published through July 1, 2016 was conducted in databases such as PubMed, EMBASE, Scopus, and the Cochrane Collaboration Library. Randomized controlled trials (RCTs) that compared rhBMP-7 with ICBG for the treatment of single-level degenerative spondylolisthesis, provided the fusion rate, clinical success rate, safety and adverse events report, operation time, and hospital stay durations as the outcome were assessed. As a result, a total of five RCTs involving 539 patients met the inclusion criteria. The outcomes of subgroup analysis demonstrated that when compared with autogenous ICBG, rhBMP-7 appear to yield lower fusion rates in instrumented posterolateral fusion patients (RR = 0.76, 95% CI [0.60, 0.98], P = 0.03), despite the test for overall fusion rates suggested that there was no significant difference between the two groups (RR = 0.89, 95% CI [0.78, 1.02], P = 0.09). Patients treated with OP-1 had shorter operation times versus those treated with ICBG (WMD = -16.70,95% CI [-25.83, -7.57], P = 0.0003). Additionally, the outcomes demonstrated a lack of significant differences between rhBMP-7 and ICBG in terms of clinical success of ODI, overall adverse events, revision rates and duration of hospitalization. In conclusion, with the exception of reducing the operation time, our review suggests that the use of the rhBMP-7 instead of ICBG produce no any additional beneficial effect on the fusion rates, clinical success of ODI, overall adverse events, revision rates and duration of hospitalization in single level PLF. On the contrary, it appeared to yield lower fusion rate in the instrumented posterolateral fusion patients and cannot be recommended as an effective tool for this set of patients.
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Affiliation(s)
- Fubiao Ye
- Department of Orthopaedic, Fujian Provincial Hospital, Provincial Clinical Medical College Affiliated to Fujian Medical University, 134 East Street, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhiyuan Zeng
- Department of Orthopedics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Jianru Wang
- Department of Orthopaedic, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, 510080, People's Republic of China
| | - Hui Liu
- Department of Orthopaedic, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, 510080, People's Republic of China
| | - Hua Wang
- Department of Orthopaedic, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, 510080, People's Republic of China.
| | - Zhaomin Zheng
- Department of Orthopaedic, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, 510080, People's Republic of China.
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Akita S, Hayashida K, Yoshimoto H, Fujioka M, Senju C, Morooka S, Nishimura G, Mukae N, Kobayashi K, Anraku K, Murakami R, Hirano A, Oishi M, Ikenoya S, Amano N, Nakagawa H. Novel Application of Cultured Epithelial Autografts (CEA) with Expanded Mesh Skin Grafting Over an Artificial Dermis or Dermal Wound Bed Preparation. Int J Mol Sci 2017; 19:ijms19010057. [PMID: 29295606 PMCID: PMC5796007 DOI: 10.3390/ijms19010057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/17/2022] Open
Abstract
Cultured epithelial autografts (CEA) with highly expanded mesh skin grafts were used for extensive adult burns covering more than 30% of the total body surface area. A prospective study on eight patients assessed subjective and objective findings up to a 12-month follow-up. The results of wound healing for over 1:6 mesh plus CEA, gap 1:6 mesh plus CEA, and 1:3 mesh were compared at 3, 6, and 12 months using extensibility, viscoelasticity, color, and transepidermal water loss by a generalized estimating equation (GEE) or generalized linear mixed model (GLMM). No significant differences were observed among the paired treatments at any time point. At 6 and 12 months, over 1:6 mesh plus CEA achieved significantly better expert evaluation scores by the Vancouver and Manchester Scar Scales (p < 0.01). Extended skin grafting plus CEA minimizes donor resources and the quality of scars is equal or similar to that with conventional low extended mesh slit-thickness skin grafting such as 1:3 mesh. A longitudinal analysis of scars may further clarify the molecular changes of scar formation and pathogenesis.
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Affiliation(s)
- Sadanori Akita
- Department of Plastic Surgery, Wound Repair and Regeneration, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan.
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
| | - Kenji Hayashida
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
- Division of Plastic and Reconstructive Surgery, Shimane University Hospital, Shimane 693-0021, Japan.
| | - Hiroshi Yoshimoto
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
| | - Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki 856-8562, Japan.
| | - Chikako Senju
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki 856-8562, Japan.
| | - Shin Morooka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki 856-8562, Japan.
| | - Gozo Nishimura
- Department of Plastic and Reconstructive Surgery, Fukuoka Tokushukai Hospital, Fukuoka 816-0864, Japan.
| | - Nobuhiko Mukae
- Department of Plastic and Reconstructive Surgery, Kitakyushu General Hospital, Kitakyushu 802-8517, Japan.
| | - Kazuo Kobayashi
- Department of Plastic and Reconstructive Surgery, Ehime Prefectural Central Hospital, Ehime 790-0024, Japan.
| | - Kuniaki Anraku
- Department of Plastic and Reconstructive Surgery, Sasebo City General Hospital, Sasebo 857-0056, Japan.
| | - Ryuichi Murakami
- Department of Plastic and Reconstructive Surgery, Yamaguchi Prefectural Grand Medical Center, Osaki 747-8511, Japan.
| | - Akiyoshi Hirano
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
| | - Masao Oishi
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan.
| | - Shintaro Ikenoya
- Department of Plastic and Reconstructive Surgery, Matsue Red Cross Hospital, Matsue 690-8506, Japan.
| | - Nobuyuki Amano
- Department of Plastic and Reconstructive Surgery, Yamaguchi Prefectural Grand Medical Center, Osaki 747-8511, Japan.
| | - Hiroshi Nakagawa
- Department of Plastic and Reconstructive Surgery, Ehime Prefectural Central Hospital, Ehime 790-0024, Japan.
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Pham TT, Kany J, Lakhal W, Sales de Gauzy J, Accadbled F. Arthroscopic Osteochondral Autograft Transfer for Juvenile Osteochondritis Dissecans of the Humeral Head: A Case Report. JBJS Case Connect 2017; 7:e63. [PMID: 29252892 DOI: 10.2106/jbjs.cc.17.00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome. CONCLUSION Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.
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Affiliation(s)
- Thuy Trang Pham
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Jean Kany
- Service de Chirurgie Orthopédique, Clinique de l'Union, Saint-Jean, France
| | - Walid Lakhal
- Service de Chirurgie Orthopédique Pédiatrique, Le Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Jérôme Sales de Gauzy
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Franck Accadbled
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
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Oranges CM, Tremp M, di Summa PG, Haug M, Kalbermatten DF, Harder Y, Schaefer DJ. Gluteal Augmentation Techniques: A Comprehensive Literature Review. Aesthet Surg J 2017; 37:560-569. [PMID: 28203698 DOI: 10.1093/asj/sjw240] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Many studies of gluteal augmentation techniques have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter survey reviews. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. Objectives The authors performed a comprehensive literature review to determine outcomes and complications of gluteoplasty techniques, including patient satisfaction. Methods A search on PubMed/Medline was performed for clinical studies involving gluteal augmentation techniques. A priori criteria were used to review the resulting articles. Results Fifty-two studies, published from 1969 through 2015, were included - representing 7834 treated patients. Five gluteal augmentation techniques were identified from these studies: gluteal augmentation with implants (n = 4781), autologous fat grafting (n = 2609), local flaps (n = 369), hyaluronic acid gel injection (n = 69), and local tissue rearrangement (n = 6). The overall complication rates of the most commonly utilized techniques were: 30.5% for gluteal augmentation with implants, 10.5% for autologous fat grafting, and 22% for local flaps. Patients' satisfaction was reported as consistently high for all the five techniques. Conclusions Implant-based gluteal augmentation is associated with high patients' satisfaction despite a high complication rate, while autologous fat grafting is associated with the lowest complication rate yet including serious major complications such as fat embolism. Local flaps and local tissue rearrangements are the ideal procedures in case of massive weight loss patients. A paucity of data is available for hyaluronic acid gel injections, which appear to be effective but temporary and expensive. Level of Evidence 4
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Affiliation(s)
- Carlo M Oranges
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | - Yves Harder
- Division of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano (ORL), Breast Centre of Switzerland (CSSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Basel University Hospital, Basel, Switzerland
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Zhao LP, Zhan YL, Hu WJ, Wang HJ, Wei YP, Zhen M, Xu T, Liu YS. [Dental implantation and soft tissue augmentation after ridge preservation in a molar site: a case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:1090-1094. [PMID: 27987520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For ideal implant rehabilitation, an adequate bone volume, optical implant position, and stable and healthy soft tissue are required. The reduction of alveolar bone and changes in its morphology subsequent to tooth extraction will result in insufficient amount of bone and adversely affect the ability to optimally place dental implants in edentulous sites. Preservation of alveolar bone volume through ridge preservation has been demonstrated to reduce the vertical and horizontal contraction of the alveolar bone crest after tooth extraction and reduce the need for additional bone augmentation procedures during implant placement. In this case, a patient presented with a mandible molar of severe periodontal disease, the tooth was removed as atraumatically as possible and the graft material of Bio-Oss was loosely placed in the alveolar socket without condensation and covered with Bio-Gide to reconstruct the defects of the alveolar ridge. Six months later, there were sufficient height and width of the alveolar ridge for the dental implant, avoiding the need of additional bone augmentation and reducing the complexity and unpredictability of the implant surgery. Soft tissue defects, such as gingival and connective tissue, played crucial roles in long-term implant success. Peri-implant plastic surgery facilitated development of healthy peri-implant structure able to withstand occlusal forces and mucogingival stress. Six months after the implant surgery, the keratinized gingiva was absent in the buccal of the implant and the vestibular groove was a little shallow. The free gingival graft technique was used to solve the vestibulum oris groove supersulcus and the absence of keratinized gingiva around the implant. The deepening of vestibular groove and broadening of keratinized gingiva were conducive to the long-term health and stability of the tissue surrounding the implant. Implant installation and prosthetic restoration showed favorable outcome after six months.
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Affiliation(s)
- L P Zhao
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y L Zhan
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - W J Hu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - H J Wang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y P Wei
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - M Zhen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - T Xu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
| | - Y S Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
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You DJ, Yoon HJ. Bone Regeneration with Bilayer Bone Augmentation Technique for the Treatment of Dehiscence-Type Defects Around Implants: A Preliminary Study in Dogs. Int J Oral Maxillofac Implants 2016; 31:318-23. [PMID: 27004279 DOI: 10.11607/jomi.4234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to histomorphometrically compare the effects of the bilayer bone augmentation technique for the treatment of dehiscence-type defects around implants and evaluate the role as a membrane of the xenogeneic bone positioned as the outer layer in the bilayer bone augmentation technique. MATERIALS AND METHODS Four standardized dehiscence defects measuring 5 mm in height from the crestal bone, 3 mm in width mesiodistally, and 4 mm in depth from the surface of the buccal bone were prepared on each mandible unilaterally in three dogs, and one implant was placed per defect, where each defect was treated with autograft, xenograft, the bilayer bone augmentation technique, or negative control without a membrane. The animals were sacrificed after an 8-week healing interval for histomorphometric analyses. The measurements of newly formed bone height, newly formed bone height contacting the implant, newly formed bone area, and the width of newly formed bone were made using incandescent and polarized light microscopy. RESULTS Bone height and newly formed bone height contacting the implant in the autograft group were higher than in the xenograft, bilayer bone augmentation, and control groups. Newly formed bone area in the bilayer bone augmentation and autograft groups was higher than in the xenograft and control groups. The width of newly formed bone at 4.5 mm apically from the implant shoulder was greater in the xenograft and bilayer bone augmentation groups than in the control and autograft groups. However, the differences between the groups in bone height, newly formed bone height contacting the implant, newly formed bone area, and width of newly formed bone were not statistically significant in the histomorphometric examinations (P < .05). Data were verified with the Kruskal-Wallis test. CONCLUSION The results of this study show the osteogenic effect of autogenous bone and the effect of mechanical support for prolonged space maintenance of xenogeneic bone for the treatment of dehiscence-type defects around implants. Further studies with a larger sample size are needed to confirm the efficacy of the bilayer bone augmentation technique.
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Abstract
Autologous skin grafts, such as full- and split-thickness, have long been part of the reconstructive ladder as an option to close skin defects. Although they are effective in providing coverage, they require the need for a trained surgeon, use of anaesthesia and operating room and creation of a wound at the donor site. These drawbacks can be overcome with the use of epidermal skin grafts (ESGs), which can be harvested without the use of anaesthesia in an office setting and with minimal to no scarring at the donor site. ESGs consist only of the epidermal layer and have emerged as an appealing alternative to other autologous grafts for the treatment of acute and chronic wounds. In this article, we provide an overview of epidermal grafting and its role in wound management.
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Affiliation(s)
- Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olivia B Hughes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Flor Macquhae
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adele Rakosi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Björnsson H, Samuelsson K, Sundemo D, Desai N, Sernert N, Rostgård-Christensen L, Karlsson J, Kartus J. A Randomized Controlled Trial With Mean 16-Year Follow-up Comparing Hamstring and Patellar Tendon Autografts in Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2016; 44:2304-13. [PMID: 27229354 DOI: 10.1177/0363546516646378] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no consensus in the current literature on which surgical options render the best long-term results after anterior cruciate ligament (ACL) reconstruction in terms of clinical outcomes and the development of radiographic osteoarthritis (OA). PURPOSE To investigate the long-term clinical and radiographic results after ACL reconstruction using either a patellar tendon (PT) autograft or a hamstring tendon (HT) autograft. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS This multicenter study was based on 2 previous randomized cohorts consisting of 193 patients who underwent unilateral primary ACL reconstruction using either a PT autograft or an HT autograft. The index surgical procedure was performed between September 1995 and January 2000. Clinical assessments, including knee laxity measurements, functional outcomes, patient-reported outcomes, and bilateral standing radiographs, were performed at the final follow-up examination. RESULTS At the long-term follow-up, 147 (76%) patients were examined: 61 in the PT group and 86 in the HT group. The mean (±SD) follow-up time was 191.9 ±15.1 months for the HT group and 202.6 ± 10.4 months for the PT group. Knee laxity measurements revealed significantly more patients with a normal pivot-shift test finding in the HT group compared with the PT group (71% vs 51%, respectively; P = .048); however, no significant differences were found in terms of the manual Lachman test or the KT-1000 arthrometer manual maximum test. The patients in the PT group had significantly more difficulty knee walking (P = .049). There were no significant differences between the study groups in terms of patient-reported outcomes or range of motion in the reconstructed knee. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral healthy knee. However, there were no significant differences between the groups in terms of radiographic OA. CONCLUSION Only minor and mostly insignificant differences were found between the PT and HT autograft groups in this long-term randomized controlled trial. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral knee.
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Affiliation(s)
- Haukur Björnsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Sundemo
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neel Desai
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ninni Sernert
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Research and Development, NU-Hospital Group, Trollhättan/Uddevalla, Sweden Department of Orthopaedics, NU-Hospital Group, Trollhättan/Uddevalla, Sweden
| | | | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jüri Kartus
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Research and Development, NU-Hospital Group, Trollhättan/Uddevalla, Sweden Department of Orthopaedics, NU-Hospital Group, Trollhättan/Uddevalla, Sweden
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Machtei EE, Rozitky D, Zigdon-Giladi H, Horwitz J. Dimensional Changes Following Lateral Wall Sinus Augmentation Without Concomitant Implant Placement Using a Composite Bone Graft. Int J Oral Maxillofac Implants 2016; 31:87-91. [PMID: 26800165 DOI: 10.11607/jomi.4084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate changes in sinus dimensions immediately postoperatively and 1 year later using a composite of bovine-derived xenograft and autogenous bone for lateral bone augmentation of the maxillary sinus. MATERIALS AND METHODS Patients who underwent lateral wall sinus augmentation procedures without concomitant implant placement were considered for this retrospective analysis if they had three consecutive panoramic radiographs: pretreatment (T0), immediately after lateral wall sinus augmentation (T1), and approximately 1 year postoperatively (T2). Eighteen subjects aged 47 to 69 years were included. The surgical protocol included grafting with a composite of bovine-derived xenograft and autogenous bone (9:1 ratio). Digital panoramic radiographs were transferred into measurement software, and the following measurements were performed: (1) vertical distance from the alveolar crest to the height of the augmented material, (2) sagittal area of the grafted area, and (3) vertical distance from the alveolar crest to the roof of the maxillary sinus. All measurements were performed by one examiner. Double measurements were performed in nine patients at T2, and the calculated Cronbach's alpha statistic was very high (.9658 to .9882). RESULTS The mean overall sinus sagittal area was 1,330 ± 481 mm2 prior to the grafting procedure, when it decreased to 858.2 ± 436 mm2 (range, 380.7 to 2,134 mm2) immediately postoperatively (P = .0035) and remained stable at 1 year (mean, 882.2 ± 384 mm2, P > .05). Similarly, the overall area of the grafted material at the time of surgery was 468.3 ± 208 mm2 and was only slightly reduced at 1 year (422.2 ± 193 mm2). The midsagittal graft height at T1 (mean, 20.67 ± 4.5 mm) was insignificantly and minimally reduced at 1 year (mean, 19.35 ± 4.9 mm). CONCLUSION The linear dimensions of composite bone-derived xenograft/autogenous bone grafts following lateral wall sinus augmentation exhibited minimal changes during the 8- to 12-month healing period.
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de Oliveira TA, Aloise AC, Orosz JE, de Mello E Oliveira R, de Carvalho P, Pelegrine AA. Double Centrifugation Versus Single Centrifugation of Bone Marrow Aspirate Concentrate in Sinus Floor Elevation: A Pilot Study. Int J Oral Maxillofac Implants 2016; 31:216-22. [PMID: 26800181 DOI: 10.11607/jomi.4170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the regenerative results of the addition of bone marrow aspirate concentrate, using a single or double centrifugation protocol, to a xenogeneic bone graft in sinus floor elevation. MATERIALS AND METHODS Using a randomized, controlled pilot study design in 15 consecutive patients, sinus floor elevation procedures were performed with a xenogenous bone graft alone (control group, CG) or associated with bone marrow aspirate concentrate obtained by single centrifugation (single centrifugation group, SCG) or double centrifugation (double centrifugation group, DCG). In the patients in the single and double centrifugation groups, bone marrow was harvested from the iliac bone. Six months after the grafting procedures, bone biopsy specimens were obtained during implant placement and were analyzed by histomorphometry. RESULTS Histomorphometric analysis revealed a great amount of vital mineralized tissue in SCG followed by DCG when compared with the CG (38.44 ± 12.34%, 34.63 ± 9.84%, and 27.30 ± 5.55%, respectively). SCG and DCG presented smaller amounts of nonvital mineralized tissue when compared with the CG (13.70 ± 7.50%, 19.63 ± 8.35%, and 22.79 ± 9.60%, respectively), thus presenting higher levels of resorption. Although these differences were not statistically significant (P > .05), a tendency toward bone gain in the experimental groups (SCG and DCG) was found. All groups (SCG, DCG, and CG) showed similar levels of nonmineralized tissue (47.87 ± 6.31%, 45.73 ± 7.33%, and 49.90 ± 7.64%, respectively). CONCLUSION This pilot study indicates that the clinical use of bone marrow aspirate concentrate, obtained by either a single or double centrifugation process, combined with a xenograft for maxillary sinus elevation seems to result in more adequate bone repair. However, clinical trials with a larger number of patients are required.
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Drenck TC, Akoto R, Meenen NM, Heitmann M, Preiss A, Frosch KH. [Operative treatment of anterior cruciate ligament ruptures with autologous hamstring tendons in children and adolescents]. Unfallchirurg 2016; 119:598-603. [PMID: 27369183 DOI: 10.1007/s00113-016-0201-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- T C Drenck
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - R Akoto
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - N M Meenen
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - M Heitmann
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - A Preiss
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - K-H Frosch
- Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Chirurgisch-Traumatologisches Zentrum, ASKLEPIOS Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
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Restoy-Lozano A, Dominguez-Mompell JL, Infante-Cossio P, Lara-Chao J, Lopez-Pizarro V. Calvarial Bone Grafting for Three-Dimensional Reconstruction of Severe Maxillary Defects: A Case Series. Int J Oral Maxillofac Implants 2016; 30:880-90. [PMID: 26252040 DOI: 10.11607/jomi.3627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the efficacy, associated morbidity, and results of a three-dimensional reconstruction technique for repairing severe defects of the maxilla using a calvarial autogenous bone graft and a soft tissue double-layered surgical approach in preparation for placing dental implants. MATERIALS AND METHODS Bone defects of the maxilla consecutively reconstructed with calvarial autologous graft in the authors' institution were retrospectively evaluated. Patients with combined maxilla alveolar ridge defects with a width less than 4 mm and a height less than 7 mm (to the level of the maxillary sinus or the nostril), with at least three teeth involved, were included in the study. Calvarial bone blocks were sagittally sectioned in fine layers and fixed three-dimensionally in a boxlike structure with particulate bone inside. The purpose was to obtain an adequate amount of vertical and horizontal alveolar bone to enable restoration with dental implants at least 3.4 mm in diameter and 11 mm in length. RESULTS Eleven reconstructive procedures were performed in 10 patients. Bone graft integration was successful in all of them. No major complications were observed in the donor cranial site. A mean bone gain of 5.04 mm (range, 3.4 to 7.8 mm) in height was obtained (standard deviation [SD], 1.69). The implant surgery was performed between the 15th and 19th weeks. A total of 28 implants were placed, and the mean follow-up time was 45 months (range, 23 to 65 months; SD, 12). The mean graft vertical resorption was 0.78 mm (range, 0.50-1.50 mm; SD, 0.00) 41 months after implant fixation. CONCLUSION Three-dimensional reconstruction technique using calvarial bone grafts to restore severe segmental or crestal bone defects in the maxilla is an effective and predictable procedure that can increase the horizontal and vertical bone volume in preparation for the successful placement of dental implants.
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Ramos-Murguialday M, Caubet J, Ramis JM, Monjo M. Evaluation of the Ideal Implant Insertion Time in Human Bone Biopsies After Sinus Elevation Using a Combination of Autologous Bone and Graft Substitute. Int J Oral Maxillofac Implants 2016; 30:891-9. [PMID: 26252041 DOI: 10.11607/jomi.3945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the ideal implant insertion time in human bone biopsies after sinus elevation with a composite graft consisting of an equal amount of biomaterial and autologous bone, by comparing the bone regeneration obtained 4 to 5 months after surgery with that obtained after 6 to 8 months, and using the adjacent native bone as reference. MATERIALS AND METHODS Twenty-six biopsy specimens of 11 patients were analyzed. Two groups were created depending on the time of implant insertion: group t1 at 4 to 5 months (n = 13) and group t2 at 6 to 8 months (n = 13). The same volume of grafted bone and native bone were analyzed for each biopsy with microcomputed tomography (microCT) and gene expression analysis. RESULTS Statistically significant differences were found in bone mineral density (BMD), bone volume fraction, and trabecular separation (TbSp) between native and grafted bone in both groups, with higher grafted bone values, except for the variable TbSp, which was lower in the grafted bone. This decrease in TbSp in the grafted bone in both groups can be explained by the significant increase in trabecular thickness in group t2 and the trabecular number in group t1, compared with native bone. No significant differences were found between the two groups in the morphometric parameters and BMD of the grafted bone. Also, no significant changes in the messenger RNA (mRNA) levels of bone formation, bone resorption, and inflammatory markers were found between both groups, with the exception that alkaline phosphatase mRNA levels were significantly lower in group t1 relative to native bone. CONCLUSION This composite graft showed no differences in three-dimensional microstructure, BMD, or at the molecular level between 4 to 5 months and 6 to 8 months of healing time. Thus, this time can be shortened to 4 months with the security of a grafted area of mature bone.
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Xavier SP, Silva ER, Kahn A, Chaushu L, Chaushu G. Maxillary Sinus Grafting with Autograft Versus Fresh-Frozen Allograft: A Split-Mouth Evaluation of Bone Volume Dynamics. Int J Oral Maxillofac Implants 2016; 30:1137-42. [PMID: 26394351 DOI: 10.11607/jomi.3924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare volumetric changes after sinus augmentation of completely edentulous maxillae with either autogenous or allogeneic fresh-frozen bone particles. MATERIALS AND METHODS This split-mouth study in patients who required bilateral sinus grafting used autograft particles for one sinus and allograft particles for the contralateral sinus. The grafted sinuses were left to heal for 6 months prior to implant insertion. All patients underwent four computed tomography scans: prior to augmentation and 1 week, 6 months, and 12 months after grafting. Computer software was used to analyze bone graft volume in each scan. RESULTS Fifteen patients (8 men, 7 women) with a mean age of 54 ± 5 years (range, 48 to 60 years) took part and underwent 30 sinus augmentation procedures. Mean autograft and allograft volumes were not statistically significantly different at each time point (1 week: 2.01 ± 0.43 cm³ vs 2.46 ± 0.79 cm³; 6 months: 1.53 ± 0.49 cm³ vs 1.75 ± 0.64 cm³; and 12 months: 1.38 ± 0.43 cm³ vs 1.59 ± 0.56 cm³, respectively). Mean volumetric reductions of 31.35% and 35.36% (23.9% and 29.9% in the 6 months prior to implant insertion, followed by an additional 9% and 9% in the following 6 months), relative to 1 week postgrafting, were noted for the autograft and allograft groups, respectively, after 12 months. CONCLUSION On the basis of this split-mouth study of 15 patients, there was no statistically significant volumetric difference after 12 months between the use of autograft or allografts for sinus augmentation. Fresh-frozen bone allograft may serve as an alternative that avoids the morbidity associated with autograft harvesting.
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Livada R, Bland PS, Shiloah J. Surgical Management of Implant-Associated Gingival Fenestrations. N Y State Dent J 2016; 82:43-47. [PMID: 27209719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Soft tissue fenestrations are extremely rare in the natural dentition and have only recently been reported on dental implants. Although the pathogenesis of their formation is not completely understood, several predisposing risk factors have been identified, some of which may affect dental implants as well. This article presents a thorough review of the literature pertaining to gingival fenestration. It also describes the surgical management of lesions developed approximately six years following osseointegration of two dental implants.
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Demarosi F, Varoni E, Rimondini L, Carrassi A, Leghissa GC. Immediate Implant Placement After Removal of Maxillary Impacted Canine Teeth: A Technical Note. Int J Oral Maxillofac Implants 2016; 31:191-4. [PMID: 26800178 DOI: 10.11607/jomi.2588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Impacted maxillary canine teeth commonly occur in the general population. The traditional therapeutic approach comprises fenestration and orthodontic traction; however, if traction is not feasible or the patient refuses orthodontic treatment, an alternative solution is to remove the impacted tooth and immediately place an implant. This technical note describes a novel surgical approach to rehabilitation after impacted canine tooth removal, entailing immediate placement of a long implant in combination with regenerative materials and a barrier. Of note, this procedure preserves the apical ridge bone crest, allowing implant anchorage and primary stability to be achieved.
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Friberg B. Bone augmentation for single tooth implants: A review of the literature. Eur J Oral Implantol 2016; 9 Suppl 1:S123-S134. [PMID: 27314117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To analyse data on bone augmentation at single-tooth implants with regard to the type of graft materials, the stability of grafts over time, reported time span towards implant placement, implant survival rates, implant marginal bone maintenance and possible complications. MATERIAL AND METHODS A literature review resulted in 585 titles after exclusion of duplicates. Analyses of article titles and abstracts reduced the number to 93 studies, which were subsequently full-text analysed. After the final selection, a total of 24 studies were included, of which 13 reported on single implants and horizontal/vertical augmentation (onlay), 10 focused on single implants and sinus augmentation (inlay), and one study presented the outcome of single implants and distraction osteogenesis. RESULTS All bone materials, i.e. autografts, allografts, xenografts, and alloplasts, were used with comparable satisfactory results, allowing for placement of 7 to 10 mm-long implants. Stability of bone graft volume over time was sparsely documented. Some onlay autografts tended to resorb early i.e. prior to implant placement, but minor bone resorption was also seen for other grafts over time. A continuous but small bone resorption of inlay autografts and alloplasts was seen over time for the few sites recorded. A staged approach predominated for the onlay grafts, with implants placed 3 to 6 months post-grafting, and overall a majority of these implants (347/363) were submerged. For the inlay graft procedures almost all implants were immediately inserted at the time of grafting, and the majority of these implants (253/256) were submerged. A total of five and two implant failures were registered during the various study periods for the onlays and inlays, respectively. Marginal bone conditions, around implants in grafted sites, were comparable to what has generally been reported for non-grafted sites. CONCLUSIONS Bone augmentation for the single-tooth implant is a viable treatment option with predictable graft and implant outcomes.
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Vandekar M, Fadia D, Vaid NR, Doshi V. Rapid Prototyping as an Adjunct for Autotransplantation of Impacted Teeth in the Esthetic Zone. J Clin Orthod 2015; 49:711-715. [PMID: 26684844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Meghna Vandekar
- Department of Orthodontics, YMT Dental College and Hospital, Sector 4, Institutional Area, Kharghar, Navi Mumbai 410210, India
| | - Dhaval Fadia
- Department of Orthodontics, YMT Dental College and Hospital, Sector 4, Institutional Area, Kharghar, Navi Mumbai 410210, India
| | - Nikhilesh R Vaid
- Department of Orthodontics, YMT Dental College and Hospital, Sector 4, Institutional Area, Kharghar, Navi Mumbai 410210, India.
| | - Viraj Doshi
- Department of Orthodontics, YMT Dental College and Hospital, Sector 4, Institutional Area, Kharghar, Navi Mumbai 410210, India
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Maridati P, Dellavia C, Pellegrini G, Canciani E, Maragno A, Maiorana C. Histologic and Radiographic Comparison of Bone Scraper and Trephine Bur for Autologous Bone Harvesting in Maxillary Sinus Augmentation. Int J Oral Maxillofac Implants 2015; 30:1128-36. [PMID: 26394350 DOI: 10.11607/jomi.3810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aims of this study were to investigate the best two of five common methods of collecting autologous bone (preliminary study [PS]) and to test clinically the effects of autografts harvested using a trephine bur or bone scraper for sinus augmentation surgery (main study [MS]). MATERIALS AND METHODS In the PS, five autograft samples from five patients (n = 25) were harvested with a bone scraper, round bur, piezoelectric device, implant bur, and trephine bur and were processed for histomorphometric analysis. In the MS, sinus augmentation was performed on 20 patients using bovine-derived bone substitute and autograft collected with a trephine bur (group A, n = 10) or collected with a bone scraper (group B, n = 10). Narrow implants were also placed. At 6 months, changes in graft volume were evaluated with cone beam computed tomography. The amounts of regenerated bone, residual graft, and osseointegration of the implants were assessed histologically. RESULTS In the PS, the trephine bur and bone scraper harvested bone chips that were medium to large and more vital than those obtained with the other tools. In the MS, no significant differences were seen between groups in terms of the amount of residual biomaterial, regenerated bone, change in graft volume, and osseointegration. CONCLUSION Biologic differences between these two bone particulates may not influence regeneration and implant osseointegration in sinus augmentation when mixed with xenograft bone.
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Saiga A, Mitsukawa N, Yamaji Y. Reconstruction using 'triangular approximation' of bone grafts for orbital blowout fractures. J Craniomaxillofac Surg 2015; 43:1369-73. [PMID: 26297418 DOI: 10.1016/j.jcms.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 06/20/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022] Open
Abstract
There are many orbital wall reconstruction materials that can be used in surgery for orbital blowout fractures. We consider autogenous bone grafts to have the best overall characteristics among these materials and use thinned, inner cortical tables of the ilium. A bone bender is normally used to shape the inner iliac table to match the orbital shape. Since orbital walls curve three-dimensionally, processing of bone grafts is not easy and often requires much time and effort. We applied a triangular approximation method to the processing of bone grafts. Triangular approximation is a concept used in computer graphics for polygon processing. In this method, the shape of an object is represented as combinations of polygons, mainly triangles. In this study, the inner iliac table was used as a bone graft, and cuts or scores were made to create triangular sections. These triangular sections were designed three-dimensionally so that the shape of the resulting graft approximated to the three-dimensional orbital shape. This method was used in 12 patients with orbital blowout fractures, which included orbital floor fractures, medial wall fractures, and combined inferior and medial wall fractures. In all patients, bone grafts conformed to the orbital shape and good results were obtained. This simple method uses a reasonable and easy-to-understand approach and is useful in the treatment of bone defects in orbital blowout fractures when using a hard graft material.
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Affiliation(s)
- Atsuomi Saiga
- Department of Plastic and Reconstructive Surgery, St. Mary's Hospital, Fukuoka, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan.
| | - Yoshihisa Yamaji
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
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Ferraro GA, De Francesco F, Razzano S, D'Andrea F, Nicoletti G. Augmentation Mastopexy with Implant and Autologous Tissue for Correction of Moderate/Severe Ptosis. J INVEST SURG 2015; 29:40-50. [PMID: 26305683 DOI: 10.3109/08941939.2015.1037940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Giuseppe Andrea Ferraro
- a Multidisciplinary Department of Medical-Surgical and Dental Specialties , Second University of Naples , Naples , Italy
| | - Francesco De Francesco
- a Multidisciplinary Department of Medical-Surgical and Dental Specialties , Second University of Naples , Naples , Italy
| | - Sergio Razzano
- a Multidisciplinary Department of Medical-Surgical and Dental Specialties , Second University of Naples , Naples , Italy
| | - Francesco D'Andrea
- a Multidisciplinary Department of Medical-Surgical and Dental Specialties , Second University of Naples , Naples , Italy
| | - Gianfranco Nicoletti
- a Multidisciplinary Department of Medical-Surgical and Dental Specialties , Second University of Naples , Naples , Italy
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Kokai S, Fukuyama E, Sato Y, Heu JC, Takahashi Y, Harada K, Ono T. Authors' response. Am J Orthod Dentofacial Orthop 2015; 147:643-4. [PMID: 26038061 DOI: 10.1016/j.ajodo.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 11/20/2022]
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Abstract
Successful root canal treatment depends on having comprehensive information regarding the root(s)/canal(s) anatomy. Dentists may have some complication in treatment of third molars because the difficulty in their access, their aberrant occlusal anatomy and different patterns of eruption. The aim of this review was to review and address the number of roots and root canals in third molars, prevalence of confluent canals in third molars, C-shaped canals, dilaceration and fusion in third molars, autotransplantation of third molars and endodontic treatment strategies for third molars.
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Affiliation(s)
- Zahed Mohammadi
- Department of Endodontics, Hamedan University of Medical Sciences, Hamedan; Iranian Center for Endodontic Research Tehran, Iran
| | - Hamid Jafarzadeh
- Associate Professor, Department of Endodontics, Dental Research Center Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad, Iran, PO Box: 91735-984, Phone: +98-51-38829501, e-mail: ,
| | | | - Shilpa Bandi
- Department of Conservative Dentistry and Endodontics MS Ramaiah Dental College and Hospital, MS Ramaiah Educational Campus, MSRIT Post, Bengaluru, Karnataka, India
| | - Shankargouda Patil
- Department of Oral and Maxillofacial Pathology, MS Ramaiah Dental College and Hospital, MS Ramaiah Educational Campus, MSRIT Post, Bengaluru, Karnataka, India
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Biercevicz AM, Akelman MR, Fadale PD, Hulstyn MJ, Shalvoy RM, Badger GJ, Tung GA, Oksendahl HL, Fleming BC. MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction. Am J Sports Med 2015; 43:693-9. [PMID: 25540298 PMCID: PMC4344859 DOI: 10.1177/0363546514561435] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical, functional, and patient-oriented outcomes are commonly used to evaluate the efficacy of treatments after anterior cruciate ligament (ACL) injury; however, these evaluation techniques do not directly measure the biomechanical changes that occur with healing. PURPOSE To determine if the magnetic resonance (MR) image-derived parameters of graft volume and signal intensity (SI), which have been used to predict the biomechanical (ie, structural) properties of the graft in animal models, correlate with commonly used clinical (anteroposterior [AP] knee laxity), functional (1-legged hop), and patient-oriented outcome measures (Knee Injury and Osteoarthritis Outcome Score [KOOS]) in patients 3 and 5 years after ACL reconstruction. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Based on a subset of participants enrolled in an ongoing ACL reconstruction clinical trial, AP knee laxity, 1-legged hop test, and KOOS were assessed at 3- and 5-year follow-up. Three-dimensional, T1-weighted MR images were collected at each visit. Both the volume and median SI of the healing graft were determined and used as predictors in a multiple regression linear model to predict the traditional outcome measures. RESULTS Graft volume combined with median SI in a multiple linear regression model predicted 1-legged hop test at both the 3- and 5-year follow-up visits (R(2) = 0.40, P = .008 and R(2) = 0.62, P = .003, respectively). Similar results were found at the 5-year follow-up for the KOOS quality of life (R(2) = 0.49, P = .012), sport/function (R(2) = 0.37, P = .048), pain (R(2) = 0.46, P = .017), and symptoms (R(2) = 0.45, P = .021) subscores, although these variables were not significant at 3 years. The multiple linear regression model for AP knee laxity at 5-year follow-up approached significance (R(2) = 0.36, P = .088). CONCLUSION The MR parameters (volume and median SI) used to predict ex vivo biomechanical properties of the graft in an animal model have the ability to predict clinical or in vivo outcome measures in patients at 3- and 5-year follow-up. CLINICAL RELEVANCE Results from this study may enhance clinical evaluation of graft health by relating the MR parameters of volume and median SI to traditional outcome measures and could potentially aid researchers in determining the appropriate timing for athletes to return to sport.
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Affiliation(s)
- Alison M Biercevicz
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Matthew R Akelman
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Paul D Fadale
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael J Hulstyn
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Robert M Shalvoy
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Glenn A Tung
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Heidi L Oksendahl
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
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Osman NI, Hillary C, Bullock AJ, MacNeil S, Chapple CR. Tissue engineered buccal mucosa for urethroplasty: progress and future directions. Adv Drug Deliv Rev 2015; 82-83:69-76. [PMID: 25451857 DOI: 10.1016/j.addr.2014.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/22/2014] [Accepted: 10/03/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE Autologous buccal mucosa is commonly utilized in the surgical treatment of urethral strictures. Extensive strictures require a larger quantity of tissue, which may lead to donor site morbidity. This review assesses progress in producing tissue engineered buccal mucosa as an alternative graft material. RESULTS Few clinical studies have introduced cells onto biological or synthetic scaffolds and implanted resulting constructs in patients. The available studies show that buccal mucosa cells on acellular human dermis or on collagen matrix lead to good acute stage tissue integration. Urothelial cells on a synthetic substrate also perform well. However while some patients do well many years post-grafting, others develop stricture recurrence. Acellular biomaterials used to treat long urethral defects in animals commonly lead to fibrosis. CONCLUSIONS Tissue engineered buccal mucosa shows promise as a substitute for native tissue. The fibrosis which occurs months post-implantation may reflect the underlying disease process recurring in these patients.
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Affiliation(s)
- N I Osman
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - C Hillary
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - A J Bullock
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - S MacNeil
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - C R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
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Meloni SM, Tallarico M, Lolli FM, Deledda A, Pisano M, Jovanovic SA. Postextraction socket preservation using epithelial connective tissue graft vs porcine collagen matrix. 1-year results of a randomised controlled trial. Eur J Oral Implantol 2015; 8:39-48. [PMID: 25738178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare epithelial connective tissue graft vs porcine collagen matrix for sealing postextraction sockets grafted with deproteinised bovine bone. MATERIALS AND METHODS A total of 30 patients, who needed a maxillary tooth to be extracted between their premolars and required a delayed, fixed, single implant-supported restoration, had their teeth atraumatically extracted and their sockets grafted with deproteinised bovine bone. Patients were randomised according to a parallel group design into two arms: socket sealing with epithelial connective tissue graft (group A) vs porcine collagen matrix (group B). Outcome measures were: implant success and survival rate, complications, horizontal and vertical alveolar bone dimensional changes measured on Cone Beam computed tomography (CBCT) scans at three levels localised 1, 3, and 5 mm below the most coronal aspect of the bone crest (levels A, B, and C); and between the palatal and buccal wall peaks (level D); and peri-implant marginal bone level changes measured on periapical radiographs. RESULTS 15 patients were randomised to group A and 15 to group B. No patients dropped out. No failed implants or complications were reported 1 year after implant placement. Five months after tooth extraction there were no statistically significant differences between the 2 groups for both horizontal and vertical alveolar bone dimensional changes. At level A the difference was 0.13 ± 0.18; 95% CI 0.04 to 0.26 mm (P = 0.34), at level B it was 0.08 ± 0.23; 95% CI -0.14 to 0.14 (P = 0.61), at level C it was 0.05 ± 0.25; 95% CI -0.01 to 0.31 mm (P = 0.55) and at level D it was 0.13 ± 0.27; 95% CI -0.02 to 0.32 mm (P = 0.67). One year after implant placement there were no statistically significant differences between the 2 groups for peri-implant marginal bone level changes (difference: 0.07 ± 0.11 mm; 95% CI -0.02 to 0.16; P = 0.41). CONCLUSIONS When teeth extractions were performed atraumatically and sockets were filled with deproteinised bovine bone, sealing the socket with a porcine collagen matrix or a epithelial connective tissue graft showed similar outcomes. The use of porcine collagen matrix allowed simplification of treatment because no palatal donor site was involved.
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Esposito M, Barausse C, Pistilli R, Sammartino G, Grandi G, Felice P. Short implants versus bone augmentation for placing longer implants in atrophic maxillae: One-year post-loading results of a pilot randomised controlled trial. Eur J Oral Implantol 2015; 8:257-268. [PMID: 26355170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate whether short (5.0 to 8.5 mm) dental implants could be a suitable alternative to longer (at least 11.5 mm-long) implants placed in atrophic maxillae augmented with autogenous bone for supporting dental prostheses. MATERIALS AND METHODS Twenty-eight patients with fully edentulous atrophic maxillae, whom had 5 to 9 mm of residual crestal bone height which was at least 5 mm thick, measured using computerised tomography (CT) scans, were randomised into two groups either to receive 4 to 8 short (5.0 to 8.5 mm) implants (15 patients) or autogenous bone from the iliac crest to allow the placement of at least 11.5 mm-long implants (13 patients). Bone blocks and the windows at the maxillary sinuses were covered with rigid resorbable barriers. Grafts were left to heal for 4 months before placing implants which were submerged. After 4 months, provisional reinforced acrylic prostheses or bar retained overdentures were delivered. Provisional prostheses were replaced, after 4 months, by definitive screw-retained metal-resin cross-arch restorations. Outcome measures were prosthesis and implant failures, any complications, peri-implant marginal bone level changes and patient satisfaction. Patients were followed up to 1 year after loading. RESULTS All patients were rehabilitated with implant-supported prostheses but two patients dropped out from the augmented group. One bilateral sinus lift procedure failed for infection, although short implants could be placed. One implant failed in the augmented group versus two short implants in two patients (Fishers exact test P = 1.00; difference in proportions = 0.06; 95% CI -0.28 to 0.17). All failures occurred before loading. Significantly more complications occurred in augmented patients: eight complications occurred in 5 augmented patients (all of them complained of pain 1 month after bone harvesting from the iliac crest) versus no complications in the short implant (Fisher's exact test P = 0.013; difference in proportions = 0.38; 95% CI 0.11 to 0.65). Both groups presented a significant peri-implant marginal bone loss at 1 year after loading (P < 0.0001); -1.05 (0.20) mm for short implants and -1.01 (0.16) mm for the augmented group, respectively, with no statistically significant differences between the two groups (mean difference -0.04 mm; 95% CI -0.22 to 0.14; P = 0.59). All patients were fully satisfied with the treatment and would have it again. CONCLUSIONS This pilot study suggests that short implants may be a suitable, cheaper and faster alternative to longer implants placed in bone augmented with autogenous bone for rehabilitating edentulous atrophic maxillae, however, these preliminary results need to be confirmed by larger trials with follow-ups of at least 5 years.
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Baş B, Özden B, Özdemir M, Yüksel EP. Herpes zoster ophthalmicus reactivation following maxillary sinus lift operation: A case report. Eur J Oral Implantol 2015; 8:177-180. [PMID: 26021228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation. MATERIALS AND METHODS A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO. RESULTS HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful. CONCLUSIONS Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.
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Shahi R, Hamada Y, Shin D, Krishna R, John V. Mucogingival Surgery--A Review of Clinical Procedures and Case Reports. J Indiana Dent Assoc 2015; 94:26-39. [PMID: 26489194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Manzon S, Philbert RF, Bush BF, Zola MB, Solomon M. Treatment of a recurrent ameloblastic fibroma. N Y State Dent J 2015; 81:30-32. [PMID: 25707166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ameloblastic fibroma (AF), a slow-growing, benign tumor of odontogenic origin, represents 2% of all odontogenic tumors. Jaw expansion is among the most common symptoms, with diagnosis often made through routine radiographs. AFs have a recurrence rate of 18% to 43.5% after conservative enucleation. Long-term follow-up by both the surgeon and referring dentist is recommended, since recurrence may be due to regrowth of residual tumor undergoing malignant transformation. Aggressive management is recommended for local tumor recurrence. En bloc excision with bone grafting, followed by implant reconstruction, can be curative and preservative of function. Treatment of a recurrent AF is described.
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Rousié M, Sattari A, Schuind F. [Mono-arthritis of the hand: case report of osteoid osteoma]. Rev Med Brux 2015; 36:38-41. [PMID: 25856970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Osteoid osteoma is a rare occurrence at the hand. There is often a long delay before the diagnosis because the clinical signs mimic other frequent affections of the hand. We report the case of a 24-year old female patient suffering from an osteoid osteoma in the first phalanx of a finger. The diagnosis was made four years after the first symptoms. We started by a curettage-biopsy, followed in a second operative step by cauterization and filling up the defect by a bone autograft. Six months after the surgery, the patient was no longer experiencing any symptom. This rare case demonstrates that osteoid osteoma remains a possible diagnosis in chronic pain affecting the hand.
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Hazzaa HH, El Adawy H, Magdi HM. A Novel Surgical Approach for Treatment of Class II Furcation Defects Using Marginal Periosteal Membrane. J Int Acad Periodontol 2015; 17:20-31. [PMID: 26233970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study was designed to describe and evaluate the use of a vascularized marginal periosteal barrier membrane (MPM) harvested by a semilunar incision, alone or combined with a bone graft, in treatment of class II furcation defects in mandibular molars, compared to open flap debridement (OFD). METHODS Thirty class II furcation defects in mandibular molars were randomly assigned into three equal groups: Group I included OFD, Group II included defects treated with MPM, and Group III consisted of defects treated with MPM after applying demineralized freeze-dried bone allograft (DFDBA). At baseline and 6-month follow-up, vertical probing depth (VPD), clinical attachment level (CAL) measurements, along with a radiographic measurement of bone height (BH), were obtained for each defect. Transmission electron microscopy (TEM) was used for further evaluation of the histological changes associated with gingival samples related to each line of treatment. RESULTS Both Groups II and III reflected significant favorable outcomes in all the assessed parameters compared to OFD. A non-significant difference was found between both groups regarding VPD, while significant improvement in CAL and BH were detected in Group III (p ≤ 0.05). Favorable histological findings were also noticed in the test groups, with more improvement in Group III. CONCLUSION Placement of a vascularized MPM as a barrier membrane, using a semilunar incision, demonstrated a significant improvement in both clinical and histological outcomes of class II furcation defects in lower molars. When it was combined with DFDBA, a meaningful difference was found with regard to early wound healing and gain in CAL and BH.
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Smolka W. Calvarial grafts for alveolar ridge reconstruction prior to dental implant placement: an update. Oral Maxillofac Surg 2014; 18:381-385. [PMID: 25249177 DOI: 10.1007/s10006-014-0464-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/25/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The aims of this review were to analyze publications related to alveolar crest reconstruction using calvarial grafts and to evaluate the survival and success rates of implants placed into the augmented area. METHODS An automated search was made in MEDLINE of clinical publications from 2000 to 2013. Only publications with at least five patients and a minimum follow-up of 6 months were included. RESULTS Graft success ranged between 97 and 100 %. Donor site complications were minimal. The most frequent complications in the recipient site were wound dehiscence. Prosthodontic loading time in most of the studies was 3 months. Implant survival rates ranged between 95 and 100 %. Implant success rates were between 90.3 and 95.05 %. CONCLUSIONS Grafting procedures with calvarial transplants show a high graft success rate and a sufficient implant success rate. Calvarial bone grafts are a reliable procedure for alveolar crest reconstruction.
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Affiliation(s)
- Wenko Smolka
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilian University, Lindwurmstr. 2a, 80337, Munich, Germany,
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O'Connell JE, Hartnett C, Hickey-Dwyer M, Kearns GJ. Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: a retrospective study including maxillofacial and ophthalmology perspectives. J Craniomaxillofac Surg 2014; 43:192-8. [PMID: 25534042 DOI: 10.1016/j.jcms.2014.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022] Open
Abstract
This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer). Twenty patients met the inclusion criteria. The mean age was 29 years. The mean follow up period was 26 months. No patient experienced significant donor site morbidity. There were no episodes of post-operative infection or graft extrusion. Three patients had diplopia in extremes of vision post-operatively, but no interference with activities of daily living. One patient had post-operative enophthalmos. Isolated orbital blow-out fractures may be safely and predictably reconstructed using autogenous iliac crest bone. The rate of complications in the group of patients studied was low. The value of pre- and post-operative ophthalmology consultation cannot be underestimated, and should be considered the standard of care in all patients with orbitozygomatic fractures, in particular those with blow-out fractures.
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Affiliation(s)
- John Edward O'Connell
- Department of Oral and Maxillofacial Surgery, St James Hospital, James' St, Dublin 8, Ireland.
| | - Claire Hartnett
- Department of Ophthalmology, Mid Western Regional Hospital, Limerick, Ireland
| | - Marie Hickey-Dwyer
- Department of Ophthalmology, Mid Western Regional Hospital, Limerick, Ireland
| | - Gerard J Kearns
- Department of Oral and Maxillofacial Surgery, St James Hospital, James' St, Dublin 8, Ireland
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