Introduction:
Since the early stages of alveolar bone grafting development, multiple types of materials have been used. Iliac cancellous bone graft (ICBG) remains the gold standard.
Design/Methods:
A ...review of literature is conducted in order to describe the different bone filling possibilities, autologous or not, and to assess their effectiveness compared to ICBG. This review focused on studies reporting volumetric assessment of the alveolar cleft graft result (by computed tomography scan or cone beam computed tomography).
Results:
Grafting materials fall into 3 types: autologous bone grafts, ICBG supplementary material, and bone substitutes. Among autologous materials, no study showed the superiority of any other bone origin over iliac cancellous bone. Yet ICBG gives inconsistent results and presents donor site morbidity. Concerning supplementary material, only 3 studies could show a benefit of adding platelet-rich fibrin (1 study) or platelet-rich plasma (2 studies) to ICBG, which remains controversial in most studies. There is a lack of 3-dimensional (3D) assessment in most articles concerning the use of scaffolds. Only one study showed graft improvement when adding acellular dermal matrix to ICBG. Looking at bone substitutes highlights failures among bioceramics alone, side-effects with bone morphogenetic protein-2 composite materials, and difficulties in cell therapy setup. Studies assessing cell therapy–based substitutes show comparable efficacy with ICBG but remain too few.
Conclusion:
This review highlights the lack of 3D assessments in the alveolar bone graft materials field. Nothing dethroned ICBG from its position as the gold standard treatment at this time.
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Breast implants are widely used after breast cancer resection and must be changed regularly to avoid a rupture. To date, there are no quantitative criteria to help this decision. The ...mechanical evolution of the gels and membranes of the implants is still underinvestigated, although it can lead to early rupture. In this study, 35 breast explants having been implanted in patients for up to 17 years were characterized by ex vivo measurements of their mechanical properties. Using Acoustic Radiation Force Impulse (ARFI) ultrasound elastography, an imaging method for non-destructive mechanical characterization, an increase in the stiffness of the explants has been observed. This increase was correlated with the implantation duration, primarily after 8 years of implantation. With an increase of the shear modulus of up to a factor of nearly 3, the loss of flexibility of the implants is likely to lead to a significant increase of their risk of rupture. A complementary analysis of the gel from the explants by mass spectrometry imaging (MSI) and liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS) confirms the presence of metabolites of cholesterol originating from the breast tissues, which most likely crossed the membrane of the implants and most likely degrades the gel. By observing the consequences of the physical–chemical mechanisms at work within patients, this study shows that ultrasound elastography could be used in vivoas a quantitative indicator of the risk of breast implant rupture and help diagnose their replacement.
Summary Background & Objective: Industry managed the main studies assessing the rupture rate of breast implants, with questionable independence. After repetitive removals of ruptured implants from ...the same model, our team decided to assess the rupture rate and the estimated risk thereof for most of the silicone gel-filled implants we’ve used since they regained market approval in France in 2001. Methods Our study is a retrospective cohort of 809 patients operated on in our University Hospital from 2001 to 2013, for cosmetic or reconstructive goals. We could track 1561 implants, 90% of them from the same manufacturer, Allergan (Irvine, CA, USA). For each of those, we gathered their exact reference, date of implantation, surgical approach, status, last follow-up visit or the eventual date and cause of removal. Results Out of 225 explanted devices, only 27 were ruptured, all from the Allergan brand. Risks of removal for rupture were estimated: 0.5% at 1000 days, 6% at 2000 days and 14% at 3000 days. Risks were significantly different between models from this same manufacturer. One of the range of macro-textured round implants showed risks of removal for rupture of 33% at 3000 days compared to 6% for the anatomically shaped range. Conclusions These results suggest a qualitative discrepancy among the different ranges of breast implants of a single manufacturer within the same timeframe of implantation. To determine more precisely and early the in-vivo lifespan of the implants we use, we suggest that each removed implant should be analyzed for wear and tear, independently from the industry.
Introduction
The medial head of the triceps brachii flap is already described as a local muscular or as a free flap. It allows coverage of defects of the posterior cubital region. The aim of this ...study was to describe the vascular anatomy of the musculocutaneous medial triceps brachii pedicled flap.
Methods
Eleven fresh–frozen upper limbs (6 come from women and 5 from men) were proximally injected with Indian ink agar solution. The medial head of the triceps brachii muscle was dissected and the superior ulnar collateral artery (SUCA) was isolated with its collaterals. The collateral arteries were dissected to determine whether there were septocutaneous or musculocutaneous arteries for vascularization of the skin in front of the medial head. Lengths of those collaterals arteries were measured.
Results
The average number of collaterals arteries from the SUCA supplying the medial head of the triceps brachii is 4.5 (from 3 to 6 arteries). Among these collaterals’ arteries, there are one average 1.5 (0.6–4.5) septocutaneous arteries and 3 (1–4.8) musculocutaneous arteries.
Discussion and conclusion
A musculocutaneous flap with the medial head of the triceps brachii muscle can be described with the muscle. The SUCA gives perforator arteries musculocutaneous and septocutaneous for the vascularization of the triceps brachii medial head. The use of local pedicled flap with similar tissue maximizes healing with a minimal morbidity of the donor site. This study demonstrated the feasibility of the medial head triceps brachii musculocutaneous flap to cover defect of the posterior aspect of the elbow.
Summary Background Free-flap breast reconstruction is a challenging surgical procedure with a steep learning curve. A reproducible large animal model could be relevant for free-flap harvesting and ...microsurgical anastomosis training. The aim of this study was to assess the feasibility of a porcine model for free-flap breast reconstruction. Methods Three female pigs were placed under general anesthesia in order to study feasibility and estimate relevance for training. The deep inferior epigastric perforator (DIEP) flap, the transverse musculocutaneous gracilis (TMG) flap, and the superior gluteal artery perforator (SGAP) flap were harvested and anastomosed to the internal thoracic vessels. Differences were noted between pig and human anatomy, and the surgical procedure was adapted to build training models. Results Under a more prominent anterior thoracic wall, the internal thoracic vessels were slightly deeper and larger than in human anatomy. The DIEP flap was never feasible in the porcine model. However, the superior epigastric artery perforator (SEAP) flap showed anatomical similarity with the human DIEP flap, and it proved to be suitable for an inverted training model. The porcine TMG flap harvesting was close to the human one, reproducing specific dissection and anastomotic difficulties. The SGAP flap was not a muscular perforator flap in pigs but a septocutaneous flap. Because of the thinness of the hypodermal fat, porcine flaps were not considered adequate training models for breast-mound shaping. Conclusions Despite any anatomical variations, the pig has proven to be a suitable training model for free-flap harvesting and transfer in the field of breast reconstruction.
Radical resection of an extended malignant sarcoma of the chest wall requires full-thickness thoracic chest wall reconstruction. Reconstruction is tedious in the case of posteriorly located tumours, ...because the ipsilateral pedicled myocutaneous latissimus dorsi flap is involved and hence not usable for soft tissue coverage. We report an original case of a left giant dorsal chondrosarcoma originating from the 11th costovertebral joint. After extended resection and skeletal reconstruction, soft tissue coverage was achieved with an original contralateral free flap encompassing both latissimus dorsi and serratus anterior muscles. The flap pedicle was anastomosed to the ipsilateral thoracodorsal vessels.
Abstract Background and purpose Cleft surgery is marked by all the controversies and the multiplication of protocols, as it has been shown by the Eurocleft study. The objective of this pilot study is ...to start a comparison and analyzing procedure between primary surgical protocols in French centers. Methods Four French centers with different primary surgical protocols for cleft lip and palate repair, have accepted to be involved in this retrospective study. In each center, 20 consecutive patients with complete cleft lip and palate (10 UCLP, 10 BCLP per center), non syndromic, have been evaluated at a mean age of 5 range, 4–6. In this second part, maxillary growth and palatine morphology were assessed on clinical examination and on dental casts (Goslon score). Speech was also evaluated clinically (Borel-maisonny classification) and by Aerophonoscope. Results Veau–Wardill–Killner palatoplasty involves a higher rate of transversal maxillary deficiency and retromaxillary. The fistula rate is statistically lower with tibial periosteum graft hard palate closure but this technique seems to give retromaxillary. Malek and Talmant two-stage-palatoplasty techniques reach Goslon scores of 1 or 2. Considering speech, Sommerlad intravelar veloplasty got higher outcomes. Conclusions Primary results. Extension to other centers required. The two-stage palatoplasty, including a Sommerlad intravelar veloplasty seems to have the less negative impact on maxillary growth, and to give good speech outcomes. Level of evidence Therapeutic study. Level III/retrospective multicenter comparative study.
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