Osteogenic capacities of tibial and cranial periosteum: a biochemical and histologic study.

The periosteum has an important role in bone regeneration. The purpose of this study was to evaluate and compare the osteogenic capacities of tibial and cranial periosteum. To achieve this, 44 New Zealand male rabbits were divided into two groups, each consisting of 22 rabbits. In group 1, periosteal flaps were prepared on the tibia of the posterior cruris of each side. In group 2, bilateral periosteal flaps were prepared on the cranial region. New bone formation was estimated quantitatively by measuring the alkaline phosphatase and osteocalcin levels, because they are the indicators of osteoblastic activity. At weeks 1, 2, 4, and 8, biopsies were taken from five animals of each group for biochemical analyses, and at weeks 2 and 8, biopsies were taken for histologic evaluation. Higher alkaline phosphatase and osteocalcin levels were evaluated in group 1, and more bone formation was observed in group 1. The results showed that osteogenic capacity is higher in tibial periosteum than cranial periosteum.

[Surgical coverage technics of pressure sores and their outcomes]. / Basi yarasi olan hastalara uyguladigimiz cerrahi tedavi yöntemleri ve sonuçlari

BACKGROUND: We reviewed the outcome of 66 patients with 100 pressure sores between 1984 and 2002. METHODS: In the current study, 100 pressure sores in 66 patients (45 male, 21 female; mean age 39.4; range 13 to 80 years) who underwent surgical repair of pressure sores reconstructed using myocutaneous or fasciocutaneous flaps, skin grafts, excision and closure. RESULTS: The risk factors for pressure sores included acute trauma-induced spinal cord injury in 40 (61%) patients with paraplegia and in 5 (7%) patients with quadriplegia; congenital spina bifida and multiple sclerosis in 7 (11%) patients and prolonged immobilization in 14 (21 patients) patients. We achieved an overall pressure sore recurrence rate of 22% and overall patient recurrence of 24% in a-3-year follow-up. The recurrence rates according to anatomic sites; 23% (10 of 43) for the ischial pressure sore, sacral 21% (8 of 37), and trochanteric 20% (4 of 20). Fasciocutaneous and myocutaneous flap reconstructions were the most durable, as they were associated with 17% (6 of 34) and 12% recurrence rates (5 of 39). CONCLUSION: To reduce the recurrence rates the authors advocate the use of myocutaneous and fasciocutaneous flaps instead of skin grafts or direct closure for the coverage of pressure sores.

Van der Woude syndrome in twins.

This article discusses monozygotic twin patients with Van der Woude syndrome, the most common form of syndromic cleft lip and palate, who have concordant manifestations. The syndrome has an autosomal dominant hereditary pattern with variable expressivity and a high degree of penetrance with clinical features, including lower lip sinuses with a cleft lip, cleft palate, or both. Some mutations have been found to cause this disorder. Genetic counseling and informing patients about inheritance is crucial. The appearance, etiology, genetic aspects, differential diagnosis, and treatment modalities are discussed. To the authors' knowledge, this is the third report of monozygotic concordant twins with this syndrome in the literature.

Microsurgical reconstruction of hepatic artery during living donor liver transplantation.

Living donor liver transplantation (LDLT) has become a well-recognized treatment modality for patients with end-stage liver disease. Arterial reconstruction during LDLT is perhaps the most important aspect of the grafting procedure. Although microsurgical hepatic artery reconstruction has become the essential technique in LDLT, it poses significant challenges even to experienced microsurgeons. In this report, the experiences of 155 microsurgical reconstructions of the hepatic artery in 150 LDLTs were reviewed, and the problems that were encountered and the solutions are discussed. From June 1999-March 2004 150 LDLTs were performed on 148 recipients at Ege University Organ Transplantation and Research Center. Hepatic arterial thrombosis was encountered in 3 patients. Microsurgical technique has overcome the difficulties in LDLT. This has increased liver transplantations in the presence of limited cadaver grafts and has decreased the patient mortality in the waiting list.

Free fibula flap mandible reconstruction in benign mandibular lesions.

The mandible may be affected by a variety of pathological conditions such as ameloblastomas, odontogenic keratocysts, central giant cell granulomas, fibro-osseous lesions, and osteomas. They generally are benign, and conservative treatment can be enough in most of the cases. However, they can be clinically aggressive, and especially ameloblastomas, odontogenic keratocysts, and fibro-osseous lesions are prone to recur. The method of treatment remains a matter of controversy in these cases. The aim of this analysis was to study 100 patients who had been treated for benign mandibular lesions, and to emphasize the importance of free fibula flap in the treatment of such lesions.

Reconstruction of congenital absent columella.

A case of congenital absence of the nasal columella accompanying a facial hemangioma is presented. The nose is an important aesthetic unit of the face, and its projection is mainly supported by the columella. The etiology of the absent columella is unclear, and the clinical feature is rare. Reconstruction of the columella remains a challenging problem in plastic surgery, and numerous techniques have been described. The authors discuss several techniques aimed at the correction of the problem and describe a method of reconstruction of the absent nasal columella that was used in the case reported.

Proteus syndrome.

Proteus syndrome is a rare sporadic, hamartoneoplastic disorder of vascular, skeletal, and soft tissues that causes asymmetry of the skull, body, arms, and the legs. The name "Proteus" of the Greek god who had the ability to change his shape was coined to define the variety of deformities including partial gigantism of the hands or feet, asymmetry of the arms and legs, hypertrophy of long bones, plantar hyperplasia, haemangiomas, lipomas, varicosities, linear verrucous epidermal naevi, macrocephaly, and cranial hyperostoses. The basic defect seems to be the focal overgrowth of cellular elements in skin, bone, and other connective tissues. The variable features of the syndrome make differential diagnosis challenging for clinicians. The most important features are the hamartomatous disorders. The long-term prognosis is still not clear. As it is a hamartoneoplastic and incompletely delineated syndrome, the patients must be followed up because of the possible risk of neoplasms.

Cancellous bone grafting in alveolar cleft repair: new experience.

Bone grafting plays an important role in the dental rehabilitation of patients with alveolar cleft. During the period between 1993 and 2001, 12 patients with alveolar clefts have been treated in our clinic. Cancellous iliac bone grafts were used in all 12 patients. Seven patients had left and five patients had right complete unilateral cleft lip and complete cleft palate operations. All patients had palatal fistulas. The ages were between 4 and 18 years (mean age, 10.5 y). Seven of them were female (58.4%) and 5 were male (41.6%). All the cancellous grafts survived. Enough filling and the closure of the fistulas were achieved except one patient who had wound dehiscence and partial graft loss. The patients experienced a limp for 2 days (mean time) because of the donor site. This surgical procedure achieves successful results if it is used with the proper indication in suitable cases.

Craniomaxillofacial fibrous dysplasia.

Fibrous dysplasia is a nonneoplastic developmental disease of osseous tissue. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. In this series of 16 patients with fibrous dysplasia of the craniomaxillofacial bones, the disease was generally monostotic and most commonly maxillary in location. Two patients demonstrated typical symptoms of the McCune Albright syndrome. Marked deformity or functional disturbances were the major indications for treatment. Total excision of the involved bone was the most successful form of treatment but produced the greatest functional and cosmetic deficits and long-term postoperative complications. A conservative therapeutic approach with a modest reduction in the bulk of these lesions may be sufficient to relieve signs and symptoms effectively. Periodic follow-up is indicated to detect recurrences or malignant changes in the early stages.