The Role of Extracellular Vesicles Secreted From Thermal Stress-Induced Adipose-Derived Stem Cells on Bone Regeneration.

PURPOSE: Extracellular vesicles (EVs) are responsible for intercellular communication. Mesenchymal stem cell-derived vesicles have been shown to have similar properties as functional mesenchymal stem cells. The aim of this study was to compare the therapeutic benefit of EVs obtained from adipose tissue-derived stem cells (ADSC) on bone repair whereas using ß-tricalcium phosphate (ß-TCP) biomaterial as a carrier. MATERIALS AND METHOD: A single critical size bone defect of 8 mm in diameter was created on the right side of rat calvarium using a custom-made punch needle. Animals were randomly divided into 5 groups: group 1 (no treatment), group 2 (bone graft), group 3 (ß-TCP + ADSC), group 4 (ß-TCP + EV), group 5 (ß-TCP). Eight weeks later, animals were sacrificed and histologic and radiologic evaluation was performed. RESULTS: Semiquantitative histologic scoring demonstrated significantly higher bone regeneration scores for groups 2, 3, and 4 compared to group 1. Radiologic imaging showed significantly higher bone mineral density for groups 2, 3, and 5 compared to group 1. There were no significant differences between treatment groups in either histologic or radiologic scoring. CONCLUSIONS: Our data showed that EVs provided from thermally induced ADSCs did not show any significant difference in bone regeneration when compared to ADSCs themselves. Future studies should focus on determining the optimum amount and content of EV application since these vary significantly depending on the microenvironment.

The Comparison of Pierre Robin Sequence and Non-Syndromic Cleft Palate.

INTRODUCTION: The aim of this study was to evaluate pre-operative nutritional status, associated syndromes and abnormalities, and post-operative outcomes of patients with Pierre Robin Sequence (PRS) versus those with non-syndromic isolated cleft palate (CIP). METHODS: Between January 1995 and December 2013, patients with a cleft palate Veau I-II according to the Veau classification with and without PRS who underwent primary repair were retrospectively analyzed. The nutrition status, age at the time of palatoplasty, additional anomalies, gestational complications, and post-operative speech abnormalities and outcomes were evaluated. RESULTS: A total of 59 patients with PRS (PRS group) and 132 patients without PRS (non-PRS group) were included in the study. Of all patients, 92 were males and 99 were females with a mean age of 14 ±â€Š4.18 (range, 6 to 26) years. The rate of gestational complications, enteral nutrition, complete cleft, additional anomalies, and velopharyngeal insufficiency was significantly higher in the PRS group (P < 0.05). However, the incidence of fistulas and age at the time of palatoplasty did not significantly differ between the groups. CONCLUSION: Based on our study results, enteral nutrition, respiratory problems, pregnancy complications, velopharyngeal insufficiency, and additional anomalies, but not post-operative palatal fistulas, are more frequently seen in patients with PRS. Although pre-operative care and treatment and rehabilitation in patients with PRS are more complicated than those with the CIP, our experience demonstrates that meticulous repair and follow-up can minimize complications, such as fistulas.

Use of abdominal negative pressure wound therapy in different indications: a case series.

Negative pressure wound therapy (NPWT) is a widely used wound management system. Several articles have been published on the advantages and complications of this system. Abdominal dressing negative pressure system (abdominal NPWT) is a newer technology, developed and used in open abdomen cases. The adherence of the sponge to the intra-abdominal organs is prevented by a polyurethane foam. This study presents a number of case series where an abdominal NPWT (ABThera, KCI, US) has been used to treat other vital organs, helping to prevent complications such as organ rupture and fatal bleeding.

A Comparative Clinical Study of Flap Thickness: Medial Sural Artery Perforator Flap Versus Anterolateral Thigh Flap.

INTRODUCTION: The purpose of this study is to measure flap thicknesses of anterolateral thigh (ALT) and medial sural artery perforator (MSAP) flaps in healthy subjects by Doppler ultrasonography and compare the results in relation to sex and body mass index (BMI). METHOD: The perforators of ALT and MSAP flaps were marked on 30 healthy subjects. The thickness of skin and subcutaneous tissue was measured in millimeters at the site of the perforator using Doppler ultrasonography. RESULTS: The mean ± SD age of the participants was 36.4 ± 10.5, the mean ± SD BMI was 25.2 ± 3.9 (19.4-32.5). The mean ± SD flap thickness was 11.55 ± 4.38 mm for ALT and 8.31 ± 3.6 mm mm for MSAP (P < 0.01). Anterolateral thigh flap was significantly thicker than MSAP in both males (9.02 vs 6.11 mm) and females (14.07 vs 10.52 mm) (P < 0.05). The thickness of both MSAP and ALT flap had a positive correlation with BMI. The relationship was stronger for ALT in males (r = 0.66 for ALT, r = 0.59 for MSAP) and for MSAP in females (r = 0.70 for ALT, r = 0.83 for MSAP). DISCUSSION: This study confirms that MSAP flap is thinner than ALT and the results correlate with BMI. Therefore, MSAP flap can be considered a good alternative to ALT, to avoid bulk, in reconstruction of shallower soft tissue defects.

Risk assessment for free tissue transfers: is old age a determining factor?

INTRODUCTION: Free tissue transfers are more often performed in the elderly with the increase in geriatric patient population. The aim of this study was to investigate the effect of advanced age in reconstructive microsurgery procedures and analyze the association of other variables with complications and surgical success. PATIENTS AND METHOD: A retrospective review of 70 consecutive free tissue transfers between January 2012 and June 2013 was performed. Patients were divided into 2 groups: those younger than 60 years and those aged 60 years or older. Besides demographics, the American Society of Anesthesiologists (ASA) risk score, comorbid conditions, and anatomic locations for surgery (head and neck, extremities, trunk), operative time, need for reoperation, intensive care unit (ICU) admission and blood transfusion, length of hospital stay, medical and surgical complications, as well as partial and total flap loss were noted and analyzed. RESULTS: A total of 71.4% of the patients were younger than 60 years (n = 50; average, 37.4 y), and 28.6% of the patients were 60 years or older (n = 20; average, 67.5 y). None of the other collected data showed significant difference between the groups. Although age was not associated with ICU admission, the location of the reconstruction site and the operative time were found to have a significant correlation with ICU referral. In this series, the operative time correlated with medical complications but not with surgical complications. Higher ASA scores did have a negative effect on the incidence of medical complications (P = 0.028). CONCLUSIONS: This retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction. However, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers.

The Effect of Liquid Nitrogen on Bone Graft Survival.

Liquid nitrogen is used in medicine for cancer treatment and tissue preservation; however, bone viability after its application is controversial. This study aims to evaluate both the tissue viability and the clinical and histopathologic findings following liquid nitrogen application with different thawing techniques in rats. Mandibular bone grafts were taken from 45 Wistar rats and freezed in liquid nitrogen for 20 minutes. In the rapid-thawing technique (Rapid Thawing-1, Rapid Thawing-2), the grafts were held for 20 minutes in room temperature; in the slow-thawing technique (Slow Thawing-1, Slow Thawing-2), 20 minutes in -20°C, 20 minutes in +4°C, and 20 minutes in room temperature, respectively. In Rapid Thawing-2 and Slow Thawing-2 groups, autografts were implanted to their origin for 3 weeks and bone staining with India ink was performed and samples taken for histologic examination. The amount of cells and blood vessels and the density of bone canaliculi were significantly reduced in Rapid Thawing-1 and Slow Thawing-1 groups comparing to the Control group. However, the reduction rate was more significant in the Slow Thawing-1 group. Histomorphometric evaluation of the healing autografts after 3 weeks revealed that the decreased amounts of canaliculi were not changed in Slow Thawing-2 group. The study results demonstrated that bone tissue survives after liquid nitrogen treatment regardless of the performed thawing technique; however, slow thawing causes more tissue damage and metabolism impairment.

Acute Liver Failure and Hepatic Encephalopathy After Cleft Palate Repair.

Paracetamol is the most commonly used analgesic after cleft palate repair. It has rarely caused acute hepatic failure at therapeutic or supratherapeutic doses. Only one case of therapeutic paracetamol toxicity after cleft palate repair had been reported previously. Here, we present a similar patient who developed acute liver failure and hepatic encephalopathy after an uncomplicated cleft palate surgery. Lack of large prospective trials in young children due to ethical concerns increases the value of the case reports of acetaminophen toxicity at therapeutic doses. The dosing recommendations of paracetamol may need to be reconsidered after cleft palate surgery.

Delayed reduction of a displaced zygomatic arch fracture by external traction.

An easy and useful method designed for the reduction of delayed and displaced zygomatic arch fractures used by the treatment of a 33-year-old female patient is presented.

Superficial musculoaponeurotic system flap for reconstruction of the intraoral defects.

Intraoral tumors are the main causes of the intraoral and maxillofacial defects. Skin grafts and several soft tissue flaps can be used to reconstruct the intraoral defects including local, regional, and free flaps. Here we present a case of intraoral adenocystic carcinoma treated with segmental maxillectomy, resection of the parotid gland, and the buccal mucosa leaving a full-thickness intraoral defect. The defect was covered with a superficial musculoaponeurotic system (SMAS) flap elevated using the preauricular incision. Reconstruction with SMAS flap for temporal defects and parotidectomy defects has been described in the literature. To our knowledge, the use of this flap for intraoral defects has not been reported. The proximity of the flap to the defect and ease of harvest in cases including total parotidectomy are few of the reasons we use and recommend this flap in reconstruction of intraoral defects.

The effect of 2 different distraction-compression models on new bone generation.

PURPOSE: To compare the stimulating effect of distraction and 2 different distraction-compression models on maturation of new bone during healing. MATERIALS AND METHODS: Thirty adult Sprague-Dawley rats underwent unilateral mandibular osteotomy. The animals were divided into 3 groups. A unidirectional external distraction device was fixed to the mandible. A total of 4 mm of distraction was planned in all groups. After a latency period of 3 days, 0.2 mm of distraction was performed twice a day for 10 days in the distraction group. In the intermittent distraction-compression group, 0.2 mm of distraction was performed twice a day for 3 days, followed by 0.2 mm of compression twice a day for 1 day. In the overdistraction-compression group, 0.2 mm of distraction was performed twice a day for 14 days, followed by 0.2 mm of compression twice a day for 4 days. After a consolidation period of 6 weeks in all groups, animals were killed for macroscopic, microscopic, and radiologic evaluation. RESULTS: Radiologic evaluation proved that more mature bone generation occurred in the groups in which compression was added to distraction. The number of osteoblasts in the intermittent distraction-compression group was significantly higher than that in the distraction group and overdistraction-compression group (P < .001). The highest number of vessels was found in the intermittent distraction-compression group (17.7 ± 6.4) (P < .001). CONCLUSIONS: The intermittent distraction-compression model was found to generate greater new bone compared with distraction alone. In clinical applications, to increase the quality of the bone and to shorten the consolidation period, compression can be applied during distraction.

3D evaluation of the effects of traumatic surgical techniques on Vomer bone volume and morphology in the treatment of lip and palate clefts.

BACKGROUND: Cleft lip/palate (CLP) deformity is the most common congenital facial anomaly. In this study, it was aimed to evaluate the changes in volume and shape of Vomer bone after CLP repair surgery. METHODS: The images of a total of 30 patients aged between 9 and 12 years which were recorded with computed tomography were retrospectively analyzed. The patients were divided into three groups: No syndrome, operated for unilateral CLP group (n=10), no syndrome, operated for bilateral CLP group (n=10), and control group (n=10) with no syndrome, no operation history, or no lip/palate deformities. Data of the patients were transferred to a software program and a new three-dimensional image was created for the Vomer. RESULTS: There was no statistically significant difference in the Sella-Nasion lengths, Vomer base lengths, and Vomer vertical lengths among the three groups. However, the Vomer bone volume of the patients with bilateral CLP was found to be statistically significantly higher than the control group. CONCLUSION: We can conclude that more bone formation may be observed due to the periosteal reaction following bilateral Vomer flap elevation or during maxillary growth, tension on the palatal flap may be increased new bone formation by pulling the bilateral Vomer flap if it is elevated and sutured palatal mucoperiosteal flap in the early period. Our findings have led us to the conclusion that size and volume of the Vomer bone can be significantly affected by environmental factors. According to the functional matrix theory, scar tissue formation and lack of Vomer-maxilla fusion cannot stimulate the further development of the anterior cranial bones, leading to shorter anterior cranial base.

Comparison of different treatment techniques in the mandibular condyle fracture.

BACKGROUND: Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures. METHODS: Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment. RESULTS: The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion. CONCLUSION: The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.

Benign nodular hidradenoma of the face.

A very rare case of nodular hidradenoma with an atypical clinical presentation of the face of a 70-year-old woman is presented. Although this rare benign tumor has the potential of local recurrence and malignant transformation, it is commonly reported in the dermatology, pathology, and oncology literature, with limited clinical information. The purpose of this report was to emphasize the clinical features of this lesion for plastic surgeons.

A complication of nasotracheal intubation after mandibular subcondylar fracture.

Among the potential risks of nasotracheal intubation are nasal bleeding, sinusitis, bacteremia, accidental turbinectomy, and some other structural damages. Retropharyngeal dissection is reported as a very rare complication of nasotracheal intubation, mostly encountered in elective surgery patients. A case with traumatic subcondylar fracture of the mandible is presented here, which is suspected to be the cause of the nasopharyngeal dissection that was observed during attempted nasotracheal intubation.

Anterior pillarplasty: a modification in cleft palate repair.

After the primary repair of cleft palate, surgeons are frequently confronted with a short soft palate and a wide velopharyngeal space, both of which are known to diminish the quality of speech. We introduce a new modification of the primary repair of cleft palate that lengthens the soft palate and helps to reduce the volume of the velopharyngeal space. Ten patients younger than 12 months with nonsyndromic cleft palate were operated on with this technique. The incision at the cleft margin extended behind the uvula as a modification to the classic design of mucoperiosteal flaps. The sagittally divided mucosal layers of each anterior tonsillar pillar are sutured at the midline 1 cm posterior to the new uvula. The rate of postoperative fistula formation and other complications were evaluated postoperatively. One patient had a uvular and partly pillar detachment at the postoperative period. All other clefts healed without complication. The primary repair of the cleft palate with the anterior pillarplasty technique is a safe and easy-to-perform procedure. This modification can effectively reduce the transverse diameter of the velopharyngeal space and increase the anteroposterior length of the palate.