Serial tissue expansion and excision for reconstruction of giant dorsal congenital melanocytic nevus: A case report.

Giant congenital melanocytic nevus often necessitates meticulous planning and multiple treatment stages for complete surgical excision. This report presents a case of giant congenital melanocytic nevus on the back managed through serial tissue expansion and excision. Initially, two expanders were placed at the deep fascia level. Sequential outpatient expansions over 10 weeks were followed by expander removal, partial nevus excision, defect coverage with expanded skin flaps, and simultaneous placement of a new expander. The subsequent single expander expansion over 12 weeks involved a total of 600 mL of saline. After three operations spanning approximately 6 months, 54 cm × 36 cm of giant congenital melanocytic nevus skin, covering 65% of the patient's back, was completely excised. Serial tissue expansion and excision may be an effective surgical approach for managing dorsal giant congenital melanocytic nevus, reducing the need for multiple surgeries and achieving favorable aesthetic outcomes.

Continuous detrimental activity of intra-articular fibrous scar tissue in correlation with posttraumatic ankle osteoarthritis.

Posttraumatic osteoarthritis is primarily characterized by articular cartilage destruction secondary to trauma or fracture events. Even while intra-articular scar tissue can be observed following ankle fractures, little is known about its nature and molecular events linking its biological activity and cartilage deterioration. Here, we investigated scar tissue's histological and molecular characteristics, and its relationship with localized articular cartilage alterations consistent with early osteoarthritic degeneration. Intra-articular scar tissues from sixty-two patients who underwent open reduction internal fixation for ankle fracture were obtained at hardware removal time (6-44 months after fracture). Histological analysis demonstrated that scar tissue has the nature of fibrosis with fibrous tissue hyperplasia, fibroblast proliferation, and chondrometaplasia. These fibrous scar tissues showed overexpressed pro-inflammatory cytokines and high mRNA expression levels of osteoarthritis-related markers (cytokines, chemokines, and enzymes) compared to the normal synovium. Furthermore, those transcriptional levels were significantly correlated with the grade of talar chondral degeneration. Our findings suggest that following an ankle fracture, the intra-articular fibrous scar tissue exhibits high catabolic and inflammatory activity, which has a long-lasting negative impact correlated to cartilage deterioration in the development of posttraumatic osteoarthritis.

Effect of Bone Morphogenetic Protein-2 Combined With Microfracture for Osteochondral Defect of the Talus in a Rabbit Model.

BACKGROUND: Osteochondral defects of the talus can be effectively treated using microfracture, which is technically safe, accessible, and affordable. However, fibrous tissue and fibrocartilage comprise the majority of tissue repairs resulting from these procedures. These tissue types lack the mechanical characteristics of native hyaline cartilage and might significantly contribute to the decline in long-term outcomes. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) has been shown to promote matrix synthesis and increase cartilage formation, thus enhancing chondrogenesis in vitro. PURPOSE: This study aimed to evaluate the treatment ability of combining rhBMP-2 with microfracture in rabbit talus osteochondral defect. STUDY DESIGN: Controlled laboratory study. METHODS: A full-thickness chondral defect (3 × 3 × 2 mm) was constructed in the center talar dome of 24 New Zealand White male rabbits, which were then divided into 4 groups of 6. Each group received the appropriate treatment: group 1 (control; no treatment of defect), group 2 (microfracture treatment), group 3 (rhBMP-2/hydroxyapatite treatment), and group 4 (microfracture combined with rhBMP-2/hydroxyapatite treatment). Animals were sacrificed at 2, 4, and 6 weeks postoperatively. The International Cartilage Regeneration & Joint Preservation Society macroscopic score, which considers the degree of defect repair, the integration to the border zone, and the macroscopic appearance, was used to assess the repaired tissue's macroscopic appearance. Subchondral bone regeneration in defects was analyzed using micro-computed tomography, and the histological findings were graded using a modified version of the Wakitani scoring system for osteochondral repair. RESULTS: At 2, 4, and 6 weeks, micro-computed tomography analysis revealed that groups 3 and 4 exhibited subchondral bone healing that was more significantly improved compared with groups 1. No sample showed excessive bone growth from the subchondral bone area. According to macroscopic and histological results, group 4 showed higher-quality cartilage and more accelerated cartilage regeneration than the other groups over time. CONCLUSION: These findings show that osteochondral defect repair in a rabbit talus model could be effectively accelerated and improved by combining rhBMP-2 with microfracture. CLINICAL RELEVANCE: Using rhBMP-2 in combination with microfracture may enhance the repair of talar osteochondral lesions.

Multifocal Osteonecrosis in the Foot and Ankle After Extracorporeal Membrane Oxygenation: A Case Report.

Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation-induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.

Comparative Osteogenesis and Degradation Behavior of Magnesium Implant in Epiphysis and Diaphysis of the Long Bone in the Rat Model.

Magnesium (Mg), as a biodegradable material, is a promising candidate for orthopedic surgery. Long-bone fractures usually occur in cancellous-bone-rich epiphysis at each end or the cortical-rich diaphysis in the center, with different bone healing processes. Little is known about the differences in results between the two regions when applying Mg implants. Therefore, this study aimed to compare the biodegradation and osteogenesis of Mg implants in a rat model's epiphysis and diaphysis of the long bone. Twelve male Sprague Dawley rats underwent Mg rod implantation in the distal femoral epiphyses and tibial diaphyses. Every three weeks for up to twelve weeks, degradation behavior, gas evolution, and new bone formation were measured by micro CT. Histomorphology was analyzed by Hematoxylin and Eosin, Villanueva bone staining, and TRAP staining for osteoclastogenesis evaluations. Micro-CT analysis showed statistically significant higher new bone formation in the epiphysis group than in the diaphysis group, which correlated with a lower gas volume. Histological analysis showed higher osseointegration of Mg implants in the epiphyseal region than in the diaphyseal region. The magnesium implant's osteoclastogenesis-inhibiting properties were shown in the surrounding areas in both the cortical bone of the diaphysis and the cancellous bone of the epiphysis. Our findings show the differences in the magnesium implant's osteogenesis and biodegradation in the epiphysis and the diaphysis. These dissimilarities indicate a better response of the epiphyseal region to the Mg implants, a promising biomaterial for orthopedic surgery applications.