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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1410-1416, 2020 Nov 15.
Artículo en Chino | MEDLINE | ID: mdl-33191699

RESUMEN

Objective: To investigate the influence of the design and application of novel surgical template on the accuracy of reconstructed mandibula and implant position in occlusion-guided functional mandibular reconstruction, so as to provide guidance for clinical treatment. Methods: Between January 2017 and May 2019, 11 patients with segmental mandible defects were treated, including 8 males and 3 females with an average age of 31.8 years (range, 19-45 years). There were 6 cases of ameloblastoma, 3 cases of keratocystic tumor, and 2 cases of ossifying fibroma. According to Urken classification of mandible defects, there were 1 case of CRB, 4 cases of RB, 2 cases of RBS, and 4 cases of SB. According to the occlusion relationship, a novel surgical template with the reconstruction titanium plate screws and implants drill-guided information was designed and manufactured. With the help of the novel surgical template, the "one and a half" fibula reconstruction mode was used for jaw functional reconstruction, and the implant supported denture was finally completed. The postoperative CT at 1 week were collected to analyze the morphology of the preoperative virtual design jaw and postoperative jaw. The coincidence of fibular reconstructed mandible (fibular upper barrel, fibular reconstructed ramus and condyle, and whole mandible) and implant in mandible were calculated. When the coincidence was less than 80%, it was considered that the deviation was obvious. Oral panoramic X-ray film and cone beam CT were examined at 6 months after operation to evaluate the osseointegration before implant repair. Results: None of the 11 flaps had postoperative vascular crisis. One flap occurred necrosis at 1 month after reconstruction combined with 3 implants failed, and had been removed at 6 months after reconstructed surgery; the others had no flap necrosis. One week postoperatively, the coincidence of the fibular upper barrel was 87.55%±3.08%, the whole mandible was 82.68%±5.94%, and the implant in mandible was 88.00%, with significant differences ( t=8.131, P=0.000; t=2.118, P=0.046; Z=4.070, P=0.000) when compared to 80%, respectively. The fibular reconstructed ramus and condyle was 77.82%±3.54%, with no significant difference ( t=-2.042, P=0.068) when compared to 80%. Six months postoperatively, oral panoramic X-ray film and cone beam CT showed that all 22 implants achieved osseointegration and the palatal mucosa transplantation was performed, then finally completed the denture rehabilitation at 6-9 months after operation. All patients were satisfied with their postoperative appearance. Conclusion: The novel surgical template can guarantee the accuracy of functional mandible reconstruction guided by occlusal guidance, and ultimately achieve the beautiful contour of jaw and occlusal function reconstruction, and improve the patient's life quality.


Asunto(s)
Ameloblastoma , Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Adulto , Ameloblastoma/cirugía , Trasplante Óseo , Femenino , Peroné/cirugía , Humanos , Masculino , Mandíbula/cirugía , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Colgajos Quirúrgicos , Adulto Joven
2.
Artículo en Inglés | MEDLINE | ID: mdl-33151192

RESUMEN

Oral cancer treatment involving the maxilla and/or mandible often results in esthetic and functional deficits that can diminish the patient's quality of life. As a result, expeditious reconstruction of the defect and dental rehabilitation is desirable. Dental rehabilitation shortly after reconstruction with an osteocutaneous free flap and resection prosthesis is a persistent challenge for patients with oncologic defects where immediate dental rehabilitation is not a possibility. Additionally, conventional prosthesis fabrication techniques are impractical or impossible due to postoperative anatomical changes and limitations in clinical armamentarium. To address these limitations, a technique and a novel implant-supported prosthetic workflow for the oncologic patient were developed to provide interim dental rehabilitation for such clinical situations. This article describes the prosthesis fabrication technique, reports short-term outcomes, and evaluates patient-reported quality-of-life outcomes using the FACE-Q Head and Neck Cancer Module.


Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Reconstrucción Mandibular , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Peroné/cirugía , Humanos , Calidad de Vida
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5519-5522, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019229

RESUMEN

Because implicit medical knowledge and experience are used to perform medical treatment, such decisions must be clarified when systematizing surgical procedures. We propose an algorithm that extracts low-dimensional features that are important for determining the number of fibular segments in mandibular reconstruction using the enumeration of Lasso solutions (eLasso). To perform the multi-class classification, we extend the eLasso using an importance evaluation criterion that quantifies the contribution of the extracted features. Experiment results show that the extracted 7-dimensional feature set has the same estimation performance as the set using all 49-dimensional features.


Asunto(s)
Reconstrucción Mandibular , Algoritmos , Peroné/cirugía
4.
J Craniomaxillofac Surg ; 48(9): 859-867, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32792109

RESUMEN

BACKGROUND: Bone volume changes following vascularized bone flaps and possible confounding factors over time are described in the literature with some controversy. The purpose of this study was to evaluate the bone volume behavior of two frequently used free flaps. MATERIALS AND METHODS: Computed tomography (CT) scans were examined with regard to bone volume using the software program ITK-SNAP for all patients who required mandibular reconstruction with a free fibula flap (FFF, conventionally vs assisted by computer-aided design/computer-aided manufacturing (CAD/CAM)) or iliac crest flap (DCIA) following mandibular resection because of benign or malign processes, between August 2010 and August 2015. Clinical data, complication rates, and CT scans were analyzed retrospectively. Additionally, complication rates (microvascular revision, flap loss, postoperative fistula or dehiscence, and postoperative bone exposure) were compared within early (≤30 days), late (31st-100th day), and overall (≤100th day) postoperative time intervals. RESULTS: 113 cases, comprizing 89 FFF and 24 DCIA cases, were included. FFF showed superior bone volume behavior over the DCIA flap. Multivariable regression models assessed the relationships between the following and bone volume behavior: interval between operation and CT scan (p < 0.683), age (p = 0.004), gender (p = 0.006), BMI (p = 0.400), adjuvant radiation therapy (p = 0.334), reconstruction with DCIA flap (p < 0.0001), number of segments (p = 0.02), and incidence of dental implant insertion (p = 0.45). CONCLUSIONS: The bone volume of FFFs remains stable. DCIA flaps show a higher bone volume reduction, but the postoperative course might be associated with fewer complications. Time interval between operation and CT scan, age, gender, reconstruction with DCIA flap, and number of fibula segments contributed significantly to bone volume behavior.


Asunto(s)
Colgajos Tisulares Libres/cirugía , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Peroné/cirugía , Humanos , Mandíbula/cirugía , Estudios Retrospectivos
5.
Artículo en Chino | MEDLINE | ID: mdl-32791639

RESUMEN

Objective:To investigate the application of free fibular flap based on digital technology in mandibular defects. Method:Eight cases of mandibular defects underwent virtual surgery and guide plate design before operation. The mandibular osteotomy guide plate, fibula plastic guide plate and mandibular reconstruction model were prepared by rapid prototyping technology. The individualized reconstruction titanium plates were prefabricated on the mandibular reconstruction model. Based on the guide plates and the individualized reconstruction titanium plates, the mandibular defects were repaired accurately. At the same time, CT angiography was used to observe the variation of peroneal artery. For patients with soft tissue defects, the superficial position of the point going out muscle of perforator vessels was located, and the skin flaps were designed to repair the soft tissue defect. Result:The free fibular flaps survived in all patients. The guide plates were successfully implanted, the position of the individualized reconstruction titanium plates were accurate, and the occlussions were well recovered. Preoperative CT angiography was carried out without complication in all patients, the desired anatomy was adequately demonstrated in all patients. The superficial position of the point going out muscle of perforator vessels during operation were basically in accordance with those detected by CT angiography. Conclusion:The free fibular flaps based on digital technology can successfully repair mandibular defects with good aesthetic and functional results.


Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Placas Óseas , Peroné/cirugía , Humanos , Mandíbula/cirugía
6.
BMC Surg ; 20(1): 125, 2020 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-32517685

RESUMEN

BACKGROUND: In children, fracture non-union is uncommon yet, curiously, non-union of distal fibula fractures are rarely reported. Historically, the most common treatment of a lateral malleolus fracture after an ankle sprain is conservative, which usually leads to fracture union. However, even in clinically stable ankles, subsequent pain arising from fracture site could suggest non-union, thereby necessitating reexamination and possible secondary treatment. CASE PRESENTATION: We report the case of an 8-year-old girl with an epiphyseal distal fibula fracture complicated with a symptomatic non-union associated with the chondral flap of the talar dome after conservative treatment. Surgical excision of the fragment and chondroplasty was performed and resulted in an excellent clinical outcome. CONCLUSION: This case report illustrates the necessity of particularly meticulous evaluation of pediatric post-traumatic ankle pain. Surgical treatment as well as talar chondral evaluation should be taken into consideration in the treatment of pediatric distal fibular nonunion.


Asunto(s)
Fracturas de Tobillo/cirugía , Articulación del Tobillo/patología , Peroné/cirugía , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Niño , Femenino , Fracturas Óseas/cirugía , Humanos , Astrágalo/patología , Astrágalo/cirugía
7.
Am J Otolaryngol ; 41(4): 102536, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32487337

RESUMEN

LEARNING OBJECTIVES: Identify factors associated with skin graft take in fibula free flaps (FFF) and radial forearm free flaps (RFFF) donor sites. STUDY OBJECTIVES: To determine which factors are associated with decreased skin graft take at the donor site in FFF and RFFF in head and neck patients. DESIGN: Retrospective Chart Review Case Series. SETTING: Multicenter Tertiary Care. METHODS: A multicenter retrospective review was performed at three institutions identifying patients who underwent free tissue transfer, specifically either FFF or RFFF, between 2007 and 2017. Patient demographics, medical history, and social history were examined including age, gender, BMI, smoking status, diabetes and preoperative anticoagulation use. Preoperative, intraoperative data, and postoperative data were also examined including tourniquet use, type of flap, area of skin graft, if the skin graft had a donor site or if it was taken from the flap, wound NPWT use, cast use, use of physical therapy, DVT prophylaxis, limb ischemia, heparin drip, and postoperative aspirin use. Statistical analysis was used to determine which factors were significantly associated with skin graft take. RESULTS: 1415 patients underwent a forearm or fibula flap and 938 patients underwent split-thickness skin graft. Of these, 592 patients had sufficient information and were included in the final analysis. There were 371 males and 220 females. The average age was 55.7. Complete skin graft take was seen in 480 patients (81.1%). On univariate analysis, patients with diabetes (p = .003), type of flap (fibula p < .001), skin graft area (p = .006), tourniquet use (p = .003), DVT prophylaxis (p = .008) and casting (p = .003) were significantly associated with decreased skin graft take rate. In a multivariate analysis, diabetes (OR 2.17 (95%CI 1.16-3.98)), fibula flaps (OR 2.86 (95%CI 1.79-4.76)), an increase in skin graft area (OR 1.01 (95%CI 1.01-1.01)), post-operative aspirin (OR 2.63 (95%CI 1.15-5.88), and casting (OR 2.94 (95%CI 1.22-7.14)) were associated with poor rates of skin graft take. CONCLUSION: Several factors affect skin graft take rate and should be considered when performing a skin graft for a donor site defect.


Asunto(s)
Peroné/cirugía , Antebrazo/cirugía , Colgajos Tisulares Libres/trasplante , Trasplante de Piel/métodos , Recolección de Tejidos y Órganos/métodos , Trasplantes , Adulto , Anciano , Aspirina/administración & dosificación , Sordera , Diabetes Mellitus Tipo 2 , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Mitocondriales , Estudios Retrospectivos , Torniquetes , Trombosis de la Vena/prevención & control
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 702-706, 2020 Jun 15.
Artículo en Chino | MEDLINE | ID: mdl-32538559

RESUMEN

Objective: To explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column. Methods: Between January 2016 and September 2018, 19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach. There were 11 males and 8 females with an average age of 43.2 years (range, 28-65 years). The causes of tibial fracture were traffic accident (12 patients), falling injury (5 patients), and falling from height (2 patients). According to the Schatzker typing, the tibial fractures were rated as type Ⅱ in 9 cases, type Ⅲ in 4 cases, type Ⅴ in 4 cases, and type Ⅵ in 2 cases. The time from injury to operation was 5-13 days (mean, 8.5 days). There were 2 patients with osteoporosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The knee X-ray film was reviewed regularly to observe the fracture healing. At last follow-up, the fracture reductions were evaluated by Rasmussen radiological score. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score system. Results: The average operation time was 95 minutes (range, 65-130 minutes). The average intraoperative blood loss was 220 mL (range, 150-350 mL). All incisions healed by first intention. No complications such as infection or deep venous thrombosis occurred. All patients were followed up 12-20 months (mean, 15.4 months). X-ray films showed that the fractures healed with the healing time of 12-20 weeks (mean, 14.5 weeks). No complications such as loosening or breakage of internal fixation occurred. At last follow-up, according to the Rasmussen radiological score, the fracture reductions were evaluated as excellent in 13 cases, good in 4 cases, fair in 1 case, and poor in 1 case. HSS scores of knee joint function were excellent in 14 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The knee joint range of motion was 90°-135°, with an average of 113.4°. Conclusion: Application of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure, less trauma, safety, and reliable reduction and fixation.


Asunto(s)
Peroné , Fijación Interna de Fracturas , Fracturas de la Tibia , Adulto , Anciano , Placas Óseas/normas , Femenino , Peroné/cirugía , Fijación Interna de Fracturas/normas , Humanos , Masculino , Persona de Mediana Edad , Fracturas de la Tibia/cirugía , Resultado del Tratamiento
9.
Int J Oral Maxillofac Surg ; 49(11): 1408-1415, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32404244

RESUMEN

The aim of this study was to present a treatment protocol for the individual repair of post-traumatic maxillofacial bone defects with vascularized flaps assisted by digital techniques. This study reviewed 20 patients with post-traumatic maxillofacial bone defects who underwent reconstruction with composite vascularized bone flaps assisted by digital techniques between April 2009 and July 2019. Preoperative computed tomography (CT) data were imported into ProPlan CMF software to complete virtual fracture reduction and reconstruction. Surgical navigation, three-dimensionally (3D) printed surgical plates, and prefabricated titanium mesh/plates were used to guide the actual surgery. All patients underwent open reduction and internal fixation and reconstruction surgery in one stage. CT data obtained at 1 week postoperative were imported into Geomagic Control software to evaluate the accuracy of the virtual surgical plan. The mean follow-up interval was 24 months (range 6-96 months). Donor and recipient site morbidity and second-stage procedures to rehabilitate the dentition and cosmetic organs were recorded. The flap success rate was 100%. Nine patients had deep circumflex iliac artery flaps and eleven patients had fibula flaps. The accuracy of computer-assisted surgery was 4.4±0.8mm. There were no postoperative complications. This study is novel in presenting a treatment protocol for individual computer-assisted reconstruction for post-traumatic maxillofacial bone defects with vascularized flaps.


Asunto(s)
Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Cirugía Asistida por Computador , Trasplante Óseo , Peroné/diagnóstico por imagen , Peroné/cirugía , Humanos , Colgajos Quirúrgicos , Tomografía Computarizada por Rayos X
10.
J Oral Maxillofac Surg ; 78(8): 1320-1327, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32404269

RESUMEN

PURPOSE: Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involved outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques. MATERIALS AND METHODS: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles. RESULTS: All 12 patients received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses. CONCLUSIONS: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.


Asunto(s)
Implantes Dentales , Peroné/cirugía , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Sistemas de Atención de Punto , Impresión Tridimensional , Flujo de Trabajo
11.
Anticancer Res ; 40(5): 2751-2755, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32366420

RESUMEN

BACKGROUND/AIM: Non-vascularized methods to reconstruct bone defects following tumor resection are associated with complications. As a result, the free vascularized fibular flap (FVF) has become a mainstay for reconstruction. The purpose of this study was to analyze FVF reconstruction in the upper extremity. PATIENTS AND METHODS: We reviewed 28 (14 female and 14 male, mean age of 29±20 years) patients reconstructed with an FVF in the upper extremity following tumor resection. Reconstruction most commonly involved the humerus (n=17, 61%) and a malignant (n=23, 82%) tumor. RESULTS: The limb salvage rate was 93% (n=26), with primary union occurring in 71% (n=20) of patients. Following bone grafting the overall union was 96% (n=27) at a mean 13±11 months. At most recent follow-up the mean MSTS93 rating was 82±22%. CONCLUSION: FVF effectively provided a functional reconstruction following tumor resection. Although, one in four patients will need additional bone grafting, the overall union rate is high.


Asunto(s)
Neoplasias Óseas/cirugía , Peroné/irrigación sanguínea , Peroné/cirugía , Procedimientos Quirúrgicos Reconstructivos , Colgajos Quirúrgicos/irrigación sanguínea , Extremidad Superior/patología , Extremidad Superior/cirugía , Adulto , Neoplasias Óseas/diagnóstico por imagen , Supervivencia sin Enfermedad , Femenino , Humanos , Recuperación del Miembro , Masculino , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Extremidad Superior/diagnóstico por imagen
12.
J Craniofac Surg ; 31(5): e483-e485, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32371716

RESUMEN

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.


Asunto(s)
Implantación Dental Endoósea , Peroné/cirugía , Colgajos Tisulares Libres/cirugía , Mandíbula/cirugía , Reconstrucción Mandibular , Femenino , Humanos , Masculino
13.
Unfallchirurg ; 123(6): 479-490, 2020 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-32399649

RESUMEN

Shaft fractures of the tibia and fibula mainly affect younger patients and are therefore of great socioeconomic importance. Due to the high proportion of high-energy direct trauma mechanisms and the thin soft tissue covering layer of the ventromedian tibia, open factures occur in up to 39%. A structured diagnostic and therapeutic approach is essential for successful treatment. Reamed intramedullary nailing is currently the gold standard surgical procedure. The suprapatellar approach, representing an interesting alternative to the popular infrapatellar approach, postoperative complications, such as anterior knee pain as well as the management of non-unions are discussed in this article. Furthermore, the indications and the application of minimally invasive plate osteosynthesis (MIPO) and external fixators are described. Every trauma surgeon should be familiar with the etiology and the surgical treatment of compartment syndrome. A firm knowledge of the classifications of open and closed soft tissue injury is mandatory.


Asunto(s)
Síndromes Compartimentales/cirugía , Peroné/lesiones , Fracturas de la Tibia/cirugía , Adulto , Placas Óseas , Síndromes Compartimentales/etiología , Peroné/diagnóstico por imagen , Peroné/cirugía , Fijación Intramedular de Fracturas , Curación de Fractura , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Fracturas Abiertas/diagnóstico , Fracturas Abiertas/cirugía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Traumatismos de los Tejidos Blandos/clasificación , Traumatismos de los Tejidos Blandos/cirugía , Fracturas de la Tibia/diagnóstico , Resultado del Tratamiento
14.
J Oral Maxillofac Surg ; 78(8): 1436.e1-1436.e7, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32283075

RESUMEN

The anterior lateral thigh osteomyocutaneous (ALTO) free flap represents a unique reconstructive option for patients who are otherwise not good candidates for traditional free flaps to repair a through-and-through defect of the head and neck. We report the case of a patient with squamous cell carcinoma of the oral cavity who had undergone composite segmental mandibulectomy with a resultant through-and-through defect. The patient was not a candidate for fibula free flap (FFF) reconstruction owing to the presence of bilaterally dominant peroneal arteries. The patient underwent reconstruction with a single free tissue ALTO flap, with a good viable flap postoperatively. The patient did not experience any major or minor surgical complications and has been living with no evidence of disease. The ALTO free flap could be an effective flap in the reconstruction of through-and-through defects of the mandible for patients who are not candidates for FFF-based reconstruction.


Asunto(s)
Colgajos Tisulares Libres , Procedimientos Quirúrgicos Reconstructivos , Arterias , Peroné/cirugía , Humanos , Osteotomía Mandibular , Estudios Retrospectivos , Muslo/cirugía
15.
Am J Otolaryngol ; 41(3): 102436, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32144022

RESUMEN

OBJECTIVE: Fibula free tissue transfer is a common and reliable method for mandibular reconstruction. Functional outcomes from this procedure are dependent on the successful union of the osseous segments postoperatively. This study was conducted to define the maximum gap-size criteria for osseous union to occur at osteotomy sites in fibula free flap reconstruction of the mandible. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care academic center. SUBJECTS AND METHODS: A retrospective chart review of computed tomography and medical records was conducted on patients who underwent fibula free flap surgery and had imaging of the mandible at <3 months and >6 months after surgery. Distances between osteotomies were measured and evaluated for interval healing. Secondary data included subject age, sex, smoking status, diabetes, number of osteotomies, complications, and adjuvant therapy. RESULTS: Thirty-eight osteotomy sites were analyzed from thirteen subjects and a total of 190 measurements were made. The mean gap size at the first scan that demonstrated union by the second scan interval was 1.31 mm and mean gap size demonstrating non-union was 2.55 mm (p < 0.01). Complication rate, number of osetotomies, adjuvant therapy, or medical co-morbidities did not significantly affect rates of union. CONCLUSIONS: In this study, osseous union was achieved with a mean osteotomy gap size of 1.31 mm. The data suggests that distances between ossesous segments >2 .55mm have a higher risk of non-union. We believe the information from this study will help augment current and future techniques in the field of mandible reconstruction.


Asunto(s)
Trasplante Óseo/métodos , Peroné/cirugía , Colgajos Tisulares Libres , Mandíbula/cirugía , Osteotomía Mandibular/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
16.
J Pediatr Orthop ; 40(4): 203-209, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32132450

RESUMEN

BACKGROUND: Deformity of the tibia, including shortening and angulation, may accompany severe forms of postaxial hypoplasia (fibular deficiency). The current literature reflects varying opinions on the appropriate management for tibial deformity in the setting of fibular deficiency. METHODS: We performed a retrospective review to determine outcomes of tibial deformity correction in patients with a primary diagnosis of fibular deficiency. Clinical and radiographic outcomes of patients treated with foot ablation were reviewed to establish indications for tibial deformity correction, identify occurrence of additional surgical procedures related to limb alignment or deformity, and characterize difficulties with prosthetic wear potentially related to residual or recurrent tibial deformity. RESULTS: From 1989 to 2016, 51 patients (57 extremities) with fibular deficiency were managed with a foot ablation procedure. Twenty-five (44%) had simultaneous correction of the tibial deformity. The initial tibial deformity measured 42.5 degrees, was corrected to 5.6 degrees intraoperatively, and measured 18.6 degrees at follow-up, suggesting recurrent deformity. In follow-up, approximately half of the patients complained of redness and one third complained of a continued prominence along the anterior tibia. Thirty-two extremities had an isolated foot ablation procedure without tibial osteotomy. Radiographic review demonstrated mild tibial bowing at the time of amputation with a mean angular deformity of 15.4 degrees and remained unchanged during the follow-up period (mean, 12.7 degrees). Similar to the osteotomy group, approximately half of the patients complained of redness and erythema over the anterior bow, with one fourth noting prominence, and only 2 reporting significant pain. CONCLUSIONS: Tibial osteotomies in patients with more significant degrees of angular deformity can be safely performed at the same setting as foot ablative procedures for fibular deficiency. Recurrent deformity with growth may occur. Patients and their caregivers should be aware that rebound deformity may occur, but typically can be managed with prosthetic adjustment and without significant disruption to the child's daily activities. LEVEL OF EVIDENCE: Level IV (case series).


Asunto(s)
Peroné , Deformidades Adquiridas del Pie , Osteotomía , Complicaciones Posoperatorias , Tibia , Adolescente , Niño , Femenino , Peroné/anomalías , Peroné/diagnóstico por imagen , Peroné/cirugía , Deformidades Adquiridas del Pie/diagnóstico , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/cirugía , Humanos , Masculino , Osteotomía/efectos adversos , Osteotomía/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/patología , Tibia/cirugía
18.
J Craniofac Surg ; 31(4): 950-955, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32149975

RESUMEN

BACKGROUND: Mandibular reconstruction is considered one of the most complex reconstructive surgeries in the field of craniomaxillofacial surgery. With the introduction of microvascular reconstructive surgery, free fibula flap become the gold standard for reconstruction of mandibular defects. For optimum restoration of the patient's esthetics and function, the free fibular flap should be recontoured to follow the natural premorbid state of the mandible. Virtual surgical planning using preoperative computed tomographic (CT) data can be rendered into 3-dimensional (3D) model for digitalized simulation of the bony resection and reconstruction with reported high accuracy. METHODS: Ten patients were included in the study for delayed mandibular reconstruction using free fibular flap. For all the patients, preoperative CT scan for the skull and lower limbs were obtained and integrated into the software for virtual planning and guides fabrications. Postoperative CT was obtained and rendered 3D model to be superimposed on the preoperative record for assessment of the virtual planning accuracy by different linear and angular measurements. RESULTS: No statistically significant difference was found between virtual group and postoperative group where P = 0.067, regarding average of linear measurements of all patients. Statistically significant difference was found between virtual group and postoperative group in measurements from axial plane where P = 0.004. No statistically significant difference was found between virtual group and postoperative group where P = 0.723, regarding angles between fibular segments. CONCLUSION: Virtual surgical planning for mandibular reconstruction offers high reproducibility and precision, reducing the side errors, besides its time saving advantage for both the operator and the patient.


Asunto(s)
Colgajos Tisulares Libres/cirugía , Imagenología Tridimensional , Mandíbula/cirugía , Reconstrucción Mandibular , Cirugía Asistida por Computador , Adolescente , Adulto , Femenino , Peroné/diagnóstico por imagen , Peroné/cirugía , Humanos , Imagenología Tridimensional/instrumentación , Imagenología Tridimensional/métodos , Masculino , Mandíbula/diagnóstico por imagen , Periodo Posoperatorio , Reproducibilidad de los Resultados , Programas Informáticos , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adulto Joven
19.
Knee ; 27(3): 930-933, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32089394

RESUMEN

BACKGROUND: To investigate the morphological changes in the tibiofibular joint following open wedge high tibial osteotomy (OWHTO). METHODS: We studied 397 joints in 341 patients. Standing femorotibial angle (FTA), %mechanical axis (%MA), corrected tibial angle, distance (D) to tibial joint surface (T) and fibular head (F) and angle (A; proximal, distal), proximal tibiofibular joint (PTFJ) osteoarthritis (OA) onset, and tibiofibular joint-related complications were the parameters assessed. RESULTS: FTA improved from 181.1° to 168.8° and %MA from 28.7 to 68.7, whereas the mean tibia corrected angle was 10.4°. Proximal TFD changed from 9.4 mm preoperatively to 7.8 mm during the investigation. The fibular head was displaced 1.6 mm upwards, and proximal tibial femoral angle (TFA) moved approximately 10° in the valgus direction from 82.5° to 92.4°. However, no significant changes were noted for the distal TFD or TFA. PTFJ OA was observed in 57 cases (14.7%), and lateroposterior knee pain in 11 cases (2.8%). Additional resection of the fibula was performed in cases with marked pain. CONCLUSIONS: With OWHTO, increased load is placed on the PTFJ postoperatively. In rare cases, this can cause pain and is therefore a complication that physicians should be aware of.


Asunto(s)
Peroné/cirugía , Artropatías/cirugía , Articulación de la Rodilla/cirugía , Osteotomía/efectos adversos , Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Peroné/diagnóstico por imagen , Peroné/patología , Humanos , Artropatías/diagnóstico por imagen , Artropatías/etiología , Artropatías/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Tibia/diagnóstico por imagen , Tibia/patología , Adulto Joven
20.
Oper Orthop Traumatol ; 32(5): 467-474, 2020 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-32100068

RESUMEN

OBJECTIVE: Functional and sensible regeneration of deficits related to common peroneal nerve palsy. INDICATIONS: Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait. CONTRAINDICATIONS: Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma. SURGICAL TECHNIQUE: Surgery in lateral position and thigh tourniquet. L­Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage. POSTOPERATIVE MANAGEMENT: Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months. RESULTS: From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.


Asunto(s)
Nervio Peroneo , Descompresión Quirúrgica , Peroné/diagnóstico por imagen , Peroné/cirugía , Humanos , Nervio Peroneo/cirugía , Neuropatías Peroneas/diagnóstico , Neuropatías Peroneas/cirugía , Resultado del Tratamiento
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