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1.
J Craniofac Surg ; 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33464774

RESUMO

OBJECTIVE: The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. METHODS: Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3 cm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. RESULTS: Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. CONCLUSIONS: Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity.

2.
Dermatol Ther ; 34(1): e14734, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33389778

RESUMO

We present hybrid reconstruction of distal lateral "through-and-through" nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

3.
J Craniofac Surg ; 31(4): 1006-1009, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32510903

RESUMO

Fibrous dysplasia (FD) is a developmental bone disorder caused by the hamartamatous proliferation of bone-forming cells. A 29-year-old male patient with diagnosis of FD was admitted to our clinic with the symptoms of severe craniomaxillofacial involvement of FD beginning from last year. Neurological examination revealed diplopia, horizontal nystagmus, conductive hearing loss, and partial vision loss. In his medical history, it was reported that he had undergone intramedullary nailing operation in his left femur due to a pathological fracture approximately 8 years ago in the orthopedics clinic of our institution. The patient underwent 3 consecutive surgeries by our plastic and neurosurgical team. The patient was followed-up in the neuro-intensive care unit between the surgical sessions and 1 week after the last operation. Afterwards, he was transferred to the neurosurgical department. No postoperative complication was detected. The preoperative signs were recovered. During his 6th month follow-up control-visit, all his preoperative symptoms were improved. In addition, the patient was satisfied with his postoperative cosmetic improvement. In conclusion, virtual surgical planning and intraoperative surgical navigation systems can make the challenging cases possible to operate with increasing the safety margin of the surgical procedures for polyostotic FD.


Assuntos
Criocirurgia , Displasia Fibrosa Poliostótica/cirurgia , Adulto , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Tomografia Computadorizada por Raios X
4.
Turk J Orthod ; 32(2): 65-71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31294408

RESUMO

Objective: The purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter-examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with an unrepaired unilateral cleft lip and palate (UUCLP). Methods: Preoperative extraoral plaster casts from 42 patients with UUCLP were measured with a digital caliper, and the image acquisition of casts was performed with the 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Two examiners (one postgraduate student, one lecturer) evaluated 19 nasolabial measurements in two separate sessions. Results: Intra-rater, inter-rater, and inter-method reliability was lower in measurements of nasal, philtral, and nasal floor width. Almost all of the interclass correlation coefficients (ICC) for measurements performed by the lecturer were above 0.75, whereas the intra-examiner reliability of some measurements performed by the postgraduate student showed low ICC (<0.75). Conclusion: Measurements of curving slopes, such as nasal width, of small dimensions, such as nostril floor width, and deformity-affected anatomic parts, such as philtrum width, presented a low reliability. Measurements on 3D images showed a higher reliability compared to plaster model measurements performed by the postgraduate student. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements especially if performed in postgraduate settings.

5.
Ann Plast Surg ; 83(3): 293-299, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30882408

RESUMO

Massive intraosseous vascular malformations, a relatively rare entity in the vascular malformation spectrum, deserves attention as involving the membranous bones of the craniofacial skeleton and may lead to severe life-threatening hemorrhages and even death. The main aim of this study was to summarize the 25 years of clinical experience with these vascular malformation osseous patients, focus on the molecular and genetic aspect of the clinical entity, and to emphasize the certain challenging conditions in the treatment of these patients. All the patients appeared to be unaffected at birth, whereas initial symptoms occasionally began with painless swelling in the mandible in early childhood. The disease was progressive in behavior especially in the pubertal ages and was specifically involving the maxilla and mandible of the craniofacial skeleton in all the patients. Calvarium and cranial base were the second most common involved regions among these patients (62.5%). Clavicular (50%), costal (25%), and vertebral (25%) involvements were also a significant manifestation of the disease. Tissue samples obtained from the affected individuals and the blood samples from their families were matched, revealing a loss of function mutation in the ELMO-2 gene of chromosome 20 leading to developmental abnormality of the vascular structures via RAC1 signaling and leading to abnormally enlarged vessels in the intraosseus portion of the membranous bone. Immunohistochemical staining revealed positive CD31 and smooth muscle actin staining but negative proliferation and maturity markers such as Ki-67, desmin, h-caldesmon, and myofibroblast-like desmin. The follow-up of 3 of 5 patients ended up with mortality (60%). vascular malformation osseous is intraosseous vascular malformation with aggressive biological behavior associated with ELMO-2 gene mutation. Further studies for obtaining prenatal diagnosis and achievement of gene therapy should take place. As the disease rapidly progresses as the affected individual grows, surgical interventions should be taken into consideration before the initiation of complications.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas do Citoesqueleto/genética , Crânio/anormalidades , Crânio/irrigação sanguínea , Coluna Vertebral/anormalidades , Malformações Vasculares/diagnóstico , Malformações Vasculares/genética , Adulto , Feminino , Seguimentos , Humanos , Masculino , Fatores de Tempo
6.
Am J Hum Genet ; 99(2): 299-317, 2016 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-27476657

RESUMO

Vascular malformations are non-neoplastic expansions of blood vessels that arise due to errors during angiogenesis. They are a heterogeneous group of sporadic or inherited vascular disorders characterized by localized lesions of arteriovenous, capillary, or lymphatic origin. Vascular malformations that occur inside bone tissue are rare. Herein, we report loss-of-function mutations in ELMO2 (which translates extracellular signals into cellular movements) that are causative for autosomal-recessive intraosseous vascular malformation (VMOS) in five different families. Individuals with VMOS suffer from life-threatening progressive expansion of the jaw, craniofacial, and other intramembranous bones caused by malformed blood vessels that lack a mature vascular smooth muscle layer. Analysis of primary fibroblasts from an affected individual showed that absence of ELMO2 correlated with a significant downregulation of binding partner DOCK1, resulting in deficient RAC1-dependent cell migration. Unexpectedly, elmo2-knockout zebrafish appeared phenotypically normal, suggesting that there might be human-specific ELMO2 requirements in bone vasculature homeostasis or genetic compensation by related genes. Comparative phylogenetic analysis indicated that elmo2 originated upon the appearance of intramembranous bones and the jaw in ancestral vertebrates, implying that elmo2 might have been involved in the evolution of these novel traits. The present findings highlight the necessity of ELMO2 for maintaining vascular integrity, specifically in intramembranous bones.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Osso e Ossos/irrigação sanguínea , Proteínas do Citoesqueleto/genética , Mutação/genética , Transdução de Sinais/genética , Malformações Vasculares/genética , Proteínas rac1 de Ligação ao GTP/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/deficiência , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adulto , Alelos , Animais , Movimento Celular , Proteínas do Citoesqueleto/deficiência , Proteínas do Citoesqueleto/metabolismo , Evolução Molecular , Feminino , Homozigoto , Humanos , Masculino , Fenótipo , Filogenia , Especificidade da Espécie , Malformações Vasculares/metabolismo , Malformações Vasculares/patologia , Peixe-Zebra/genética , Peixe-Zebra/fisiologia , Proteínas rac de Ligação ao GTP/genética
7.
Plast Reconstr Surg ; 137(1): 134-43, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26710017

RESUMO

BACKGROUND: The aim of this study was to generate skin tissue using adipose tissue-derived mesenchymal stem cells. METHODS: Thirty Wistar albino rats were used. A 2-cm-diameter full-thickness skin defect on the back of each rat was formed. A secondary wound healing model was constituted in group 1, fibrin matrix only was applied in group 2, a keratinocyte-coated fibrin matrix was applied in group 3, an adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied in group 4, and a keratinocyte-coated and adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied to the defects in group 5. RESULTS: A similar form of wound healing, with contraction from the edges and ulceration at the center, was observed in groups 1, 2, and 3. The wound contraction was reduced in group 4, and the epidermis was creeping from the surrounding tissue but with some ulcerations in the central part of the wounds. In group 5, the defect area was almost totally epithelialized, with minimal wound contraction. By microscopic analysis, significant increases in the collagen volume ratios and vascular volume ratios were determined in groups 4 and 5. From the fluorescent micrographs, fibroblastic differentiation and extracellular matrix synthesis, endothelial differentiation of stem cells, and neoangiogenesis and epithelium derived from marked keratinocytes were observed in group 5. CONCLUSION: Formation of the adipose tissue-derived mesenchymal stem cell-seeded and keratinocyte-coated autologous fibrin scaffold leads to significant skin replacement.


Assuntos
Tecido Adiposo/citologia , Transplante de Células-Tronco Mesenquimais/métodos , Regeneração/fisiologia , Pele Artificial , Pele/lesões , Adipócitos/citologia , Animais , Células Cultivadas , Modelos Animais de Doenças , Fibroblastos/citologia , Queratinócitos/citologia , Queratinócitos/transplante , Ratos , Ratos Wistar , Sensibilidade e Especificidade , Pele/crescimento & desenvolvimento , Engenharia Tecidual/métodos , Tecidos Suporte , Transplante Autólogo
8.
J Craniofac Surg ; 26(5): e426-30, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26163852

RESUMO

BACKGROUND: In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. MATERIALS AND METHODS: A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. RESULTS: The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. DISCUSSION: The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Países em Desenvolvimento , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lábio/cirurgia , Masculino , Duração da Cirurgia , Palato/cirurgia , Reprodutibilidade dos Testes , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento , Cicatrização , Adulto Jovem
9.
J Craniofac Surg ; 26(1): e58-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25569418

RESUMO

Epidermoid cyst located in cranium is uncommon and usually diagnosed with a growing mass leading to symptoms. Asymptomatic intradiploic epidermoid cyst has not been reported yet. In this study, incidental diagnosis of asymptomatic cyst and potential impact of that cyst on surgical planning of a patient with craniosynostosis are presented.


Assuntos
Doenças Assintomáticas , Doenças Ósseas/diagnóstico , Craniossinostoses/diagnóstico , Cisto Epidérmico/diagnóstico , Osso Frontal/patologia , Craniossinostoses/cirurgia , Cisto Epidérmico/cirurgia , Feminino , Osso Frontal/cirurgia , Humanos , Imageamento Tridimensional/métodos , Achados Incidentais , Lactente , Planejamento de Assistência ao Paciente , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tomografia Computadorizada por Raios X/métodos
10.
Am J Orthod Dentofacial Orthop ; 145(3): 381-92, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24582029

RESUMO

The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results.


Assuntos
Anodontia/terapia , Fenda Labial/terapia , Fissura Palatina/terapia , Equipe de Assistência ao Paciente , Erupção Ectópica de Dente/terapia , Dente Canino/patologia , Estética Dentária , Feminino , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Incisivo/anormalidades , Má Oclusão de Angle Classe II/terapia , Doenças Nasais/cirurgia , Fístula Bucal/cirurgia , Fechamento de Espaço Ortodôntico/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Técnica de Expansão Palatina , Planejamento de Assistência ao Paciente , Satisfação do Paciente , Fístula do Sistema Respiratório/cirurgia , Tomografia Computadorizada por Raios X/métodos , Técnicas de Movimentação Dentária/métodos , Interface Usuário-Computador , Adulto Jovem
12.
J Craniofac Surg ; 25(2): 363-6, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24514890

RESUMO

BACKGROUND AND OBJECTIVE: The growth of maxillary sinus is closely connected to the development of facial structures. However, its definition and reference standards on fetal magnetic resonance imaging (MRI) have not been analyzed so far. In this study, the objectives were to define and evaluate the fetal maxillary sinus (fMS) formation with MRI. METHODS: We reviewed T2-weighted coronal MRI images of 75 fetuses. The MRI features, time of appearance, and boundaries of fMS were defined. Craniocaudal and transverse diameters of both maxillary sinuses and bone biparietal diameters were measured and statistically evaluated. RESULTS: In 150 fMS site analysis, 91 fMSs were identified. The fMSs were visualized as a hyperintense structures on T2-weighted image above the tooth bud. It first appeared at the 22nd gestational week, and in 4% (3/75) of fetuses, there was unilateral development. Mean craniocaudal length was 2.84 mm (1.1-4.8 mm), and mean transverse diameter was 2.67 mm (1.5-4.2 mm). CONCLUSIONS: Magnetic resonance imaging features of fMS that should be sought for the assessment of craniofacial anatomy are identified in this study. Fetal maxillary sinuses can be observed as hyperintense structures on T2-weighted MRI images starting from 22 weeks of gestation. The growth of fMS follows a predictable course throughout gestation; however, the dimensions are larger than the previously reported ex vivo series.


Assuntos
Imagem por Ressonância Magnética/métodos , Seio Maxilar/embriologia , Pontos de Referência Anatômicos/embriologia , Cefalometria/métodos , Feminino , Idade Gestacional , Humanos , Processamento de Imagem Assistida por Computador/métodos , Maxila/embriologia , Osso Parietal/embriologia , Gravidez , Estudos Retrospectivos
13.
J Craniofac Surg ; 24(5): 1586-92, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24036732

RESUMO

The vascularized iliac osteocutaneous flap has been used successfully for jaw reconstruction. To obtain a better contour of the reconstructed area in large upper and lower jaw resections, the transferred bone actually needs to be osteotomized. Single closing-wedge osteotomy of the iliac flap for mandibular reconstruction has been previously described. In this article, the modified multiple osteotomized perforator-based versatile free iliac osteocutaneous flap is described. Eleven cases were enrolled. Seven patients had wide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1 patient had complicated orbitomaxillary defect due to blast injury. Skin paddle was based on the perforators. In 8 patients, the bony segment was divided into 3 segments by 2 osteotomies, whereas in 2 patients the bony segment was divided into 4 segments by 3 osteotomies. In 10 cases, the flap was used for anterior mandibular defects, whereas in 1 case the flap was customized to fit an L-shaped defect at the naso-orbito-maxillary region. The overall flap success rate was 100%. No resorption or morbidity related to the osteotomy of the bony segments was observed. The size of perforator skin paddle was 6 to 8 × 15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneous iliac flap can provide a safe and versatile bony segment to be arranged and adapted to reconstruct complex mandibular and maxillofacial defects.


Assuntos
Transplante Ósseo/métodos , Aloenxertos Compostos/provisão & distribução , Neoplasias Maxilomandibulares/cirurgia , Reconstrução Mandibular/métodos , Traumatismos Maxilofaciais/cirurgia , Neoplasias Bucais/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação
15.
J Cutan Aesthet Surg ; 5(3): 198-200, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23112518

RESUMO

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.

16.
Ann Plast Surg ; 67(6): 583-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22123539

RESUMO

OBJECTIVE: The aim of the study is to investigate the effectiveness of the controlled slow-release granulocyte-monocyte colony-stimulating factor (GM-CSF) system in burn wound healing. MATERIAL AND METHODS: In vivo effect of controlled slow-release GM-CSF from chitosan gel on burn wound healing was evaluated on 18 Wistar-Albino rats, weighing between 250 and 300 g. They were randomly divided into 3 groups; (1) burned only group (n = 6), (2) burned + chitosan group (n = 6), (3) burned + chitosan + GM-CSF group (n = 6). Wound area was measured macroscopically. Hematoxylin and eosin and Masson's trichrome stained sections were evaluated for wound healing and tissue response to the polymer. RESULTS: The best healing process was observed with the controlled slow-release GM-CSF-applied group (group 3) in which the wound area was significantly narrowed. CONCLUSION: The study demonstrated the positive contribution of the single-dose controlled slow-release GM-CSF from chitosan gel on burn wound healing.


Assuntos
Queimaduras/tratamento farmacológico , Quitosana/administração & dosagem , Quitosana/farmacologia , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/farmacologia , Géis/administração & dosagem , Géis/farmacologia , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Distribuição Aleatória , Ratos , Ratos Wistar
17.
J Craniofac Surg ; 22(5): 1814-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21959441

RESUMO

Hemangiomas (proliferating endothelial tumors) are the most common benign tumors of infancy. Most often hemangiomas are self-regressing lesions without any treatment. Approximately 10% of hemangiomas cause complications such as major ulceration/destruction, distortion of involved tissues, and obstruction of a vital structure. When the situation becomes complicated, there are different treatment alternatives, ranging from systemic or local corticosteroid use to surgery. Sclerotherapy using intralesional polidocanol (Aethoxysklerol) injection may be used before surgery to decrease blood loss or when a vital structure of the face is in danger because of sudden increase in size of a surrounding hemangioma. Before any kind of treatment for both hemangiomas and vascular malformations, preoperative diagnosis and anatomic position of the lesion must be documented thoroughly. With the help of magnetic resonance imaging, tridimensional vascular pattern of such lesions can be shown successfully. We used three-dimensional contrast-enhanced time-resolved magnetic resonance angiography to detect the changes of lesions for 2 children who have large hemangiomas on their faces, before and after sclerotherapy with polidocanol injection. The findings of three-dimensional magnetic resonance imaging studies help to better assess the success rate of treatment not only for us as the physicians but also for the parents of these children who cannot understand anything with standard two-dimensional radiologic imaging.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Hemangioma/cirurgia , Imageamento Tridimensional , Angiografia por Ressonância Magnética/métodos , Pré-Escolar , Meios de Contraste , Feminino , Gadolínio DTPA , Neoplasias de Cabeça e Pescoço/terapia , Hemangioma/terapia , Humanos , Polidocanol , Polietilenoglicóis/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Técnicas de Sutura
18.
Plast Reconstr Surg ; 128(3): 158e-165e, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21865989

RESUMO

BACKGROUND: Although thoracodorsal artery perforator flaps have not gained popularity in the reconstructive era, the results of recent studies regarding the vascularity of thoracodorsal artery perforator flaps are promising. In the present study, the authors aimed to determine the clinical outcomes of free multiple-perforator versus single-perforator thoracodorsal artery perforator flaps. METHODS: Eighty-seven patients with various defects underwent reconstruction with free thoracodorsal artery perforator flaps. The flap was used for upper extremity reconstruction in 43 patients (49.4 percent), for head and neck reconstruction in 16 patients (18.4 percent), and for lower extremity reconstruction in 28 patients (32.2 percent). Of the 87 flaps, 48 (55.2 percent) were based on a single perforator, whereas 39 flaps (44.8 percent) were based on multiple perforators. The single- and multiple-perforator-based thoracodorsal artery perforator flaps were compared regarding clinical outcomes and morbidity. RESULTS: The morbidity rate was found to be significantly higher in the single-perforator-based group. Of the patients in the single-perforator group, seven patients had transient venous congestion, five were heparinized and treated with leeches for permanent venous congestion, six had partial necrosis, and one had total necrosis. In the multiple-perforator-based group, two patients had transient venous congestion, and no partial or total necrosis was observed. CONCLUSION: Despite the fact that dominant perforators may often be absent, this study showed that a multiple-perforator-based thoracodorsal artery perforator flap may be more reliable with safe vascularity compared with a single-perforator-based flap.


Assuntos
Microcirurgia/métodos , Complicações Pós-Operatórias/etiologia , Retalhos Cirúrgicos/irrigação sanguínea , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto/fisiologia , Heparina/administração & dosagem , Humanos , Hiperemia/etiologia , Hiperemia/terapia , Aplicação de Sanguessugas , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Necrose , Complicações Pós-Operatórias/terapia , Retalhos Cirúrgicos/patologia
19.
J Craniofac Surg ; 21(5): 1393-9, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20856027

RESUMO

AIM: The aim of this study was to compare the clinical facial soft tissue measurements with the measurements of facial plaster cast, three-dimensional scanned facial plaster cast, 3-dimensional digital photogrammetrical images, and three-dimensional laser scanner images. MATERIALS AND METHODS: Three-dimensional facial images of 15 adults were obtained with stereophotogrammetry and a three-dimensional laser scanner. Facial models of subjects were obtained using silicone impression and were scanned. Landmarks were marked on the subjects and plaster casts, digitized on three-dimensional models, and measured in Mimics 12.0 software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). RESULTS: No statistically significant differences were found between all three-dimensional measurement methods in mouth width, philtrum median height, and nasal width. Comparison of clinical measurements with facial plaster cast measurements revealed that philtral width, nasal tip protrusion, and right lip and nostril heights were wider and longer in clinical measurements than in facial plaster cast measurements. Comparison of clinical measurements to the laser scanned and stereophotogrammetric model measurements revealed that philtrum lateral and lip heights and philtral width were significantly different between methods. When laser scanned and stereophotogrammetric measurements were compared, significant differences were observed in lip and nostril heights. CONCLUSIONS: Facial impression may be problematic owing to the depression caused by the impression material especially on the tip of the nose. Laser scanning is not sensitive enough to visualize the deeper indentations such as nostrils. Stereophotogrammetry is promising for three-dimensional facial measurements and even will be better when color identification between mucocutaneous junctions of the lip region is achieved.


Assuntos
Face/anatomia & histologia , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Lasers , Anormalidades Maxilofaciais/patologia , Modelos Anatômicos , Fotogrametria , Adulto , Alginatos , Sulfato de Cálcio , Materiais Dentários , Feminino , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Masculino , Silicones , Propriedades de Superfície
20.
Ann Plast Surg ; 64(3): 342-50, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20179488

RESUMO

Bone grafts, used for providing structural integrity of cranial vault remodeling, could not always integrate with the remaining bone structures. All efforts are focused on increasing incorporation of the applied bone grafts. Allografts were covered by chitosan so that slow release of bone morphogenetic protein-2 (BMP-2) and Transforming growth factor-beta-2 (TGF-beta-2) was achieved. Two hundred forty Wistar-Albino rats were distributed equally in 8 study groups. Study groups were designed as; defect group, autograft group, allograft group, chitosan group, allograft + chitosan, TGF-beta-2 group, BMP-2 group, and TGF-Beta-2 +BMP-2 group. Bone biopsies were obtained at second, eight, and 14th weeks. Bone regeneration was evaluated by morphologic studies detecting histologic bone healing and radiologic studies detecting bone density. Histologic findings were evaluated in 2 categories; tissue response to the implant and defect healing. Additionally, scanning electron microscopy for detailed morphologic evaluation was done. Bone density of the applied scaffold and the parietal bone at the same computed tomography section were measured in Hounsfield scale and this ratio was used for densitometry evaluations. Kruskal-Wallis test was used to analyze difference among groups according to the histologic and radiologic data. Pairwise comparisons were done using Mann-Whitney U test with Bonferroni correction. P < 0.05 was considered significant. In the morphologic studies, bone regeneration in BMP-2 group was found to be compatible with bone regeneration in gold standard autograft group and even better than it within 15 days. Chitosan is a biocompatible material. TGF-Beta-2 alone is not effective enough in bone regeneration; BMP-2 alone has a positive effect in every step of bone regeneration. Combining TGF-Beta-2 with BMP-2 does not lead to a better bone regeneration than using BMP-2 alone. A synergistic effect is not obtained by using these 2 factors together.


Assuntos
Matriz Óssea/efeitos dos fármacos , Matriz Óssea/metabolismo , Proteína Morfogenética Óssea 2/efeitos dos fármacos , Quitosana/farmacologia , Sobrevivência de Enxerto , Periósteo , Crânio/efeitos dos fármacos , Crânio/metabolismo , Fator de Crescimento Transformador beta2/efeitos dos fármacos , Animais , Materiais Biocompatíveis , Feminino , Periósteo/efeitos dos fármacos , Periósteo/patologia , Periósteo/cirurgia , Ratos , Ratos Wistar , Regeneração/efeitos dos fármacos
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