Case series: Laser treatments for soft tissue problems in children

: Musculoskeletal tumors of the hand are a rare entity and are divided into skeletal and soft tissue tumors. Either category comprises benign and malignant or even intermediate tumors. Basic radiology allows an optimal resolution of bone and related soft tissue areas, ultrasound and more sophisticated radiologic tools such as scintigraphy, CT and MRI allow a more accurate evaluation of tumor extent. Enchondroma is the most common benign tumor affecting bone, whereas chondrosarcoma is the most commonly represented malignant neoplasm localized to hand bones. In the soft tissues ganglions are the most common benign tumors and epithelioid sarcoma is the most frequently represented malignant tumor targeting hand soft tissues. The knowledge regarding diagnostic and therapeutic management of these tumors is often deriving from small case series, retrospective studies or even case reports. Evidences from prospective studies or controlled trials are limited and for this lack of clear and supported evidences data from the medical literature on the topic are controversial, in terms of demographics, clinical presentation, diagnosis prognosis and therapy.The correct recognition of the specific subtype and extension of the tumor through first line and second line radiology is essential for the surgeon, in order to effectively direct the therapeutic decisions.

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An unusual case of aggressive malignant spread of epithelioid hemangioendothelioma

Rare Tumors ◽

10.1177/20363613211010858 ◽

2021 ◽

Vol 13 ◽

pp. 203636132110108

Author(s):

Ashley D Hickman ◽

Evandro D Bezerra ◽

Anja C Roden ◽

Matthew T Houdek ◽

Jonathan D Barlow ◽

...

Keyword(s):

Respiratory Failure ◽

Soft Tissue ◽

Multimodal Treatment ◽

Unusual Case ◽

Case Reports ◽

Case Series ◽

Epithelioid Hemangioendothelioma ◽

Vascular Neoplasm ◽

Pulmonary Imaging ◽

Low Incidence

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm which typically originates from liver, lung, or bone. Due to the low incidence of disease, the most effective treatment is not easily studied and much of the information known about EHE has been learned through case reports and case series. In this case, we will present an uncommon form of primary soft tissue EHE with local recurrence, bone metastasis, and lymphangitic spread to the lungs leading to respiratory failure. Imaging of the chest was atypical for EHE with intraseptal thickening and hilar lymphadenopathy. Respiratory failure was progressive despite aggressive multimodal treatment. This case highlights an unusually aggressive recurrence and metastasis of primary soft tissue EHE with atypical pulmonary imaging findings.

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Gemcitabine-Containing Chemotherapy for the Treatment of Metastatic Myxofibrosarcoma Refractory to Doxorubicin: A Case Series

Current Oncology ◽

10.3390/curroncol28010078 ◽

2021 ◽

Vol 28 (1) ◽

pp. 813-817

Author(s):

Arielle Elkrief ◽

Suzanne Kazandjian ◽

Thierry Alcindor

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Objective Response ◽

Case Series ◽

Progression Free Survival ◽

Distant Metastases ◽

First Line ◽

Pleomorphic Sarcoma ◽

Line Setting

Background: Myxofibrosarcoma is a type of soft-tissue sarcoma that is associated with high rates of local recurrence and distant metastases. The first-line treatment for metastatic soft-tissue sarcoma has conventionally been doxorubicin-based. Recent evidence suggests that myxofibrosarcoma may be molecularly similar to undifferentiated pleomorphic sarcoma (UPS), which is particularly sensitive to gemcitabine-based therapy. The goal of this study was to evaluate the activity of gemcitabine-containing regimens for the treatment of metastatic myxofibrosarcoma refractory to doxorubicin. Material and Methods: We retrospectively evaluated seven consecutive cases of metastatic myxofibrosarcoma at our institution treated with gemcitabine-based therapy in the second-line setting, after progression on doxorubicin. Baseline clinical and baseline characteristics were collected. Primary endpoints were objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). Results: After progression on first-line doxorubicin, a partial, or complete radiological response was observed in four of seven patients who received gemcitabine-based chemotherapy. With a median follow-up of 14 months, median progression-free and overall survival were 8.5 months and 11.4 months, respectively. Conclusions: Gemcitabine-based chemotherapy was associated with encouraging response rates in this cohort, similar to those seen in UPS. Both entities could be studied together for novel gemcitabine-based regimens.

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Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120974349 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097434

Author(s):

Daniel F. O’Brien ◽

Lilah Fones ◽

Victoria Stoj ◽

Cory Edgar ◽

Katherine Coyner ◽

...

Keyword(s):

Soft Tissue ◽

Acl Reconstruction ◽

Sports Medicine ◽

Cruciate Ligament ◽

Case Series ◽

Graft Fixation ◽

Level Of Evidence ◽

Lateral Cortex ◽

Suture Button ◽

Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

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A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites

Scientific Reports ◽

10.1038/s41598-021-81402-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kwantae Noh ◽

Daniel S. Thoma ◽

Jung-Chul Park ◽

Dong-Woon Lee ◽

Seung-Yun Shin ◽

...

Keyword(s):

Soft Tissue ◽

Tooth Extraction ◽

Case Series ◽

Tissue Level ◽

Ridge Preservation ◽

Bone Augmentation ◽

Implant Placement ◽

Alveolar Ridge Preservation ◽

Tissue Changes ◽

Facial Area

AbstractInformation regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

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659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.324 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S195-S195

Author(s):

Nicole M Kopari ◽

Yazen Qumsiyeh

Keyword(s):

Soft Tissue ◽

Cell Suspension ◽

Negative Pressure ◽

Wound Closure ◽

Negative Pressure Wound Therapy ◽

Case Series ◽

Dermal Substitute ◽

Wound Therapy ◽

Skin Cell ◽

Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

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Soft tissue problems with and without complicated diabetes after surgery for distal fibula fracture

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.212 ◽

2016 ◽

Vol 22 (2) ◽

pp. 84

Author(s):

C.-A. Shih ◽

P.-T. Wu ◽

C.-L. Li Li ◽

Y.-F. Liu ◽

P.-C. Cheng ◽

...

Keyword(s):

Soft Tissue ◽

Distal Fibula ◽

Fibula Fracture ◽

Soft Tissue Problems

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The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016

Otolaryngology ◽

10.1177/0194599817725713 ◽

2017 ◽

Vol 157 (4) ◽

pp. 602-607 ◽

Cited By ~ 7

Author(s):

Alexander Lanigan ◽

Brentley Lindsey ◽

Stephen Maturo ◽

Joseph Brennan ◽

Adrienne Laury

Keyword(s):

Soft Tissue ◽

Tertiary Care ◽

Case Series ◽

Soft Tissue Injuries ◽

Published Data ◽

Care Hospital ◽

Neck Injuries ◽

Facial Fractures ◽

Tympanic Membrane Perforations ◽

Tissue Injuries

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

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Soft Tissue Applications of Er,Cr:YSGG Laser in Pediatric Dentistry

International Journal of Clinical Pediatric Dentistry ◽

10.5005/jp-journals-10005-1432 ◽

2017 ◽

Vol 10 (2) ◽

pp. 188-192 ◽

Cited By ~ 7

Author(s):

Ferah Rehman ◽

Vivek Chaturvedy

Keyword(s):

Soft Tissue ◽

Laser Energy ◽

Case Series ◽

Pediatric Dentistry ◽

Patient Comfort ◽

Operating Efficiency ◽

Hard Tissue ◽

Contact Mode ◽

Tooth Structure ◽

Dental Tissues

ABSTRACT Soft tissue laser, such as diode and Nd:YAG lasers were initially used in soft tissue lesions because of its increased success rate. It was because of the fact that these lasers were well-absorbed by chromophores, such as hemoglobin and melanin which are found abundant in the oral mucosa. The introduction of erbium family in 1990 comprising the Er:YAG and Er,Cr:YSGG lasers made the hard tissue laser a boon for dentistry. Erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG) was introduced in 1997 for the surgical needs of clinical dentistry in general practice. The erbium belongs to the rare earth which is embedded in a host crystal. The actual lasing process takes place in the Er ion Er3+. Two host crystals consisting of yttrium, aluminum, and garnet (Y3A5O12) and yttrium, scandium, gallium, and garnet (Y3Sc2Ga3O12) are added to the erbium. The interest to use these hard tissue laser in the treatment of soft tissue lesion was because of the properties of these lasers which are well-absorbed by chromophore water apart from hydroxy appetite crystals. Erbium laser energy is absorbed by collagen, hydroxyapatite, and water components. It allows the laser to cut soft tissue, tooth structure, and bone. In the noncontact mode, the incision is scalpel-like, with very little hemostasis. In contact mode, it performs soft tissue sculpting with adequate hemostasis. The Er,Cr:YSGG is the world's most advanced dental laser, which is ideal all-tissue laser because all dental tissues contain water, for the multidisciplinary dentist who performs a broad spectrum of procedures. It delivers the highest level of clinician control, operating efficiency, flexibility in tip, and accessory selection. For optimal clinical results and patient comfort in hard and soft tissue procedures, the erbium lasers have set a new standard of clinical performance. The present case series aims to highlight the various soft tissue applications of Er,Cr:YSGG (Waterlase Biolase®, Biolase, Inc, San Clemente, California, USA) in pediatric patients. How to cite this article Kumar G, Rehman F, Chaturvedy V. Soft Tissue Applications of Er,Cr:YSGG Laser in Pediatric Dentistry. Int J Clin Pediatr Dent 2017;10(2):188-192.

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