scholarly journals Experience with Mandibular Reconstruction Using Transport-Disc-Distraction Osteogenesis

2015 ◽  
Vol 8 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Lorena Pingarrón-Martín ◽  
T. González Otero ◽  
L.J.Arias Gallo
Keyword(s):  
Distraction Osteogenesis ◽  
Soft Tissues ◽  
Donor Site ◽  
Latency Period ◽  
Donor Site Morbidity ◽  
Mandibular Reconstruction ◽  
Distraction Device ◽  
Duration Of Hospitalization ◽  
Education And Awareness ◽  
Comminuted Fractures

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients’ education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes.

scholarly journals Automating Skeletal Expansion: An Implant for Distraction Osteogenesis of the Mandible

2009 ◽  
Vol 3 (1) ◽  
Author(s):  
John C. Magill ◽  
Marten F. Byl ◽  
Batya Goldwaser ◽  
Maria Papadaki ◽  
Roger Kromann ◽  
...  
Keyword(s):  
Distraction Osteogenesis ◽  
Treatment Time ◽  
Patient Activation ◽  
Latency Period ◽  
Bone Lengthening ◽  
Loop Control ◽  
New Device ◽  
Distraction Device ◽  
Component Failures ◽  
Natural Healing

Distraction osteogenesis is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created, and a rigid distraction device is attached to the bone. After a latency period, the device is activated two to four times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface, and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40 N of distraction force on linear trajectories as well as curved distraction paths. In this paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11 day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then on carrying out clinical trials.

A STUDY ON DIFFERENT SURGICAL OPTIONS OF LOWER THIRD LEG DEFECTS AND ITS OUTCOME

2021 ◽  
pp. 32-34
Author(s):  
Ajay Kumar Pathak ◽  
Md Ghulam Jeelani Naiyer ◽  
Pragati Awasthi
Keyword(s):  
Reconstructive Surgery ◽  
Soft Tissues ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Conventional Teaching ◽  
Surgical Options ◽  
Soft Tissue Loss ◽  
Flap Cover ◽  
Upper Third

Background: The bones of the lower third are vulnerable to injury. Due to the paucity of soft tissues around them, the fractures that occur are often open. Most muscles become tendons at that level and in the case of soft tissue loss, skin graft may not sufce and flap cover becomes mandatory. Conventional teaching recommends gastrocnemius muscle and myocutaneous aps and fasciocutaneous aps for the upper third leg defects, soleus aps for the middle third defects and free aps for the lower third defects. Aim: Different surgical options in management of lower third leg defects. Material And Method: The study was conducted from JANUARY 2018 to December 2019, in the Department of Plastic & Reconstructive Surgery Institute of Post Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, KOLKATA. Result: 70 patients admitted to the Department of Plastic & Reconstructive Surgery and referred patients from Department of General Surgery & Orthopaedic Surgery, IPGME&R and SSKM Hospital, KOLKATA. Association of FLAP LOSS with Pedicled ap was statistically signicant (p=0.0259). We found that association of DONOR SITE MORBIDITYwith Pedicled ap was not statistically signicant (p=0.7679). Conclusion: We consider that perforator propeller aps are ideal in reconstructing small-medium defects of the middle and distal third of the leg, being safe, easy to perform, providing similar tissue in texture and thickness of damaged tissues, with low donor-site morbidity.

The Evolution of the Iliac Crest Flap

2019 ◽  
pp. 449-454
Author(s):  
Peirong Yu ◽  
Mark V. Schaverien
Keyword(s):  
Iliac Crest ◽  
Donor Site ◽  
Surgical Techniques ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Postoperative Management ◽  
Mandibular Reconstruction ◽  
Thigh Muscle ◽  
Iliac Crest Flap ◽  
The Many

The iliac crest free flap, although the gold standard for many years for mandibular reconstruction, remains an important option in the armamentarium for mandibular reconstruction. With the increasing popularity of the fibula osteocutaneous flap, which allows for more refined reconstruction and permits multiple osteotomies, the iliac crest flap is typically reserved for where the fibula flap is contraindicated, including in those with peripheral vascular disease, peroneal magnum, history of fibula fractures, and with previous bilateral fibular flaps. The many limitations of the traditional osteomusculocutaneous flap have been overcome by modified approaches to harvest, including the split iliac crest based on the inner cortex to preserve the thigh muscle attachments and reduce donor site morbidity, and the deep circumflex iliac artery perforator flap that does not include the bulky abdominal wall musculature and allows greater freedom of movement of the skin paddle. This chapter reviews the indications, anatomy, surgical techniques, and postoperative management for the free iliac crest flap.

Development of a Biodegradable Regenerative Implant for the Treatment of Long Bone Comminuted Fractures

2013 ◽  
Author(s):  
Christie M. Bergerson ◽  
Michael R. Moreno
Keyword(s):  
Donor Site ◽  
Polymeric Materials ◽  
The United States ◽  
Donor Site Morbidity ◽  
Long Bone ◽  
The Past ◽  
Upper And Lower Extremities ◽  
Extremity Reconstruction ◽  
Comminuted Fractures ◽  
Orthopedic Injuries

There were approximately 1,620,000 surgical bone graft procedures in the United States in 2005 and 672,000 fracture reductions in 20061. The estimated economic costs for orthopedic injuries to upper and lower extremities collectively account for 17% ($68 billion) of total lifetime costs that originated in 20001. Over the past 15 years, significant efforts have focused on the development of bioactive, load-bearing polymeric materials designed to restore function within critical-sized bone defects. Traditional reconstructive approaches use autografting of the defects, but these approaches have significant limitations2. As a result, transfer of grafts greater than 2 cm are associated with an unacceptably high complication rate. Thus, the optimal skeletal extremity reconstruction would be one in which the reconstruction is performed with material that may be taken “off the shelf” to eliminate donor site morbidity, but is degradable and resorbable affording incorporation into the host.

Stem Cell in Dentistry – Potential Contributions, Challenges and Future

2017 ◽  
Vol 6 (10) ◽  
pp. 55
Author(s):  
Tejinder Kaur
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Soft Tissues ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Loss Of Function ◽  
Dental Stem Cells ◽  
Separate Branch ◽  
Regenerative Dentistry ◽  
Orofacial Region

Stem cells are unspecialised and unclassified cells but their unique property “pluripotency” makes them special because it has opened the new doors of opportunities and possibilities in the field of dentistry and regenerative medicine to regenerate different organs and tissues. Currently, several studies are undergoing on dental stem cells (SCs) to find out their possible uses in oromaxillofacial region and various stem cells have already been identified for their application in orofacial region. Therefore, a new separate branch of dentistry names as “Regenerative Dentistry” is emerging very fast as dental stem cells offer a lot of benefits over outdated procedures andhave the ability to replace the old restorative techniques of repairing oromaxillofacial trauma which involve disadvantages like scarring, loss of function of replaced part, infection and donor site morbidity with early and late complications [1]. Although oromaxillofacial region is difficult to repair because of its complex anatomical structure but undoubtedly,from past few decades, regeneration of this region using stem cell therapy has also fascinated the entire world of stem cell biologists, molecular biologists, geneticists, clinicians and dentists to discover new advancements in the field of craniofacial engineering[2]. Clearly, future of dentistry lies in stem-cell based powerful therapeutic approach which can potentially transform the reparative and regeneration process of defective hard and soft tissues in orofacial region.

scholarly journals Hand Surgeon Perspectives on Upper Extremity Allograft: A Survey of the American Society for Surgery of the Hand

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 476-479
Author(s):  
Anthony J Archual ◽  
Andy C H Lee ◽  
Brent R DeGeorge
Keyword(s):  
Upper Extremity ◽  
Soft Tissues ◽  
Flexor Tendon ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complication Rates ◽  
Web Based ◽  
Allograft Tissue ◽  
Tendon Allograft ◽  
American Society

ABSTRACT Introduction Allograft tissue products have widespread applications across surgical specialties, but little data exist about surgeon attitudes toward the use of these products in the upper extremity. Methods Using a web-based survey, we sought to investigate the use of and feelings toward allograft products among hand surgeons. A short questionnaire was distributed to all active members of American Society for Surgery of the Hand as of October 2015 (N = 2,578). Demographic and practice setting information was collected. Additionally, questions concerning the use of human allograft tissue products of various types including bone, skin, and soft tissues were asked. Results Of 2,578 American Society for Surgery of the Hand members, 406 hand surgeons (15.8%) responded to the survey. A large majority (92%) reported having used allograft products in the upper extremity. Orthopedic-trained surgeons were more likely to have used bone and tendon allograft, whereas plastic and general surgery-trained surgeons were more likely to have used nerve and dermis allograft. Reduced donor site morbidity and complication rates were factors motivating surgeons to use allograft tissue. Conclusions In spite of variation with respect to their use, allograft tissue products are popular and interest in new products, especially to improve flexor tendon pulley reconstruction, is high.

scholarly journals Central arch mandibular reconstruction after surgery of oral carcinoma: an observational experience at MDACC, Houston, Texas, USA

2017 ◽  
Vol 5 (6) ◽  
pp. 2412
Author(s):  
Prafulla Kumar Das ◽  
Geoffrey L. Robb
Keyword(s):  
Head And Neck ◽  
Functional Outcome ◽  
Donor Site ◽  
Mouth Opening ◽  
Donor Site Morbidity ◽  
Mandibular Reconstruction ◽  
Cancer Center ◽  
Neoplastic Disease ◽  
Ablative Surgery ◽  
Free Fibula

Background: Reconstruction of head and neck defects in general and oro-mandibular defects in particular, represents a challenge to the head and neck reconstructive surgeon. The most common indication of oro-mandibular reconstruction remains ablative surgery for neoplastic disease of the oral cavity and oropharynx. The principal purpose was evaluation of the various methods of such reconstruction done in order to achieve the best cosmetic and functional outcome in terms of adequate mouth opening, oral competence, deglutition of semisolid to solid foods, speech intelligibility, minimum donor site morbidity and complication.Methods: The authors presented an observational work on the reconstruction of head and neck cancer after their curative excision, mostly oro-mandibular defects of various sizes ranging from 6cm to 12cm with special reference to the central arch during the first authors fellowship to MD Anderson Cancer Center (MDACC), Texas, where the second author was the supervisor.Results: The authors reported 24 reconstructions including 10 bony reconstructions. The free flap was preferred to pedicle flap for the reason of better aesthetic and functional outcome. The free fibula was mostly preferred due to its characters akin to the native mandible. Seventy-five patients were also observed in the outpatient clinic and evaluated during the follow up period for aesthetic and functional aspects, donor site morbidity, and long term complications. The first auther also evaluated that the incidence of primary closure with residual cosmetic defect in his study had come down from 28.47% before MDACC visit to only 4.38% today owing to more number of free and pedicle flaps were used.Conclusions: The free fibula was found to be the best option for mandible reconstruction overall. Observation within high volume centers however limited it may be, certainly upgraded the knowledge and working skills of the second author after he came back to his institution of Acharya Harihar Regional Cancer Center (AHRCC) in India.

scholarly journals Role of distraction osteogenesis in craniomaxillofacial surgery

2016 ◽  
Vol 1 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Nicole Ernst ◽  
Nicolai Adolphs
Keyword(s):  
Distraction Osteogenesis ◽  
Soft Tissues ◽  
Limb Lengthening ◽  
Craniofacial Skeleton ◽  
Craniomaxillofacial Surgery ◽  
Growth Deficiency ◽  
Distraction Device ◽  
Consolidation Phase ◽  
Gradual Expansion

AbstractIn the field of orthopedic surgery, distraction osteogenesis (DO) is well known for limb lengthening procedures or secondary corrective surgery in the fracture treatment of the extremities. The principle of gradual expansion of bone and surrounding soft tissues as originally described by G.A. Ilizarov is also applicable to the craniofacial skeleton when growth deficiency is present, and the patients affected by craniofacial or dentofacial anomalies may require distraction procedures. The surgical management is comparable. After osteotomy and the mounting of a specific craniomaxillofacial distraction device, active distraction is started after a latency phase of several days, with a distraction rate of up to 1 mm/day until the desired amount of distraction has been achieved. Subsequently, distractors are locked to provide appropriate stability within the distraction zone for callus mineralization during the consolidation phase of 3–6 months, which is followed by a further remodeling of the bony regenerate. After 14 years of clinical application, the role and significance of craniomaxillofacial DO are discussed after reviewing the files of all patients who were treated by craniomaxillofacial distraction procedures.

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