INFLUENCE OF DIFFERENT INCISION DESIGNS ON FLAP EXTENSION: A CADAVERIC ANIMAL MODEL

2020 ◽  
Author(s):  
Bassel Traboulsi Garet ◽  
Albert González Barnadas ◽  
Octavi Camps Font ◽  
Rui Figueiredo ◽  
Eduard Valmaseda-Castellón
Keyword(s):  
Animal Model ◽  
Bone Regeneration ◽  
Primary Closure ◽  
Wound Closure ◽  
Wound Dehiscence ◽  
Guided Bone Regeneration ◽  
The Other ◽  
Primary Wound Closure ◽  
Flap Design ◽  
Two Sides

It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) upon the extension of three different flap designs: envelope, triangular and trapezoidal flaps. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the three flap groups. Each mandible was divided into two sides: one was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm, with no statistically significant differences among them (p = 0.165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (p < 0.001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.

scholarly journals Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

2019 ◽  
Vol 6 (10) ◽  
pp. 3708
Author(s):  
M. N. Sasikumar ◽  
Sam Christy Mammen
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Primary Closure ◽  
Wound Closure ◽  
Wound Dehiscence ◽  
Infection Rates ◽  
Saline Irrigation ◽  
Primary Wound Closure ◽  
Group A ◽  
Perforation Peritonitis

Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.

scholarly journals Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
John Rong Hao Tay ◽  
Xiaotong Jacinta Lu ◽  
Wei Ming Clement Lai ◽  
Jia-Hui Fu
Keyword(s):  
Bone Regeneration ◽  
Surgical Complications ◽  
Wound Dehiscence ◽  
Guided Bone Regeneration ◽  
Cochrane Central Register ◽  
Weighted Mean ◽  
Recipient Site ◽  
Barrier Membrane ◽  
Incidence Proportion ◽  
Level Analysis

AbstractIt is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.

Comparison of primary and delayed wound closure of dog-bite wounds

2013 ◽  
Vol 26 (03) ◽  
pp. 204-207 ◽  
Author(s):  
H. Xiaowei ◽  
X. Yunbei ◽  
L. Zhenhua ◽  
Y. Yeqing ◽  
Y. Jiaqi ◽  
...  
Keyword(s):  
Infection Rate ◽  
Primary Closure ◽  
Wound Closure ◽  
Systemic Infection ◽  
Dog Bite ◽  
Cosmetic Appearance ◽  
Primary Wound Closure ◽  
Bite Wounds ◽  
Delayed Closure ◽  
Closure Group

Summary Background: Primary bite wound suturing in the emergency department remains controversial in some cases. Objective: We conducted a study to investigate the infection rate and cosmetic appearance between primary wound closure and delayed wound closure in dog bite wounds in humans. Methods: All patients with bite wounds were treated with oral antibiotic medications. We adopted a randomized cohort study, dividing the patients who needed wound closure into two groups: 60 patients for primary closure, and 60 patients for delayed closure, and compared the infection rate and wound cosmetic appearance scores. Results: In the primary closure group, four people (6.7%) developed a wound infection without systemic infection. In the delayed closure group, three people (5%) developed a wound infection (p = 0.093), but there were not any patients that developed a systemic infection. Thirty-three patients (55%) in the primary closure group had optimal cosmetic scores, whereas 20 patients (33.3%) in the delayed closure group had optimal cosmetic scores (p = 0.012). Conclusion: Although primary wound closure for dog bites may be associated with a higher infection rate, the cosmetic appearance after primary closure was still acceptable.

scholarly journals Combined use of xenogenous bone blocks and guided bone regeneration for three-dimensional augmentation of anterior maxillary ridge: A case series

2019 ◽  
Vol 11 (2) ◽  
pp. 94-98
Author(s):  
Mohammadreza Talebi ◽  
Noushin Janbakhsh
Keyword(s):  
Bone Regeneration ◽  
Primary Closure ◽  
Three Dimensional ◽  
Case Series ◽  
Guided Bone Regeneration ◽  
Alveolar Ridge ◽  
Bone Augmentation ◽  
3 Dimensional ◽  
Ridge Augmentation ◽  
Combined Use

Background. Bone augmentation ensures a favorable 3-dimensional position of implants. Onlay grafting is one of the techniques in ridge augmentation, which can be performed with the use of xenogenous blocks. Methods. Three cases of the vertical and horizontal ridge are discussed, which were augmented using xenogenous blocks. The blocks were shaped in a favorable size and puzzled along the grafting area. All the gaps were filled with granular xenografts. The flaps were coronally advanced to obtain primary closure. Results. An average of 4.2-mm gain in width and 4.2-mm gain in height of the ridge was observed at the implantation stage. Conclusion. The outcomes of these cases could pave the way for suggesting xenograft blocks for augmenting wide areas of the alveolar ridge on average of 4 mm in width and height in selected cases as an alternative to standard autogenous blocks. Long-lasting xenograft ensures implant and lip support in the esthetic zone.

scholarly journals High loads of nano-hydroxyapatite/graphene nanoribbon composites guided bone regeneration using an osteoporotic animal model

2019 ◽  
Vol Volume 14 ◽  
pp. 865-874 ◽  
Author(s):  
Francilio Carvalho Oliveira ◽  
Jancineide Oliveira Carvalho ◽  
Suziete Batista Soares Gusmão ◽  
Licia de Sousa Gonçalves ◽  
Liana Martha Soares Mendes ◽  
...  
Keyword(s):  
Animal Model ◽  
Bone Regeneration ◽  
Guided Bone Regeneration ◽  
Graphene Nanoribbon

Definitive Wound Closure Techniques in Fournier's Gangrene

2018 ◽  
Vol 84 (1) ◽  
pp. 86-92
Author(s):  
Margaret Lauerman ◽  
Olga Kolesnik ◽  
Habeeba Park ◽  
Laura S. Buchanan ◽  
William Chiu ◽  
...  
Keyword(s):  
Wound Healing ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Primary Closure ◽  
Wound Closure ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Secondary Intention ◽  
Primary Wound Closure

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885–11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727–0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.

scholarly journals The Influence of Different Guided Bone Regeneration Procedures on the Contour of Bone Graft after Wound Closure: A Retrospective Cohort Study

Materials ◽  
2021 ◽  
Vol 14 (3) ◽  
pp. 583
Author(s):  
Maoxia Wang ◽  
Xiaoqing Zhang ◽  
Yazhen Li ◽  
Anchun Mo
Keyword(s):  
Bone Graft ◽  
Bone Regeneration ◽  
Bone Substitute ◽  
Wound Closure ◽  
Guided Bone Regeneration ◽  
Collagen Membrane ◽  
Group 4 ◽  
Surgical Template ◽  
Group 2 ◽  
Group 1

The aim of this study was to evaluate the impact of different guided bone regeneration (GBR) procedures on bone graft contour after wound closure in lateral ridge augmentation. A total of 48 patients with 63 augmented sites were included in this study. Participants were divided into 4 groups (n = 12 in each group) based on different surgical procedures: group 1: particulate bone substitute + collagen membrane; group 2: particulate bone substitute + collagen membrane + healing cap, group 3: particulate bone substitute + injectable platelet-rich fibrin (i-PRF) + collagen membrane; group 4: particulate bone substitute + i-PRF + surgical template + collagen membrane. After wound closure, the thickness of labial graft was measured at 0–5 mm apical to the implant shoulder (T0–T5). At T0–T2, the thickness of labial graft in group 4 was significantly higher than the other three groups (p < 0.05). And group 4 showed significantly more labial graft thickness than group 1 and group 2 at T3–T5 (p < 0.05). Within the limitations of this study, the use of i-PRF in combination with the surgical template in GBR may contribute to achieving an appropriate bone graft contour after wound closure.

scholarly journals Augmentation Stability of Guided Bone Regeneration for Peri-Implant Dehiscence Defects with L-shaped Porcine-Derived Block Bone Substitute

Materials ◽  
2021 ◽  
Vol 14 (21) ◽  
pp. 6580
Author(s):  
Jae-Hong Lee ◽  
Eun-Hee Jung ◽  
Seong-Nyum Jeong
Keyword(s):  
Bone Regeneration ◽  
Wound Dehiscence ◽  
Bone Substitutes ◽  
Guided Bone Regeneration ◽  
Hard Tissue ◽  
Significant Difference ◽  
Subjective Pain ◽  
Membrane Exposure ◽  
Radiographic Changes ◽  
Early Wound

Block bone substitutes have better augmentation stability for guided bone regeneration (GBR) than particulate bone substitutes. This study sought to determine whether GBR with an L-shaped porcine block bone (DPBM-C) differs from GBR with an L-shaped bovine block bone (DBBM-C) based on clinical, radiographic, and volumetric outcomes for peri-implant dehiscence defects. A total of 42 peri-implant defects were grafted with 20 L-shaped DPBM-C and 22 DBBM-C groups. The horizontal and vertical thicknesses of the augmented hard tissue were measured using sagittal cone-beam computed tomography, and the volumetric tissue change was evaluated by stereolithography image superimposition. Postoperative discomfort, early wound healing outcomes, and implant stability were also assessed. Among the clinical (subjective pain and swelling, wound dehiscence, membrane exposure, and periotest values), radiographic (changes in horizontal and vertical hard tissue thickness), and volumetric parameters of the L-shaped DPBM-C and DBBM-C groups during the healing period, only the periotest values showed a statistically significant difference (0.67 ± 1.19, p = 0.042). Within the limitations of this study, an L-shaped DPBM-C is not inferior to an L-shaped DBBM-C based on their clinical, radiographic, and volumetric outcomes for GBR of peri-implant dehiscence defects.

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