Pedicled Buccal Flaps as a Back-Up Procedure for Intraoral Reconstruction

2021 ◽  
Author(s):  
Gesche Frohwitter ◽  
Marco Rainer Kesting ◽  
Andrea Rau ◽  
Manuel Weber ◽  
Christoph Baran ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Chart Review ◽  
Dental Trauma ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Microvascular Reconstruction ◽  
Harvest Technique ◽  
Exposed Bone ◽  
Common Problems ◽  
Buccal Flap

Abstract BackgroundIntraoral soft tissue deficiency and impaired wound beds are common problems after cleft and tumour surgery or after dental trauma. Frequently, limited defects are overtreated with extensive microvascular reconstruction procedures and pedicled flaps remain useful, as they are simple to harvest and provide a reliable outcome. The buccal flap, first described in the 1970s, has been used for palatine lengthening in cleft patients over decades. In the following we present an expanded indication in cases of palatal fistula, complex vestibulum, exposed bone in orthognathic surgery and osteoradionecrosis. MethodsWe conducted a retrospective chart review and report on all buccal flaps harvested within the last three years. 16 buccal flaps were performed in 10 patients. The median age at the time of surgery was 42 years, reaching from 12 years up to 66 years. Results 14 buccal flaps were used for upper jaw or palatal coverage, two buccal flaps were used in the mandible.In terms of complications (four flaps; 25 %) there were two partial flap failures, one wound dehiscence and one wound dehiscence. There were no failures of the remaining mucosal flap islands after the cut of the pedicles.ConclusionThe buccal flap is a reliable and straight forward approach to challenging intraoral wound beds with soft tissue deficiency. We thoroughly discuss the additional indications for buccal flap surgery, describe the harvest technique and provide strategies to prevent intra- and postoperative complications.

Utilization of Alexandrite Laser for Hair Removal in Pediatric Auricular Reconstruction

2021 ◽  
pp. 019459982110419
Author(s):  
Peng You ◽  
Tara L. Rosenberg ◽  
Yi-Chun Carol Liu
Keyword(s):  
Soft Tissue ◽  
Chart Review ◽  
Laser System ◽  
Retrospective Chart Review ◽  
Hair Removal ◽  
Procedural Sedation ◽  
Alexandrite Laser ◽  
Auricular Reconstruction ◽  
Laser Hair Removal ◽  
Soft Tissue Envelope

Auricular reconstruction with autologous rib cartilage involves using a soft tissue envelope to cover the cartilage framework. In patients with a low hairline, hair-bearing skin may be incorporated on the reconstructed ear, creating a difficult and conspicuous aesthetic problem. A retrospective chart review was conducted to summarize and share the experience of using the Candela GentleMax Pro 755-nm alexandrite laser system (Candela Corp) in children following auricular reconstruction. Nine patients received laser hair removal via the alexandrite laser system with good results. The number of completed sessions ranged from 1 to 5. The procedures were completed without the need for premedication or procedural sedation. Laser hair removal with an alexandrite laser system was safe, fast, and effective. With multistage auricular reconstruction, it was feasible to incorporate laser hair removal between the stages.

scholarly journals Utility of Groin Flap in Penile Reconstruction

2020 ◽  
Vol 16 (3) ◽  
pp. 150-157
Author(s):  
Ji-An Choi ◽  
Jung-Ha Kwak ◽  
Kwang-Ryeol Lim ◽  
Chung-Min Yoon
Keyword(s):  
Chart Review ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Postoperative Patient ◽  
Groin Flap ◽  
Volumetric Reconstruction ◽  
Tissue Defects

Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

scholarly journals Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections

2020 ◽  
Author(s):  
Dahn Jeong ◽  
Ha Nhan Thi Nguyen ◽  
Mark Tyndall ◽  
Yoko S Schreiber
Keyword(s):  
Soft Tissue ◽  
First Nations ◽  
Chart Review ◽  
Clinical Symptoms ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Indigenous Communities ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Treatment And Prevention

Abstract Background Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting. Methods A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment. Results A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA. Conclusions This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

scholarly journals Surgical Outcomes of Myelomeningocele Repair: a 20-Year Experience from a Single Center in a Middle-Income Country

2021 ◽  
Author(s):  
Sina Zoghi ◽  
Maryam Feili ◽  
Mohammad Amin Mosayebi ◽  
Mohammad Amin Afifi ◽  
Afrooz Feili ◽  
...  
Keyword(s):  
Surgical Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
P Value ◽  
Fars Province ◽  
Middle Income ◽  
Middle Socioeconomic Status ◽  
Myelomeningocele Repair ◽  
Complications And Mortality

Abstract Objective Spina bifida primarily affects people of low and middle socioeconomic status. Herein, we describe the outcome of myelomeningocele surgical management in Iran and predictors of its postoperative complications and mortality. Methods This retrospective chart review studies the children who underwent surgical management for myelomeningocele in Shiraz, Fars province, Iran, from May 2001 to September 2020. To this end, we investigated mortality and 30-day complications and the factors that determined the operation's outcome. Results 256 patients were enrolled. The median age at the operation was roughly eight days (IQR: 7). The most common site of involvement of Myelomeningocele (MMC) was Lumbosacral (86%, n = 204). At the evaluation conducted prior to operation, CSF leaking was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients were expired in the 30 days following the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). No variable was significantly associated with postoperative complication except for the site of the lesion (p-value = 0.035) and the presence of the lipid content in the defect (p-value = 0.044). Conclusions Most patients born with MMC are referred for the neurosurgical evaluation following their birth; however, as results show there is much left to be desired compared with the 48h recommended by The Congress of Neurological Surgeons. Here, we concluded that presence of lipid compartment in the lesion and the site of the lesion are the two factor that were associated with the rate of mortality. However, further investigation into preoperative interventions and risk factors to mitigate risk of postoperational complications and mortality is highly encouraged. We highly advocate for the investigation and dissemination of the outcome of the conventional surgical management of MMC in financially restrained areas; because they can show the limitation these settings are confronted with (that are in a way unique to them and different from the resourceful settings) and provide a model for other similar areas with limited suitable care.

Survival of the 8.5 mm osseointegrated abutment, and its utility in the obese patient

2013 ◽  
Vol 127 (7) ◽  
pp. 643-649 ◽  
Author(s):  
M D Darley ◽  
A A Mikulec
Keyword(s):  
Cohort Study ◽  
Soft Tissue ◽  
Retrospective Cohort ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Mechanical Forces ◽  
Obese Patients ◽  
Hearing Rehabilitation ◽  
Obese Population ◽  
Bone Anchored Hearing Aid

AbstractBackground:Most of the literature regarding osseointegrated implantation for hearing rehabilitation focuses on the 5.5 mm abutment. This study aimed to add to the data available on the survival of the 8.5 mm abutment, and to describe its utility in obese patients.Objective:To review the outcomes of patients who received a bone-anchored hearing aid implant, and create a model comparing the mechanical forces acting upon combinations of fixture and abutment lengths.Methods:Retrospective chart review and mathematical modelling.Results:In this retrospective cohort study comprising 25 patients, less abutment overgrowth was observed in the 8.5 mm abutment recipients versus recipients of the 5.5 mm abutment. When the principle of equilibrium of a rigid body was applied, the 8.5 mm abutment was at a calculated mechanical disadvantage compared with the 5.5 mm abutment.Conclusion:The 8.5 mm abutment may be useful in patients with copious subcutaneous soft tissue as in the obese population. The 8.5 mm abutment has a calculated mechanical disadvantage, potentially putting the implant under greater mechanical stress; however, the clinical relevance of this is unclear.

Outcome Analysis of Patients Undergoing Colorectal Resection for Emergent and Elective Indications

2007 ◽  
Vol 73 (10) ◽  
pp. 991-993 ◽  
Author(s):  
Justin Kim ◽  
Raj Mittal ◽  
Viken Konyalian ◽  
Justin King ◽  
Michael J. Stamos ◽  
...  
Keyword(s):  
Chart Review ◽  
Colorectal Resection ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Outcome Analysis ◽  
Elective Operation ◽  
Urgent Operation ◽  
Elective Group ◽  
Colon And Rectum

Despite advances in perioperative care and operative techniques, urgent colorectal operations are associated with higher morbidity and mortality. To evaluate our rate of complications in elective and urgent colorectal operations, we performed retrospective chart review of 209 consecutive patients who underwent colorectal resection between 1998 and 2002 at Harbor-UCLA Medical Center. One hundred, forty-three (71%) patients underwent elective colorectal resection. A total of 19 (13.3%) complications occurred in the elective group, compared with 24 (38.1%) in the urgent group ( P = 0.003). Both right-sided and left-sided operations were associated with higher incidence of complications when performed urgently. Wound infection occurred in 7.7 per cent of patients undergoing an elective operation and 14.3 per cent in an urgent setting ( P = 0.21). Intra-abdominal abscess occurred in 1.4 per cent of patients undergoing elective operation, compared with 11.1 per cent in the urgent operation group. Four (1.9%) patients developed wound dehiscence, 1 in elective and 3 in the urgent group ( P = 0.09). Anastomotic leak occurred in 1.9 per cent of patients, 2 in each group ( P = 0.6). There were six deaths, 3 in elective and 3 in urgent cases ( P = 0.4). Urgent operation of the colon and rectum is associated with higher incidence of complications. Both right- and left-sided resections have a higher complication rate when performed in a nonelective setting.

Skin and Soft Tissue Abscess: 1 Year's Experience

2009 ◽  
Vol 13 (5) ◽  
pp. 257-261 ◽  
Author(s):  
Sandhya Nalmas ◽  
Eliahu Bishburg ◽  
Monica Shah ◽  
Trini Chan
Keyword(s):  
Soft Tissue ◽  
Drug Users ◽  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Underlying Disease ◽  
Recurrence Rates ◽  
Immunodeficiency Virus ◽  
Soft Tissue Abscess

Background: The incidence of skin and soft tissue abscesses (SSTAs) has increased owing to the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Some of these patients are treated as outpatients (OPs) and some as inpatients (IPs). Objective: To review the microbiology and clinical features of SSTAs and the clinical parameters that may have influenced clinicians to treat patients as IPs. Methods: The study was conducted in a 673-bed teaching hospital between January and December 2005. A retrospective chart review of patients identified from a microbiology culture log was conducted. Data were collected for demographics, underlying disease, SSTA number and site, recurrence rates, and clinical presentation. Results: One hundred thirty-eight patients were identified; 76 (55%) were female, with a mean age of 42 years (range 18–80 years); 76 (55.5%) had no underlying disease, 27 (19.6%) had diabetes, 20 (14.5%) had human immunodeficiency virus (HIV) infection, and 13 (9.4%) were intravenous drug users. Common SSTA sites involved were the perineal area (43; 31.2%), upper extremities (35; 25.4%), lower extremities (19; 13.8%), head and neck (14; 10.1%), chest (13; 9.4%), and abdomen (8; 5.8%). Conclusions: CA-MRSA was the most commonly isolated organism overall and in patients treated as OPs. The decision to treat SSTA patients as IPs seems to be influenced by SSTA number and site and the presence of fever at presentation. SSTA number and site (variables that led to the decision to treat patients as IPs) were confirmed by demonstrating statistical significance in the analysis between the IP and OP groups, but the other determinant of admission, the presence of fever at presentation, was based on chart review statements and not confirmed by statistical analysis between the IP and OP groups.

scholarly journals Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections

2020 ◽  
Author(s):  
Dahn Jeong(Former Corresponding Author) ◽  
Ha Nhan Thi Nguyen ◽  
Mark Tyndall ◽  
Yoko S Schreiber(New Corresponding Author)
Keyword(s):  
Soft Tissue ◽  
First Nations ◽  
Chart Review ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Indigenous Communities ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Treatment And Prevention ◽  
High Prevalence

Abstract Background Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting.Methods A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment.Results A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA.Conclusions This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

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