scholarly journals MULTIMODAL APPROACH IN THE RECONSTRUCTION OF FIRING DEFECTS OF THE LOWER LIMBS (CLINICAL CASE)

2020 ◽  
Author(s):  
І. П. Хоменко ◽  
К. В. Гуменюк ◽  
С. О. Король ◽  
Є. В. Цема ◽  
Р. М. Михайлусов ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Thermal Imaging ◽  
Clinical Case ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Left Thigh ◽  
Lower Limbs ◽  
Wound Area ◽  
Superficial Femoral Vein ◽  
Second Stage

According connection with the global trends, manifested by an increase in the number of illegal firearms, an increase in social, political, ethnic, racial and religious conflicts, accompanied by the use of firearms, the problem of treating gunshot wounds is becoming increasingly important. It is especially acute during local and widespread hostilities, during peacekeeping missions, anti-terrorist operations, in cases of massive gunshot wounds. The aim of the work is to improve the surgical tactics in the reconstruction of severe wounded with soft tissue gunshot defects due to the multimodal scheme. Improvement of dynamic audio and thermal imaging diagnostics of the damaged anatomical area, analysis and modeling of the shape and direction of movement of the donor flap. A clinical case of closure of a bullet-through bullet wound of the left thigh (03.25.19 year) with a gunshot multi-fragment fracture of the left femoral pigtail in the middle third, damage to the superficial femoral vein and marginal damage to the superficial femoral artery was demonstrated.In the preoperative period, the first stage was dynamic digital thermography of the surface of wounds and surrounding soft tissues, which allowed thermal imaging to assess the state of damaged structures, to identify areas of preservation of blood supply. The second stage was the audio control of the identified areas of the "supply" - perforating vessels with a comparison of the blood flow velocity. The results obtained formed the basis for modeling the donor zone and monitoring its movement. The described clinical case of soft tissue defect closure consisted of three stages: The first stage - preparatory (diagnostics and cleaning) - (9 days of inpatient treatment) - repeated surgical treatment of wounds using low-frequency ultrasound (cavitation of the wound surface), controlled negative pressure (in a pulsed mode - 125 mm Hg), the imposition of secondary early sutures, due to which the wound area decreased by 35% compared to the wound area at the time of admission to the VICC of the Southern region. The second stage - the final (reconstructive) - (12 days after the injury) - plastic reconstruction of the defect of the posterior surface of the middle third of the left thigh by moving a ball-and-socket flap from the outer surface of the thigh using the Keystone technique. Conclusions: A multimodal algorithm with dynamic control of changes in the perfusion of the defect zone and surrounding structures is at the heart of the successful reconstruction of a gunshot defect in the soft tissues of the lower extremities, which reduces the treatment time by 1.5 times.

scholarly journals A CLINICAL CASE OF REMOVING A RESIDUAL FOREIGN BODY FROM THE LEFT SUPRACLAVICULAR REGION

2017 ◽  
Vol 4 (3) ◽  
pp. 120-122
Author(s):  
V.V. Boyko ◽  
V.V. Makarov ◽  
A.L. Sochnieva ◽  
V.V. Kritsak
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Soft Tissue ◽  
Clinical Case ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Life Quality ◽  
The Other ◽  
Practical Case ◽  
The One

Boyko V.V., Makarov V.V., Sochnieva A.L., Kritsak V.V.Residual foreign bodies in soft tissues are one of the main causes of chronical infection lesions and decrease in life quality. Surgical treatment is the most common way to relieve the patient from a foreign body. Often there is a question whether to remove a foreign body? On the one hand, all foreign bodies that are in the human body must be removed. On the other hand, in the absence of symptoms, the risk of surgery performed for the purpose of removal exceeds the risk associated with finding the foreign body. We would like to describe a practical case of removing a foreign body (Kirschner`s wires) from the left supraclavicular region. The young patient lived with a fragment of Kirschner's wire left after the osteosynthesis of the fractured clavicle for 5 years. Surgery to remove the residual foreign body was successful. On the 7th postoperative day the patient was discharged from the hospital under the supervision of surgeons at the place of residence.Key words: foreign body in soft tissue, Kirschner`s wire, surgical treatment. КЛІНІЧНИЙ ВИПАДОК ВИДАЛЕННЯ ЗАЛИШКОВ СТОРОННЬОГО ТІЛА З ЛІВОЇ НАДКЛЮЧИЧНОЇ ОБЛАСТІБойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Залишкові чужорідні тіла м'яких тканин залишаються однією з основних причин виникнення вогнища хронічної інфекції та зниження рівня якості життя. Хірургічне лікування основний спосіб позбавити хворого від наявності чужорідного агента. Часто виникає питання чи видаляти чужорідне тіло. З одного боку, усі сторонні тіла, що знаходяться в тілі людини, підлягають видаленню, з іншого боку при відсутності симптомів ризик операції, проводимої з метою видалення, перевищує ризик, пов'язаний з перебуванням чужорідного тіла. Ми хотіли б поділитися випадком видалення залишкового стороннього тіла (спиці Кіршнера) лівої надключичної ділянки із власної практики. Молода пацієнтка прожила з уламком спиці Кіршнера, залишеної після металлоостеосинтезу поламаної ключиці протягом 5 років. Операція з видалення залишкового стороннього тіла пройшла успішно. На 7 післяопераційну добу пацієнтка була виписана зі стаціонару під спостереження хірурги за місцем проживання.Ключові слова: чужорідне тіло м'яких тканин, спиця Кіршнера, хірургічне лікування. кЛИНИЧЕСКИЙ СЛУЧАЙ УДАЛЕНИЯ ОСТАТКОВ ИНОРОДНОГО ТЕЛА ИЗ ЛЕВОЙ ПОДКЛЮЧИЧНОЙ ОБЛАСТИ Бойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Остаточные инородные тела мягких тканей остаются одной из основных причин возникновения очага хронической инфекции и снижения уровня качества жизни. Хирургическое лечение основной способ избавить больного от наличия чужеродного агента. Часто возникает вопрос удалять ли инородное тело? С одной стороны, все инородные тела, находящиеся в теле человека, подлежат удалению, с другой стороны при отсутствии симптомов риск операции, производимой с целью удаления, превышает риск, связанный с нахождением инородного тела. Мы хотели бы поделится случаем удаления остаточного инородного тела (спицы Киршнера) левой надключичной области из собственной практики. Молодая пациентка прожила с обломком спицы Киршнера, оставленной после металлоостеосинтеза поломанной ключицы в течении 5 лет. Операция по удалению остаточного инородного тела прошла успешно. На 7 послеоперационные сутки пациентка была выписана из стационара под наблюдение хирурги по месту жительства.Ключевые слова: инородное тело мягких тканей, спица Киршнера, оперативное лечение.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals Postextraction Alveolar Preservation and Use of the Crown of the Extracted Tooth as a Temporary Restoration

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Andrea Rodríguez Moreno ◽  
Mariné Ortiz Magdaleno ◽  
Marissa Muñoz Islas ◽  
Jorge Armando Villar Mercado ◽  
María del Pilar Goldaracena Azuara ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Tissue ◽  
Clinical Case ◽  
Soft Tissues ◽  
Anterior Tooth ◽  
Defect Site ◽  
The Stability ◽  
Provisional Restoration

Ranging from the extraction of teeth from anterior sector commitment to the loss of bone and soft tissues, alveolar preservation is a regenerative technique that employs biomaterials that induce the preservation of bone tissue and minimize resorption. Placement of provisional restorations at the defect site maintains the stability of the soft tissues and aesthetics at which the definitive restoration is found. The objective of this clinical case was alveolar preservation postextraction of the anterior tooth that presented a coronal fracture, placing the clinical crown of the extracted tooth as the provisional restoration to maintain stability and to avoid soft tissue collapse and compromise to an aesthetic area.

scholarly journals Gingival Response to Dental Implant: Comparison Study on the Effects of New Nanopored Laser-Treated vs. Traditional Healing Abutments

2020 ◽  
Vol 21 (17) ◽  
pp. 6056
Author(s):  
Barbara Ghinassi ◽  
Angela Di Baldassarre ◽  
Gianmaria D’Addazio ◽  
Tonino Traini ◽  
Mauro Andrisani ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surface Topography ◽  
Soft Tissues ◽  
Point Of View ◽  
Lower Grade ◽  
Machined Surface ◽  
Tissue Microenvironment ◽  
Second Stage ◽  
The One

The health of peri-implant soft tissues is important for the long-term success rate of dental implants and the surface topography is pivotal in influencing it. Thus, the aim of this study was to evaluate, in human patients, the inflammatory mucosal microenvironment in the tissue surrounding a new, nanoscale, laser-treated healing abutment characterized by engineered nanopores versus a standard machined-surface. Analyses of anti- and pro-inflammatory markers, cytokeratins, desmosomal proteins and scanning electron microscopy were performed in 30 soft-tissue biopsies retrieved during second-stage surgery. The results demonstrate that the soft tissue surrounding the laser-treated surface was characterized by a lower grade of inflammation than the one facing the machined-surface, which, in turn, showed a disrupted epithelium and altered desmosomes. Moreover, higher adhesion of the epithelial cells on the laser-treated surface was detected compared to the machined one. In conclusion, the laser-treated surface topography seems to play an important role not only in cell adhesion, but also on the inflammatory makers’ expression of the soft tissue microenvironment. Thus, from a clinical point of view, the use of this kind of topography may be of crucial importance not only on healing abutments but also on prosthetic ones.

scholarly journals ENCAPSULATION OF METALLIC SOFT-TISSUE FOREIGN BODIES WITH A LONG CARRIER LIFE

2020 ◽  
pp. 160-164
Author(s):  
V. V. Negoduyko ◽  
R. M. Mikhailusov ◽  
T. P. Yakimova ◽  
P. M. Zamyatin ◽  
S. O. Beresnev ◽  
...  
Keyword(s):  
Foreign Body ◽  
Soft Tissue ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Clinical Laboratory ◽  
Gunshot Wounds ◽  
Analysis Data ◽  
Capsule Formation ◽  
Iron And Steel ◽  
Morphological Studies

Sumary. The aim is to investigate the features of pathogenesis in capsule formation around metallic foreign bodies of soft tissues. Materials and methods. The results of a study of 6 patients with metallic foreign bodies of soft tissues with a carrier period of 16 to 50 years were analyzed. 3 injured had foreign bodies of gunshot origin and 3 patients had foreign bodies as a result of personal injury. Used clinical, laboratory, instrumental, histological, immunohistochemical, X-ray spectrometric studies. Results. All foreign soft tissue bodies were removed with the capsule. By gender: 5 men and 1 woman. By localization - the lower extremity. Pain was present in all the victims. Radiography and ultrasound were informative, magnetodetection is informative only at the superficial location of a foreign body. The foreign bodies were made of gray cast iron and steel needle wire. Histologically, immunohistochemically and radiospectrometrically, it has been found that the capsule formation around the foreign body is affected by the mechanism and extent of damage to the soft tissues, the composition of the metal and its coating, and the carrier term of the foreign body. Conclusions. Depending on the composition of the metal and its coating, there is a different rate of oxidation of the foreign body in the soft tissues: oxidation of metal foreign bodies of fire origin is faster. The formation of the capsule around the foreign body is affected by the mechanism of tissue damage: when the needle penetrates, the soft tissues are destroyed minimally, in the case of gunshot wounds, they are destroyed more. Spectral analysis data in conjunction with morphological studies are the basis for the removal of a foreign body of inflammatory origin along with the capsule.

scholarly journals ORGANIZATION OF DIAGNOSTIC AND DYNAMIC OBSERVATION DURING RECONSTRUCTIVE RESTORATION OF GUNSHIRTING SOFT TISSUES

2020 ◽  
pp. 119-126
Author(s):  
I. P. Khomenko ◽  
Ye. V. Tsema ◽  
К. V. Gumenuk ◽  
S. V. Tertyshnyi ◽  
V. Yu. Shapovalov
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Surgical Care ◽  
Diagnostic Procedures ◽  
Gunshot Wounds ◽  
Front Line ◽  
Medical Evacuation ◽  
Material Resources ◽  
Dynamic Observation

Summary. Damage to the soft tissues of the human body is found both in peacetime and during the war, but the firearms nature has become relevant for Ukraine. Despite the experience gained surgery from previous wars in the treatment of gunshot injuries, there is still no generally accepted diagnostic scheme and classification for reconstructive closure of such specific injuries. The aim. Demonstrate the features of various methods for diagnosing gunshot wounds of soft tissues proposed for reconstruction of a damaged area. Results. In order to improve the quality of surgical care at the stages of medical evacuation, it is always necessary to carry out diagnostic procedures and treatment together. Sometimes it is impossible to implement medical care — it is on the front line, sometimes there is a lack of material resources — in the CDL, but it must be understood that the amount of diagnosis and treatment of a gunshot wound with soft tissue damage is always a difficult process. Conclusions. A multimodal approach to diagnostics and dynamic observation in the reconstruction of soft tissue gunshot injury not only restores the integrity of the damaged anatomical structure but also increases the percentage of functional capacity.

scholarly journals Inkjet Oxygen-Sorption Treatment in Local Treatment Purulent Soft Tissue Wounds

2020 ◽  
Vol 13 (1) ◽  
pp. 41-45
Author(s):  
Dmitry Valerievich Arkhipov ◽  
Alexander Alekseevich Andreev ◽  
Dmitry Andreevich Atyakshin ◽  
Alexander Anatol'evich Glukhov ◽  
Anton Petrovich Ostroushko
Keyword(s):  
Soft Tissue ◽  
Wistar Rats ◽  
Soft Tissues ◽  
Local Treatment ◽  
Control Group ◽  
Wound Surface ◽  
Traditional Treatment ◽  
Wound Area ◽  
Oxygen Sorption ◽  
Experimental Group

Relevance. Traditional treatment of septic wounds of soft tissues often leads to the development of complications, causing more than 30% of deaths after surgery. The oxidative and bacterial components have a key role in the pathogenesis of septic processes. The aim of the study was to develop a method of treatment of septic wounds, based on a combination of jet technologies, oxygenation and sorption therapy, and also to study the effectiveness of its use. Materials and methods. Studies were conducted on 120 white Wistar rats with septic wounds of soft tissue. There were 4 groups: 3 control and 1 experimental. There was no treatment in the 1st control group. Bandages and treatment of the wound with oxygen flow were performed in the 2nd control group. In the 3rd control group, bandages were performed, and the sorbent was applied to the wound surface. In the experimental group, in addition to dressings, jet oxygen-sorption treatment of the wound surface was carried out. The study of the effectiveness of the method was carried out using objective, histological, histochemical, bacteriological and statistical methods. Result. During the jet oxygen-sorption treatment of the wound surface, the disappearance of hyperemia was noted by 23.1%, the end of necrolysis - by 25.7%, the appearance of granulation - by 24.3%, wound epithelization - by 17.0% faster, compared with the data of the 1st control group. Conclusion. Use of the method the jet oxygen-sorption treatment for the treatment of septic wounds of soft tissues reduced the wound area by 1 day by 4.8%, 3 day by 6.7%, to 7-days 19.1% and to 10-day 43.9% compared to the 3rd control group.

scholarly journals Total Hip Arthroplasty in Patient with Melorheostosis (Case Report)

2019 ◽  
Vol 25 (3) ◽  
pp. 135-142
Author(s):  
V. V. Kuzin ◽  
K. A. Egiazaryan ◽  
A. P. Raksha ◽  
A. P. Ratyev ◽  
A. V. Kuzin ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clinical Case ◽  
Soft Tissues ◽  
Proximal Part ◽  
Early Postoperative Period ◽  
X Rays ◽  
Total Hip ◽  
Lower Back

Melorheostosis is a rare mesenchymal dysplasia of bone manifesting as regions of sclerosing and thickening of bone tissue. This disease may involve the adjacent soft tissues and lead to joint pain, limitation of joint motion, stiffness resulting from abnormal ossification and soft-tissue contractures due to periarticular fibrosis. The paper describes a clinical case of a patient who presented with pain and stiffness in the proximal part of the left hip which patient suffered for the last 10 years. At first the patient had intermittent pain in the lower back and left hip during and after walking. Radiographs revealed dense sclerotic and wavy cortex and hyperostosis involving the left iliac crest, the acetabulum, and the femur. CT angiography with contrast was performed for preoperative planning. During the procedure the authors performed total hip arthroplasty of the left hip with excision of fibro-ossifications in the left ilioinguinal area. Severe periarticular fibrosis of the soft tissue was observed intraoperatively and cartilage-like formation was visible around the joint. A sample of the ossification bone was resected for histologic confirmation of the diagnosis; extensive cortical sclerosis with varying thickness typical of melorheostosis was found. Early postoperative period went without complications following routine post-THR protocol. Postoperative X-rays at 6, 12, 24 months did not reveal any complications or new ossifications. Full ROM and pain-free function were achieved in the left hip and lower back of the patient. The present clinical case of total hip arthroplasty with excision of fibroossifications provided good clinical outcome for melorheostosis of the left hip.

P065 A case of fibrodysplasia ossificans progressiva in Kenya

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Aura Mwende ◽  
Athul Kooliyath ◽  
Pauline Samia ◽  
Kavulani Mutiso ◽  
Ravjit Sagoo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Functional Disability ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Fibrodysplasia Ossificans Progressiva ◽  
Laboratory Evaluation ◽  
Soft Tissue Calcification ◽  
Tissue Calcification ◽  
Normal Ranges

Abstract Background Fibrodysplasia Ossificans Progressiva (FOP) is an extremely rare and disabling disorder affecting 1 in 2 million individuals worldwide. It is caused by mutations in bone morphogenetic protein which leads to extra-skeletal ossification of soft tissues in a characteristic cranio-caudal pattern. Hallux valgus, episodic flares and progressive functional disability are characteristic features. The cause of death is often cardio-respiratory failure following thoracic insufficiency. The objective of our case study is to describe a rare but interesting case of fibrodysplasia ossificans progressiva (FOP) in an African setting. Methods This was a retrospective case review Results Two-year-old boy presented with painful firm masses of bony consistency over the axilla, neck, occiput and the forehead for seven months. He developed progressive inability to lift the arms, flex his neck and had a characteristic stiff posture while walking. The masses had a waxing and waning nature lasting about 4–5 days but with no complete resolution. He was previously treated with antibiotics for lymphadenitis which was diagnosed by biopsy of the neck mass at a different health facility. On examinationhe had bony masses on the posterior aspect of the neck tender on palpation and attached to the underlying subcutaneous tissue. Similar masses were found on his anterior and posterior chest wall measuring 1 cm by 1 cm anteriorly and larger masses- measuring 5 cm by 5 cm posteriorly. He had bilateral hallux valgus and both elbows held in fixed flexion. His fingers had varying degrees of fixed flexion. The lower limbs were unaffected. Laboratory evaluation within normal ranges. extensive dystrophic soft tissue calcification around both elbows outlining the joint capsules. dystrophic soft tissue calcification in the bilateral axillae extensive “sheet like” soft tissue dystrophic calcifications overlying the posterior elements of the vertebral column separate from the vertebrae. Histology showed muscle replacement by hyaline cartilage and bone with intervening fibromyxoid stroma. Discussion & Conclusions This case is meant to raise awareness of this rare disease across Africa. The misdiagnosis of FOP approaches 90% of cases worldwide. Definitive genetic testing of FOP is now available and can now confirm a diagnosis before the appearance of heterotopic ossifications. Clinical suspicion of FOP early in life on the basis of malformed great toes can lead to early clinical diagnosis. Current management focuses on early diagnosis, avoidance of trauma and optimization of function. A short course of oral steroids is beneficial in prevention of flares.

Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

2020 ◽  
Author(s):  
Matteo Guzzini ◽  
Leopoldo Arioli ◽  
Clelia Rugiero ◽  
Marco Rossini ◽  
Giuseppe Argento ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Healing ◽  
Soft Tissues ◽  
Femoral Condyle ◽  
Donor Site ◽  
Medial Femoral Condyle ◽  
Lower Limbs ◽  
Femoral Diaphysis ◽  
Recipient Site ◽  
Non Union

Abstract Backgrounds Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap. Materials and methods The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications. Results The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients. Conclusions Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.

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