THE TYPOLOGY OF EXTERNAL NOSE DEFECTS WITH LOSS OF THE CARTILAGE IN PATIENTS WITH SKIN TUMORS

Objective: to substantiate the necessity to differentiate certain types of nasal defects with loss of the lower third nose cartilage. Material and methods. 121 patients with malignant neoplasm’s of the external nose having undergone radical surgery with single-step plastics of the lower third nose defect were included into the study. 35 of them (28.9 %) had cartilage loss. We used different reconstructive techniques to remove the skin defects, two-layer (skin + cartilage) and full-thickness defects. Results. From the technical point of view the most difficult was to remove unclosed full-thickness defects. The necessity was caused by the reconstruction of external and internal epithelial linings, missing cartilage and modeling of the nostril contour. Most of specific complications were revealed while removing the unclosed full-thickness defects. Conclusion . Full-thickness and two-layer (skin + cartilage) defects can be singled out among defects with loss of cartilage. In addition we divide full-thickness defects into defects with closed and unclosed contours. The suggested classification determines reconstructive methods and techniques and the predicted risk of complications.

Download Full-text

Simulating Metal Implants in Full Thickness Cartilage Defects

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53235 ◽

2011 ◽

Author(s):

Krishnagoud Manda ◽

Anders Eriksson

Keyword(s):

Animal Models ◽

Point Of View ◽

Cartilage Defects ◽

Full Thickness ◽

Metal Implants ◽

Chondral Defects ◽

Dependent Behavior ◽

Biomechanical Forces ◽

A Site ◽

Articulating Surface

Damage or degeneration in the articular cartilage is a major problem that affects millions of people in the world. The biomechanical forces at a site of damage in the cartilage may make the tissue more susceptible to continued long-term degeneration. Various biological treatments are currently available, but all have drawbacks. Alternatively, a contoured articular resurfacing implant is developed to offer a treatment to such full thickness chondral defects [1,3,4]. The main goal of using metal implants, to fill the degenerated portion of the cartilage, is to seal the surrounding cartilage so that further damage can be prevented, and to re-establish the integrity of the joint articulating surface. Many researchers have studied the safety, feasibility and reliability of the metal implants in animal models from a biological point of view [3,4]. They showed promising results. Till date, the mechanical behavior of cartilages surrounding the implant has not been studied, even in animal models. It is essential to understand the time dependent behavior of the cartilages due to biphasic nature of cartilage. Any protrusion of metal implant into the joint cavity damages the opposing soft tissue [1]. In order to avoid this, the positioning of implant together with the behavior of the cartilages immediately surrounding the implant have to be studied.

Download Full-text

Analysis of reconstructive methods in surgical treatment of nasal skin defects

Vojnosanitetski pregled ◽

10.2298/vsp140829052j ◽

2016 ◽

Vol 73 (8) ◽

pp. 723-727

Author(s):

Marko Jovic ◽

Milovan Dimitrijevic ◽

Ana Dimitrijevic ◽

Goran Stojkovic

Keyword(s):

Defect Size ◽

Skin Defect ◽

Skin Grafts ◽

Full Thickness ◽

Skin Defects ◽

Thickness Skin ◽

Side Walls ◽

Average Skin ◽

Nasal Defects ◽

Reconstructive Methods

Background/Aim. Surgeons often face with the problem when selecting a reconstructive method for nasal skin defects. The aim of this study was to determine functional and aesthetic character-istics of different reconstructive methods used for skin defects in different regions of the nose. Methods. The study involved 44 patients with basocellular carcinoma in nasal area. The nasal skin was divided into four subunits: the tip, the alar lobules, the side-walls and the dorsum. The average skin defect size was 10 mm in diameter. Local flaps and full thickness skin grafts were used in the study. We analyzed the functional and esthetic results of dif-ferent reconstructive methods used for nasal defects in different regions of the nose 12 months after the surgery. Results. The study shows that different reconstructive methods produce dif-ferent functional and esthetic results in the same nasal subunits and that the same reconstructive method produces different re-sults in different nasal subunits. Conclusions. Estimation the postoperative functional and esthetic characteristics of different reconstructive methods is one of the basic preconditions of suc-cessful reconstruction.

Download Full-text

First experiences with a new surgical approach in adult full-thickness burns: single step reconstruction of epidermal, dermal and subcutaneous defects by use of split-thickness skin grafting, a dermal collagen matrix and autologous fat-transfer

European Surgery ◽

10.1007/s10353-013-0211-2 ◽

2013 ◽

Vol 45 (5) ◽

pp. 263-269 ◽

Cited By ~ 5

Author(s):

M. Keck ◽

H. F . Selig ◽

J. Kober ◽

D. B . Lumenta ◽

H. Schachner ◽

...

Keyword(s):

Skin Grafting ◽

Collagen Matrix ◽

Single Step ◽

Full Thickness ◽

Fat Transfer ◽

Autologous Fat ◽

Autologous Fat Transfer ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Dermal Collagen

Download Full-text

Allogeneic Umbilical Cord Blood–Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120973052 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097305

Author(s):

Hong-Chul Lim ◽

Yong-Beom Park ◽

Chul-Won Ha ◽

Brian J. Cole ◽

Beom-Koo Lee ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Events ◽

Cartilage Repair ◽

Older Patients ◽

Cartilage Defects ◽

Full Thickness ◽

Phase 3 ◽

Randomized Controlled ◽

Cartilage Restoration

Background: There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients. Purpose: To determine whether implantation of a composite of allogeneic umbilical cord blood–derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participants who improved by ≥1 grade on the ICRS Macroscopic Cartilage Repair Assessment (blinded evaluation) at 48-week arthroscopy. Secondary outcomes included histologic assessment; changes in pain visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) score from baseline; and adverse events. Results: Among 114 randomized participants (mean age, 55.9 years; 67% female; body mass index, 26.2 kg/m2), 89 completed the phase 3 clinical trial and 73 were enrolled in the 5-year follow-up study. The mean defect size was 4.9 cm2 in the UCB-MSC-HA group and 4.0 cm2 in the microfracture group ( P = .051). At 48 weeks, improvement by ≥1 ICRS grade was seen in 97.7% of the UCB-MSC-HA group versus 71.7% of the microfracture group ( P = .001); the overall histologic assessment score was also superior in the UCB-MSC-HA group ( P = .036). Improvement in VAS pain, WOMAC, and IKDC scores were not significantly different between the groups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up ( P < .05). There were no differences between the groups in adverse events. Conclusion: In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture. Registration: NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).

Download Full-text