Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric☆☆☆

PubMed Central

Santos, Leandro Emílio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brandão; Soares, Eduardo Augusto Marques

2014-01-01

Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed. PMID:26229777

Treatment of war injuries of the shoulder with external fixators.

PubMed

Davila, Slavko; Mikulić, Danko; Davila, Neda Jarza; Popović, Ljiljana; Zupancić, Bozidar

2005-05-01

In this retrospective study, 18 patients with war injuries of the shoulder were reviewed to evaluate the technical problems associated with external fixation and to analyze the incidence of infection and late functional results. The average patient age was 28.5 years. All patients were male. Thirteen patients had explosive wounds, whereas five wounds were caused by gunshot missiles. All injuries were extensive in terms of bone and soft tissue defects. Six patients presented with complex injuries involving neurovascular structures. Sixteen patients were treated with external fixation. Application of the proximal pins of the external fixator through the humeral head was possible in eight patients, the scapula served as the site of proximal fixation in four patients, only the clavicle was available for placement of pins in two patients, and both the scapula and the clavicle had to be pinned to achieve proximal stabilization in two patients. In two patients, fixation was not possible and early amputation was performed. Infection was eventually eradicated in all patients, allowing for adequate soft tissue coverage of the wounds. Analysis of functional results at an average of 6 years after the injury showed a considerable degree of functional deficit in most patients.

A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

PubMed Central

Faroug, Radwane; Stirling, Paul; Ali, Farhan

2013-01-01

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome. PMID:23819090

Enhanced Soft Tissue Attachment and Fixation Using a Mechanically-Stimulated Cytoselective Tissue-Specific ECM Coating

DTIC Science & Technology

2012-08-01

currently used for surgical reinforcement for tendon rotator cuff repair . All scaffolds in this study were seeded using this protocol. PLA fabric...extracellular matrix scaffolds for rotator cuff tendon repair . Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am 2006;88(12):2665-72...mechanical stimulation of a co-cultured biomaterial scaffold can improve/expedite healing of a tendon-to-bone interface for soft tissue repair . There

Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Hoffmann, Reinhard F G; Bail, Hermann J; Rehm, Oliver; Südkamp, Norbert P

2002-02-01

Tendon-to-bone healing of soft-tissue grafts has been described to progress by the development of a fibrous interzone that undergoes a maturation process leading to the development of an indirect type of ligament insertion. Previous studies used extra-articular models or fixation far away from the joint line; thus, no data are available investigating tendon-to-bone healing of a soft-tissue graft fixed anatomically. Therefore, we studied the tendon-to-bone healing of the anatomic soft-tissue graft interference fit fixation in a model of anterior cruciate ligament (ACL) reconstruction in sheep. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with biodegradable poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and histologic evaluations were performed. Undecalcified specimens were evaluated under normal and polarized light. Additionally, animals received a polychrome sequential labeling (tetracycline, xylenol orange, and calcein green) to determine bone growth per time under fluorescent light. Intratunnel histologic findings at 6 weeks showed a tendon-bone junction with only a partial fibrous interzone between the graft tissue and the surrounding bone. A mature intratunnel tendon-bone junction with a zone of fibrocartilage was found at 9 to 12 weeks. At the tunnel entrance site a wide regular ligamentous insertion site was seen in all specimens after 24 weeks. This insertion showed regular patterns such as the direct type of insertion of a normal ligament with a dense basophilic transition zone consisting of mineralized cartilage. A fibrous interzone between the graft tissue and the bone tunnel was only partially developed, which is in contrast to all previous studies in which nonanatomic fixation was used. Thus, it is reasonable to assume that the tendon-to-bone healing in the present study may progress partially by direct-contact healing without the development of a fibrous interzone. To our knowledge, this is the first report describing the development of a direct type of ligament insertion after ACL replacement with a soft-tissue graft. This is in contrast to previous studies reporting the development of an indirect type of insertion when using nonanatomic fixation far away from the joint line. Thus, histologic data strongly indicate that anatomic interference fit fixation is beneficial for tendon-to-bone incorporation by leading to the development of a direct type of ligament insertion.

Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture.

PubMed

Nelson, Joshua D; McIff, Terence E; Moodie, Patrick G; Iverson, Jamey L; Horton, Greg A

2010-03-01

Internal fixation of the os calcis is often complicated by prolonged soft tissue management and posterior facet disruption. An ideal calcaneal construct would include minimal hardware prominence, sturdy posterior facet fixation and nominal soft tissue disruption. The purpose of this study was to develop such a construct and provide a biomechanical analysis comparing our technique to a standard internal fixation technique. Twenty fresh-frozen cadaver calcanei were used to create a reproducible Sanders type-IIB calcaneal fracture pattern. One calcaneus of each pair was randomly selected to be fixed using our compressive headless screw technique. The contralateral matched calcaneus was fixed with a nonlocking calcaneal plate in a traditional fashion. Each calcaneus was cyclically loaded at a frequency of 1 Hz for 4000 cycles using an increasing force from 250 N to 1000 N. An Optotrak motion capturing system was used to detect relative motion of the three fracture fragments at eight different points along the fracture lines. Horizontal separation and vertical displacement at the fracture lines was recorded, as well as relative rotation at the primary fracture line. When the data were averaged, there was more horizontal displacement at the primary fracture line of the plate and screw construct compared to the headless screw construct. The headless screw construct also had less vertical displacement at the primary fracture line at every load. On average those fractures fixed with the headless screw technique had less rotation than those fixed with the side plate technique. A new headless screw technique for calcaneus fracture fixation was shown to provide stability as good as, or better than, a standard side plating technique under the axial loading conditions of our model. Although further testing is needed, the stability of the proposed technique is similar to that typically provided by intramedullary fixation. This fixation technique provides a biomechanically stable construct with the potential for a minimally invasive approach and improved post-operative soft tissue healing.

Biological approach to treatment of intra-articular proximal tibial fractures with double osteosynthesis.

PubMed

Singh, Saurabh; Patel, Pankaj R; Joshi, Anil Kumar; Naik, Rajnikant N; Nagaraj, Chethan; Kumar, Sudeep

2009-02-01

The treatment of intra-articular proximal tibial fractures is associated with complications, and much conflicting literature exists concerning the treatment of choice. In our study, an attempt has been made to develop an ideal and adequate treatment protocol for these intra-articular fractures. The principle of double osteosynthesis, i.e., lateral minimally invasive plate osteosynthesis (MIPO), was combined with a medial external fixator to treat 22 intra-articular proximal tibial fractures with soft tissue injury with a mean follow-up of 25 months. Superficial pin track infection was observed in one case, and no soft tissue breakdown was noted. Loss of articular reconstruction was reported in one case. Bridging callus was seen at 12 weeks (8 weeks-7 months). The principle of substitution or double osteosynthesis, i.e., lateral MIPO, was combined with a medial external fixator and proved to be a fairly good method of fixation in terms of results and complications.

Management of Gustilo Anderson III B open tibial fractures by primary fascio-septo-cutaneous local flap and primary fixation: The 'fix and shift' technique.

PubMed

Ramasamy, P R

2017-01-01

Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with "fix and shift" technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. Management of Gustilo Anderson III B open tibial fractures with "fix and shift" technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, "fix and shift" could be recommended as one of the treatment modalities for open III B tibial fractures.

A biomechanical evaluation to optimize the configuration of a hinged external fixator for the primary treatment of severely displaced intraarticular calcaneus fractures with soft tissue damage.

PubMed

Besch, Lutz; Schmidt, Ina; Mueller, Michael; Daniels-Wredenhagen, Mark; Hilgert, Ralf-Eric; Varoga, Deike; Seekamp, Andreas

2008-01-01

The purpose of this investigation was to develop an optimized hinged external fixator for the primary treatment of dislocated, intra-articular calcaneus fractures with associated soft tissue damage. To this end, a calcaneus model was made out of a polyurethane block, and a steel cylinder served as the ankle joint and was connected to a synthetic model of the tibia via a metal clamp. A saw cut served as the fracture in the model. A Steinmann nail and Schanz screw were placed in defined positions in the model and connected medially and laterally with longitudinal support rods. The fixator allowed a total of 20 degrees of plantar- and dorsiflexion, with rotation in the virtual axis of the upper ankle joint. Changes in the model fracture were measured during cyclical strain, and at different screw positions in the model tibia and calcaneus. Miniature force sensors located on the longitudinal support rods, and a plantar tension spring, were used to measure pressure and tension. Reproducible values were determined and, with the optimal configuration, shifting within the osteotomy was minimal. In the experimental configuration, optimal tibial screw placement was 70 mm proximal to the rotation axis of the upper ankle joint, and optimal placement of the Steinmann nail was in the posterior surface of the calcaneus. These findings indicated that the hinged fixator allows 20 degrees of ankle movement without alteration of the rotation axis, and suggest that this type of external fixator can be used in all types of calcaneal fracture regardless of the soft tissue damage. ACFAS Level of Clinical Evidence: 5c.

Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

PubMed

Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

2014-01-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The management of ankle fractures in patients with diabetes.

PubMed

Wukich, Dane K; Kline, Alex J

2008-07-01

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques. Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome. Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates

PubMed Central

Prasad, G Thiruvengita; Kumar, T Suresh; Kumar, R Krishna; Murthy, Ganapathy K; Sundaram, Nandkumar

2013-01-01

Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as ≤2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee mobilization. Careful soft tissue handling and employing minimal invasive techniques minimizes soft tissue complications. PMID:23682182

Enhanced renal image contrast by ethanol fixation in phase-contrast X-ray computed tomography.

PubMed

Shirai, Ryota; Kunii, Takuya; Yoneyama, Akio; Ooizumi, Takahito; Maruyama, Hiroko; Lwin, Thet Thet; Hyodo, Kazuyuki; Takeda, Tohoru

2014-07-01

Phase-contrast X-ray imaging using a crystal X-ray interferometer can depict the fine structures of biological objects without the use of a contrast agent. To obtain higher image contrast, fixation techniques have been examined with 100% ethanol and the commonly used 10% formalin, since ethanol causes increased density differences against background due to its physical properties and greater dehydration of soft tissue. Histological comparison was also performed. A phase-contrast X-ray system was used, fitted with a two-crystal X-ray interferometer at 35 keV X-ray energy. Fine structures, including cortex, tubules in the medulla, and the vessels of ethanol-fixed kidney could be visualized more clearly than that of formalin-fixed tissues. In the optical microscopic images, shrinkage of soft tissue and decreased luminal space were observed in ethanol-fixed kidney; and this change was significantly shown in the cortex and outer stripe of the outer medulla. The ethanol fixation technique enhances image contrast by approximately 2.7-3.2 times in the cortex and the outer stripe of the outer medulla; the effect of shrinkage and the physical effect of ethanol cause an increment of approximately 78% and 22%, respectively. Thus, the ethanol-fixation technique enables the image contrast to be enhanced in phase-contrast X-ray imaging.

Inflammatory fibrous hyperplasia treated with a modified vestibuloplasty: a case report.

PubMed

Jaimes, Miguel; Muñante, Jose; Olate, Sergio; Rodriguez-Chessa, Jaime Giuseppe; de Albergaria-Barbosa, Jose Ricardo; Mazzonetto, Renato; Klüppel, Leandro Eduardo

2008-03-01

The purpose of this report is to present a case of surgical and prosthetic treatment of a woman with inflammatory fibrous hyperplasia (IFH) and her evaluation during a six month period. IFH is a benign pathology, prevalent in female patients, and principally associated with ill-fitting prosthetic devices in need of adjustment. It is common for patients to require surgical removal of the hyperplastic tissue and fabrication of a new prosthesis. A 55-year-old female with a history of smoking presented with a chief complaint of missing the scheduled adjustment of her maxillary complete denture and the presence of moveable tissue under the denture. Surgical excision of the hyperplastic tissue followed with fixation of the prosthesis for six months to guide the healing of the soft tissue and to reshape the contours of the maxillary supporting tissues. Surgical removal of hyperplasic soft tissue is a routine procedure, and the fixation of the prosthesis for the support of tissue during healing improves intraoral conditions for the fabrication of a new prosthesis in the future.

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

PubMed

Domos, Peter; Tytherleigh-Strong, Graham; Van Rensburg, Lee

2017-01-01

Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications. There is little information about outcome and management of local wound complications after clavicle fracture fixations. Ninety-seven patients underwent open reduction and internal fixation, 17 were treated with IM screw fixation and 80 with plate fixation. Wound complication occurred in eight patients (8.2%) and rates differed significantly between IM and plate fixations (29.4% vs. 3.8%). Patients were assessed on average 58.3 months with visual analogue pain scores (VASs), Oxford Shoulder Score (OSS), and QuickDash (QD) score. Five patients had wound breakdown and three patients had wound erythema. In seven patients with stable fixation, it was possible to "dress and suppress" with average 3 weeks of oral antibiotics. One patient had unstable fixation and required longer antibiotic treatment with early screw removal. One patient developed a chronic discharging wound, requiring debridement and later plate removal. At final follow-up, all wounds remained healed, bony union was achieved in all. The average scores were: VAS 1, OSS 46, and QD 4.5. Good function with dry healed wound and united clavicle can be achieved. Further studies are required to investigate the difference in soft tissue complication rates, which may be due to the IM technique of retrograde drilling with a guide wire and due to aseptic thermal bone necrosis, rather than true infection.

Nature and results of treatment of war wounds caused by cluster bombs.

PubMed

Mitković, Milorad; Bumbasirević, Marko; Grubor, Predrag; Milenković, Sasa; Micić, Ivan; Stojiljković, Predrag; Kostić, Igor; Karaleić, Sasa; Stamenić, Sonja; Pavlović, Predrag; Stanojlović, Milos; Jovanović, Vladimir; Radovanović, Zoran; Cirić, Tamara; Kutlesić-Stojanović, Katarina; Mitković, Milan

2013-01-01

The aim of this study is to describe the nature of war wounds with fracture caused by cluster bombs and to suggest treatment options for such injuries. The nature of wounds caused by cluster bombs differs from those caused by conventional arms (they are more severe). The sides of the wounds are represented by conquasated soft tissues (such as fat and muscle) with thick dead tissues, ordinarily with a thickness of 0.5-4.5 cm. Another main characteristic of such injuries is the high percentage of amputations needed due to the high rate of neurovascular damage. This paper investigates the cases of 81 patients who sustained a total of 99 war wounds with fractures. The average age of the patients was 32.7 years while the youngest was 20 and the oldest, 77. According to The International Committee of the Red Cross (ICRC) classification of war wounds, 14 patients had grade I injuries, 48 patients grade II, and 29 patients, grade III. Mitkovic external fixation system, known also as the "War Fixator" was used for all fractures fixation. One protocol, which was a modification of the ICRC's protocol adapted to our specific conditions, was used throughout the study. For solving soft tissue defects, a rotator fasciocutan flap was the most frequently used. For solving of bones defect Mitkovic reconstructive external fixation device was used. All fractures we treated healed. We concluded that shortening the procedural time and being a very simple, immediate using of Mitkovic versatile external fixator ("War Fixator") is, leads to desirable results.

Complications of ankle fracture in patients with diabetes.

PubMed

Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

2008-03-01

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

PubMed

Harper, Carl M; Iorio, Matthew L

2016-09-01

Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8.

Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a systematic review.

PubMed

Joss, Christof Urs; Joss-Vassalli, Isabella Maria; Kiliaridis, Stavros; Kuijpers-Jagtman, Anne Marie

2010-06-01

The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5 years for WF. The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were 50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the soft tissue pogonion to pogonion in BSSO with RIF; they tended to be greater than a 1:1 ratio. The upper lip mainly showed retrusion but with high variability. Despite a large number of studies on the short- and long-term effects of mandibular advancement by BSSO, the results of the present systematic review have shown that evidence-based conclusions on soft tissue changes are still unknown. This is mostly because of the inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measures. Well-designed prospective studies with sufficient sample sizes that have excluded patients undergoing additional surgery (ie, genioplasty or maxillary surgery) are needed. 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Tendon healing in a bone tunnel. Part I: Biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Peine, Ricarda; Pashmineh-Azar, Alireza; Abel, Clemens; Südkamp, Norbert P; Hoffmann, Reinhard F G

2002-02-01

Interference fit fixation of soft-tissue grafts has recently raised strong interest because it allows for anatomic graft fixation that may increase knee stability and graft isometry. Although clinical data show promising results, no data exist on how tendon healing progresses using this fixation. The purpose of the present study was to investigate anterior cruciate ligament (ACL) reconstruction biomechanically using direct tendon-to-bone interference fit fixation with biodegradable interference screws in a sheep model. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and standard biomechanical evaluations were performed. All grafts at time zero failed by pullout from the bone tunnel, whereas grafts at 6 and 9 weeks failed intraligamentously at the screw insertion site. At 24 and 52 weeks, grafts failed by osteocartilaginous avulsion. At 24 weeks, interference screws were macroscopically degraded. At 6 and 9 weeks tensile stress was only 6.8% and 9.6%, respectively, of the graft tissue at time zero. At 52 weeks, tensile stress of the reconstruction equaled 63.8% and 47.3% of the Achilles tendon graft at time zero and the native ACL, respectively. A complete restitution of anterior-posterior drawer displacement was found at 52 weeks compared with the time-zero reconstruction. It was found that over the whole healing period the graft fixation proved not to be the weak link of the reconstruction and that direct interference fit fixation withstands loads without motion restriction in the present animal model. The weak link during the early healing stage was the graft at its tunnel entrance site, leading to a critical decrease in mechanical properties. This finding indicates that interference fit fixation of a soft-tissue graft may additionally alter the mechanical properties of the graft in the early remodeling stage because of a possible tissue compromise at the screw insertion site. Although mechanical properties of the graft tissue had not returned to normal at 1 year compared with those at time zero, knee stability had returned to normal at that time. There was no graft pullout after 24 weeks, indicating that screw degradation does not compromise graft fixation.

Direct microCT imaging of non-mineralized connective tissues at high resolution.

PubMed

Naveh, Gili R S; Brumfeld, Vlad; Dean, Mason; Shahar, Ron; Weiner, Steve

2014-01-01

The 3D imaging of soft tissues in their native state is challenging, especially when high resolution is required. An X-ray-based microCT is, to date, the best choice for high resolution 3D imaging of soft tissues. However, since X-ray attenuation of soft tissues is very low, contrasting enhancement using different staining materials is needed. The staining procedure, which also usually involves tissue fixation, causes unwanted and to some extent unknown tissue alterations. Here, we demonstrate that a method that enables 3D imaging of soft tissues without fixing and staining using an X-ray-based bench-top microCT can be applied to a variety of different tissues. With the sample mounted in a custom-made loading device inside a humidity chamber, we obtained soft tissue contrast and generated 3D images of fresh, soft tissues with a resolution of 1 micron voxel size. We identified three critical conditions which make it possible to image soft tissues: humidified environment, mechanical stabilization of the sample and phase enhancement. We demonstrate the capability of the technique using different specimens: an intervertebral disc, the non-mineralized growth plate, stingray tessellated radials (calcified cartilage) and the collagenous network of the periodontal ligament. Since the scanned specimen is fresh an interesting advantage of this technique is the ability to scan a specimen under load and track the changes of the different structures. This method offers a unique opportunity for obtaining valuable insights into 3D structure-function relationships of soft tissues.

Fifth Metatarsal Osteotomies.

PubMed

Weil, Lowell; Consul, Devon

2015-07-01

A tailor's bunion or bunionette deformity is a combination of osseous and soft tissue bursitis on the lateral aspect of the fifth metatarsal head. This article discusses 7 corrective measures: medial oblique sliding osteotomy with fixation, medial oblique slide osteotomy-minimal incision procedure without fixation, SERI (simple, effective, rapid, inexpensive) with fixation, chevron with or without fixation, closing, lateral wedge osteotomy at the metatarsal neck or proximal diaphysis, Weil osteotomy, and scarfette. These evidence-based techniques can be used by practitioners for medical management of their patients through evaluation, diagnosis, and prognosis. Complications are also addressed. Copyright © 2015 Elsevier Inc. All rights reserved.

Damage control and intramedullary nailing for long bone fractures in polytrauma patients.

PubMed

Patka, Peter

2017-06-01

The early fracture treatment in patients with multiple injuries should be focused on damage control. The fracture type and its location, local soft tissue condition as well as the patient's physiological condition shall determine the time and type of fracture treatment. Prevention of local and systemic complications must be immediately considered and included in the treatment planning. The use of external fixator (ExFix), which will be replaced by IM-implants in most cases at a later stage, provides adequate temporary fracture stabilization with less collateral damage. Good clinical results can be expected in patients with long bone fractures if the principles of damage control surgery are applied and local complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lawn-mower injuries in children.

PubMed

Love, S M; Grogan, D P; Ogden, J A

1988-01-01

The power lawn mower is capable of inflicting serious injury, particularly to the pediatric population. A total of 27 patients who had sustained lawn-mower injuries were reviewed to identify those factors responsible for power-mower accidents and to determine an effective treatment regimen for these patients. The injuries included amputations in 19, major lacerations in 34, and fractures in 23 extremities. Aggressive treatment of both the soft tissue and bony injuries was necessary. Fractures were treated with either open reduction and internal fixation or external fixation, as appropriate, and early soft tissue coverage. The results were satisfactory in the majority of patients, but often required multiple surgical procedures over a number of years. The incidence of these injuries can be reduced by educating the public about the potential dangers of these machines, and by encouraging the use of proper safety procedures.

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches.

PubMed

Xue, Youdi; Zhang, Hui; Pei, Fuxing; Tu, Chongqi; Song, Yueming; Fang, Yue; Liu, Lei

2014-01-01

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85). Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.

Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome.

PubMed

Kim, Joon-Woo; Oh, Chang-Wug; Oh, Jong-Keon; Kyung, Hee-Soo; Park, Kyeong-Hyeon; Kim, Hee-June; Jung, Jae-Wook; Jung, Young-Soo

2017-06-01

High-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome. Twenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9-158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out. Twenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the occurrence of infection. Staged MIPO for proximal tibial fractures with acute compartment syndrome may achieve satisfactory bony union and functional results, while decreasing deep infections and soft tissue complications. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Metacarpal Locked Intramedullary Nail: Comparative Biomechanical Evaluation of New Implant Design for Metacarpal Fractures.

PubMed

Boonyasirikool, Chinnakart; Tanakeatsakul, Sakkarin; Niempoog, Sunyarn

2015-04-01

The optimal fixation of metacarpal fracture should provide sufficient stability to permit early functionfor all types of fracture. However; it must preserve surrounding soft tissue during application and not require secondary removal due to its prominence. The prototype of metacarpal locked intramedullary nail (MCLN) was designed by our institute aiming to achieve those allfeatures. To biomechanically test our newly designed, locked metacarpal nail and compare with common current available fixation methods. Thirty chicken humeri were devided into 3 groups (n = 1 per group) according tofixation techniques: MCLN, 1.5 mm miniplate (Synthes), and Kirschner wire. After complete fixation, all specimens were osteotomized at mid-shaft creating transverse fractures. Five specimens from each group were tested by load of failure under axial compression, and another five under bending force. In axial compression model, the loads tofailure in MCLN group was greatest (460 ± 17 N), which was significant higher than the Kirschner wire group. The MCLN group also showed the highest load to failure in bending test (341 ± 10 N). This value reaches statistical significance when compared with plate and Kirschner wire groups. The MCLN construct provided higher stability than miniplate and Kirschner wire fixation both in axial and bending mode. Together with the minimally invasive and soft tissue-friendly design concept, this study suggests that MCLN is promising fixation option for metacarpal fracture.

Comparison of two-staged ORIF and limited internal fixation with external fixator for closed tibial plafond fractures.

PubMed

Wang, Cheng; Li, Ying; Huang, Lei; Wang, Manyi

2010-10-01

To compare the results of two-staged open reduction and internal fixation (ORIF) and limited internal fixation with external fixator (LIFEF) for closed tibial plafond fractures. From January 2005 to June 2007, 56 patients with closed type B3 or C Pilon fractures were randomly allocated into groups I and II. Two-staged ORIF was performed in group I and LIFEF in group II. The outcome measures included bone union, nonunion, malunion, pin-tract infection, wound infection, osteomyelitis, ankle joint function, etc. These postoperative data were analyzed with Statistical Package for Social Sciences (SPSS) 13.0. Incidence of superficial soft tissue infection (involved in wound infection or pin-tract infection) in group I was lower than that in group II (P < 0.05), with significant difference. Group I has significantly less radiation exposure (P < 0.001). Group II had higher rates of malunion, delayed union, and arthritis symptoms, with no statistical significance. Both groups resulted similar ankle joint function. Logistic regression analysis indicated that smoking and fracture pattern were the two factors significantly influencing the final outcomes. In the treatment of closed tibial plafond fractures, both two-staged ORIF and LIFEF offer similar results. Patients undergo LIFEF carry significantly greater radiation exposure and higher superficial soft tissue infection rate (usually occurs on pin tract and does not affect the final outcomes).

A role for iron and oxygen chemistry in preserving soft tissues, cells and molecules from deep time.

PubMed

Schweitzer, Mary H; Zheng, Wenxia; Cleland, Timothy P; Goodwin, Mark B; Boatman, Elizabeth; Theil, Elizabeth; Marcus, Matthew A; Fakra, Sirine C

2014-01-22

The persistence of original soft tissues in Mesozoic fossil bone is not explained by current chemical degradation models. We identified iron particles (goethite-αFeO(OH)) associated with soft tissues recovered from two Mesozoic dinosaurs, using transmission electron microscopy, electron energy loss spectroscopy, micro-X-ray diffraction and Fe micro-X-ray absorption near-edge structure. Iron chelators increased fossil tissue immunoreactivity to multiple antibodies dramatically, suggesting a role for iron in both preserving and masking proteins in fossil tissues. Haemoglobin (HB) increased tissue stability more than 200-fold, from approximately 3 days to more than two years at room temperature (25°C) in an ostrich blood vessel model developed to test post-mortem 'tissue fixation' by cross-linking or peroxidation. HB-induced solution hypoxia coupled with iron chelation enhances preservation as follows: HB + O2 > HB - O2 > -O2 > +O2. The well-known O2/haeme interactions in the chemistry of life, such as respiration and bioenergetics, are complemented by O2/haeme interactions in the preservation of fossil soft tissues.

Fixation Strength of Polyetheretherketone Sheath-and-Bullet Device for Soft Tissue Repair in the Foot and Ankle.

PubMed

Christensen, Jay; Fischer, Brian; Nute, Michael; Rizza, Robert

Tendon transfers are often performed in the foot and ankle. Recently, interference screws have been a popular choice owing to their ease of use and fixation strength. Considering the benefits, one disadvantage of such devices is laceration of the soft tissues by the implant threads during placement that potentially weaken the structural integrity of the grafts. A shape memory polyetheretherketone bullet-in-sheath tenodesis device uses circumferential compression, eliminating potential damage from thread rotation and maintaining the soft tissue orientation of the graft. The aim of this study was to determine the pullout strength and failure mode for this device in both a synthetic bone analogue and porcine bone models. Thirteen mature bovine extensor tendons were secured into ten 4.0 × 4.0 × 4.0-cm cubes of 15-pound per cubic foot solid rigid polyurethane foam bone analogue models or 3 porcine femoral condyles using the 5 × 20-mm polyetheretherketone soft tissue anchor. The bullet-in-sheath device demonstrated a mean pullout of 280.84 N in the bone analog models and 419.47 N in the porcine bone models. (p = .001). The bullet-in-sheath design preserved the integrity of the tendon graft, and none of the implants dislodged from their original position. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

[Safety evaluation of secondary conversion from external fixation to internal fixation for open tibia fractures].

PubMed

Liu, Xi; Cen, Shiqiang; Xiang, Zhou; Zhong, Gang; Yi, Min; Fang, Yue; Liu, Lei; Huang, Fuguo

2017-06-01

To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P >0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group ( P =0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference ( χ 2 =0.013, P =0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference ( χ 2 =0.509, P =0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference ( χ 2 =2.168, P =0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference ( χ 2 =0.361, P =0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference ( χ 2 =1.059, P =0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.

Comparison of Early and Delayed Open Reduction and Internal Fixation for Treating Closed Tibial Pilon Fractures.

PubMed

Tang, Xin; Liu, Lei; Tu, Chong-qi; Li, Jian; Li, Qi; Pei, Fu-xing

2014-07-01

The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial. The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures. Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided). In the delayed group, 9 patients were treated first by temporary external fixation. All the closed fractures were managed by ORIF with locking plates. At follow-up, the clinical and radiographic results were retrospectively analyzed. The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B. There was no significant difference (P > .05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score. The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 ± 3.7 weeks, P < .05), operating time (84.3 ± 12.1 months vs 100.6 ± 13.7 months, P < .01), and hospital stay (7.6 ± 2.6 days vs 15.2 ± 4.2 days, P < .01). If soft tissue conditions are acceptable, early ORIF for treating closed type C pilon fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay. These results favorably compare with delayed ORIF treatment. Level III, retrospective comparative study. © The Author(s) 2014.

Circular External Fixation as a Primary or Adjunctive Therapy for the Podoplastic Approach of the Diabetic Charcot Foot.

PubMed

Short, Daniel J; Zgonis, Thomas

2017-01-01

Numerous techniques have been described for surgical management of the diabetic Charcot foot. External fixation has become a main surgical tool for the reconstructive foot and ankle surgeon when dealing with the ulcerated diabetic Charcot foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot foot. This article describes a variety of circular external fixation applications for the diabetic Charcot foot. Copyright © 2016 Elsevier Inc. All rights reserved.

Temporary Fixation Using a Long Femoral-tibial Nail to Treat a Displaced Medial Tibial Plateau Fracture in a 90-year-old Patient: A Case Report

PubMed Central

Batta, V; Sinha, S; Trompeter, A

2017-01-01

Introduction: Tibial plateau fractures are complex injuries in the elderly population. When traditional methods of fixation are not suitable, an alternative method needs to be chosen for a favorable outcome. We demonstrate a previously undescribed treatment for displaced tibial plateau fractures in the very elderly with poor soft-tissue integrity. Case Report: A 90-year-old woman suffered an open, Gustilo Grade IIIA, displaced fracture of the tibial plateau. An intramedullary knee arthrodesis, the femoral-tibial nail was used to temporarily stabilize her fracture. She was able to weight bear immediately postfixation. Conclusion: A long femoral-tibial nail allows favorable fracture and soft tissue healing, ease of nursing and immediate full weight-bearing. It shows good promise and should be considered as a management option when traditional methods are not applicable in select patients. PMID:29181350

Temporary Fixation Using a Long Femoral-tibial Nail to Treat a Displaced Medial Tibial Plateau Fracture in a 90-year-old Patient: A Case Report.

PubMed

Batta, V; Sinha, S; Trompeter, A

2017-01-01

Tibial plateau fractures are complex injuries in the elderly population. When traditional methods of fixation are not suitable, an alternative method needs to be chosen for a favorable outcome. We demonstrate a previously undescribed treatment for displaced tibial plateau fractures in the very elderly with poor soft-tissue integrity. A 90-year-old woman suffered an open, Gustilo Grade IIIA, displaced fracture of the tibial plateau. An intramedullary knee arthrodesis, the femoral-tibial nail was used to temporarily stabilize her fracture. She was able to weight bear immediately postfixation. A long femoral-tibial nail allows favorable fracture and soft tissue healing, ease of nursing and immediate full weight-bearing. It shows good promise and should be considered as a management option when traditional methods are not applicable in select patients.

Management of severe open ankle-foot trauma by a simple external fixation technique: an alternative during war and in resource-poor and low-technology environments.

PubMed

Pedrini, Gianpaolo; Cardi, Maurizio; Landini, Alberto; Strada, Gino

2011-03-01

Severe open foot and ankle injuries are still a challenge for the orthopaedic surgeon. Their treatment is even more difficult in third world countries and in war settings where high-energy trauma with severe soft tissue damage is more frequent. Lack of equipment, poor resources and hygiene, and different cultural systems make most of the standard proposed treatments difficult to apply. The authors describe an inexpensive, rapid, minimally invasive, and easy-to-apply external fixation technique for the treatment of severe open ankle-foot fractures. With the main goal of soft tissue management rather than definitive treatment of any bony injuries, this technique was developed over time during many consecutive missions in Sierra Leone and Afghanistan as an alternative to more appropriate treatments with surprisingly satisfactory short- and long-term results.

Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures.

PubMed

Natoli, R M; Baer, M R; Bednar, M S

2016-05-01

Distal radius fractures are common injuries treated in a multitude of ways. One treatment paradigm not extensively studied is initial treatment by external fixation (EF) followed by conversion to open reduction internal fixation (ORIF). Such a paradigm may be beneficial in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available for immediate internal fixation. There is no increased risk of infection when converting EF to ORIF in the treatment of complex distal radius fractures when conversion occurs early or if EF pin sites are overlapped by the definitive fixation. Using an IRB approved protocol, medical records over nine years were queried to identify patients with distal radius fractures that had undergone initial EF and were later converted to ORIF. Charts were reviewed for demographic data, injury characteristics, operative details, time to conversion from EF to ORIF, assessment of whether the EF pin sites overlapped the definitive fixation, presence of infection after ORIF, complications, and occupational therapy measurements of range of motion and strength. In total, 16 patients were identified, only one of which developed an infection following conversion to ORIF. Fisher's exact testing showed that infection did not depend on open fracture, time to conversion of one week or less, presence of EF pin sites overlapping definitive fixation, fracture classification, high energy mechanism of injury, or concomitant injury to the DRUJ. Planned staged conversion from EF to ORIF for complex distal radius fractures does not appear to result in an increased rate of infection if conversion occurs early or if the EF pin sites are overlapped by definitive fixation. This treatment paradigm may be reasonable for treating complex distal radius fractures in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available for immediate internal fixation. IV, retrospective case series. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Potential biomedical applications of ion beam technology

NASA Technical Reports Server (NTRS)

Banks, B. A.; Weigand, A. J.; Van Kampen, C. L.; Babbush, C. A.

1976-01-01

Electron bombardment ion thrusters used as ion sources have demonstrated a unique capability to vary the surface morphology of surgical implant materials. The microscopically rough surface texture produced by ion beam sputtering of these materials may result in improvements in the biological response and/or performance of implanted devices. Control of surface roughness may result in improved attachment of the implant to soft tissue, hard tissue, bone cement, or components deposited from blood. Potential biomedical applications of ion beam texturing discussed include: vascular prostheses, artificial heart pump diaphragms, pacemaker fixation, percutaneous connectors, orthopedic prosthesis fixation, and dental implants.

Primary Retrograde Tibiotalocalcaneal Nailing For Fragility Ankle Fractures.

PubMed

Taylor, Benjamin C; Hansen, Dane C; Harrison, Ryan; Lucas, Douglas E; Degenova, Daniel

2016-01-01

Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures. In this study, we retrospectively evaluated 31 patients treated with primary retrograde tibiotalocalcaneal nail without joint preparation for a mean of 13.6 months postoperatively from an urban Level I trauma center during the years 2006-2012. Overall, there were two superficial infections (6.5%) and three deep infections (9.7%) in the series. There were 28 (90.3%) patients that went on to radiographic union at a mean of 22.2 weeks with maintenance of foot and ankle alignment. There were three cases of asymptomatic screw breakage observed at a mean of 18.3 months postoperatively, which were all treated conservatively.. This study shows that retrograde hindfoot nailing is an acceptable treatment option for treatment of ankle fragility fractures. Hindfoot nailing allows early weightbearing, limited soft tissue injury, and a relatively low rate of complications, all of which are advantages to conventional open reduction internal fixation techniques. Given these findings, larger prospective randomized trials comparing this treatment with conventional open reduction internal fixation techniques are warranted.

Treatment of open tibial fracture with bone defect caused by high velocity missiles: a case report.

PubMed

Golubović, Zoran; Vukajinović, Zoran; Stojiljković, Predrag; Golubović, Ivan; Visnjić, Aleksandar; Radovanović, Zoran; Najman, Stevo

2013-01-01

Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications. A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis), the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy. Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic.

Fixation of zygomatic and mandibular fractures with biodegradable plates.

PubMed

Degala, Saikrishna; Shetty, Sujeeth; Ramya, S

2013-01-01

In this prospective study, 13 randomly selected patients underwent treatment for zygomatic-complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champy's principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. Descriptives, Frequencies, and Chi-square test were used. In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome.

Rigid Posterior Lumbopelvic Fixation without Formal Debridement for Pyogenic Vertebral Diskitis and Osteomyelitis Involving the Lumbosacral Junction: Technical Report.

PubMed

Mazur, Marcus D; Ravindra, Vijay M; Dailey, Andrew T; McEvoy, Sara; Schmidt, Meic H

2015-01-01

Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis. To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction. Technical report. We describe the management of PVDO at the lumbosacral junction in which the infection invaded the endplates, disk space, vertebrae, prevertebral soft tissues, and epidural space. Pedicle involvement precluded screw fixation at L5. Surgical management consisted of a single-stage posterior operation with rigid lumbopelvic fixation augmented with S2-alar-iliac screws and without formal debridement of the infected area, followed by long-term antibiotic treatment. At 2-year follow-up, successful fusion and eradication of the infection were achieved. PVDO at the lumbosacral junction may be treated successfully using rigid posterior-only fixation without formal debridement combined with antibiotic therapy.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study.

PubMed

Guner, Savas; Guner, Sukriye Ilkay; Isik, Yasemin; Gormeli, Gokay; Kalender, Ali Murat; Turktas, Ugur; Gokalp, Mehmet Ata; Gozen, Abdurrahim; Isik, Mustafa; Ozkan, Sezai; Turkozu, Tulin; Karadas, Sevdegul; Ceylan, Mehmet Fethi; Ediz, Levent; Bulut, Mehmet; Gunes, Yusuf; Gormeli, Ayse; Erturk, Cemil; Eseoglu, Metehan; Dursun, Recep

2013-01-01

This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma. We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome. The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively. The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Iliac screw fixation using computer-assisted computer tomographic image guidance: technical note.

PubMed

Shin, John H; Hoh, Daniel J; Kalfas, Iain H

2012-03-01

Iliac screw fixation is a powerful tool used by spine surgeons to achieve fusion across the lumbosacral junction for a number of indications, including deformity, tumor, and pseudarthrosis. Complications associated with screw placement are related to blind trajectory selection and excessive soft tissue dissection. To describe the technique of iliac screw fixation using computed tomographic (CT)-based image guidance. Intraoperative registration and verification of anatomic landmarks are performed with the use of a preoperatively acquired CT of the lumbosacral spine. With the navigation probe, the ideal starting point for screw placement is selected while visualizing the intended trajectory and target on a computer screen. Once the starting point is selected and marked with a burr, a drill guide is docked within this point and the navigation probe re-inserted, confirming the trajectory. The probe is then removed and the high-speed drill reinserted within the drill guide. Drilling is performed to a depth measured on the computer screen and a screw is placed. Confirmation of accurate placement of iliac screws can be performed with standard radiographs. CT-guided navigation allows for 3-dimensional visualization of the pelvis and minimizes complications associated with soft-tissue dissection and breach of the ilium during screw placement.

Soft tissue graft interference fit fixation: observations on graft insertion site healing and tunnel remodeling 2 years after ACL reconstruction in sheep.

PubMed

Hunt, Patrick; Rehm, Oliver; Weiler, Andreas

2006-12-01

Using soft tissue grafts for anterior cruciate ligament (ACL) reconstruction, insertion site healing plays a crucial role in the long-term fate of the graft. It has been shown in an experimental animal study that using a soft tissue graft and anatomic graft fixation, a direct ligamentous insertion alike the native ACL developed 24 weeks postoperatively. Yet there are no reports on the long-term insertion site healing of anatomically fixed soft tissue grafts. The objective of this study was to evaluate graft insertion site healing, the intra-tunnel fate of the graft and its osseous replacement 2 years after ACL reconstruction in sheep. The left ACLs of six sheep were replaced by an autologous flexor tendon split graft and anatomically fixed with biodegradable poly-(D, L-lactide) interference screws. Animals received polychromic sequential labeling at different points in time to determine bone apposition per period. For evaluation of the insertion site healing and intra-tunnel changes, MRI scans were taken in vivo. Following sacrifice, radiographic imaging, conventional histology and fluorescence microscopy was undertaken. Most of the specimens showed a wide direct ligamentous insertion. It showed patterns alike the direct ligament insertion seen in intact ACLs. The intra-tunnel part of the graft had completely lost its tendon-like structure and in two cases, it was separated from the graft insertion by a thick bony layer. The biodegradable interference screw was fully degraded in all specimens. Ossification of the former drill tunnels was intense, showing only partial-length tunnel remnants in one femoral and three tibial specimens. As the graft heals to the joint surface and the aperture site is closed with soft tissue, mechanical stress of the intra-tunnel part of the graft is eliminated and the bone tunnel is protected from synovial fluid, resulting in osseous bridging of the tunnel aperture site, accelerated intra-tunnel graft resorption and its osseous replacement.

Foam-reinforced elderly human tibia approximates young human tibia better than porcine tibia: a study of the structural properties of three soft tissue fixation devices.

PubMed

Bailey, Shana B; Grover, Dustin M; Howell, Stephen M; Hull, Maury L

2004-01-01

Because there is an insufficient supply of young human knees, an alternative is needed for evaluating anterior cruciate ligament reconstructions. The authors determined whether an elderly human tibia reinforced with foam is a better substitute for a young human tibia than a porcine tibia in this study of the tibialfixation of a soft tissue anterior cruciate ligament graft using 3 devices. A foam-reinforced elderly human tibia more closely approximates the performance of a young human tibia than porcine tibia. Biomechanical study. Failure mode, stiffness, yield, and slippage were determined for a double-looped tendon graft fixed with either an interference screw, WasherLoc, or tandem washers in young human tibiae, foam-reinforced tibiae from elderly humans, and porcine tibiae. The stiffness and yield of interference screw and WasherLoc fixation in foam-reinforced tibiae more closely approximate those in young human tibiae than in porcine tibiae. Slippage of all combinations of tibiae and fixation devices was similar A foam-reinforced human tibia more closely approximates the performance of a young human tibia than that of porcine tibia in this study. Fixation devices should be tested in foam-reinforced tibiae from elderly humans rather than tibiae from large farm animals when the supply of young human knees is insufficient.

Tibial Plateau Fractures in Elderly Patients

PubMed Central

Vemulapalli, Krishna C.; Gary, Joshua L.; Donegan, Derek J.

2016-01-01

Tibial plateau fractures are common in the elderly population following a low-energy mechanism. Initial evaluation includes an assessment of the soft tissues and surrounding ligaments. Most fractures involve articular depression leading to joint incongruity. Treatment of these fractures may be complicated by osteoporosis, osteoarthritis, and medical comorbidities. Optimal reconstruction should restore the mechanical axis, provide a stable construct for mobilization, and reestablish articular congruity. This is accomplished through a variety of internal or external fixation techniques or with acute arthroplasty. Regardless of the treatment modality, particular focus on preservation and maintenance of the soft tissue envelope is paramount. PMID:27551570

[Treatment strategy and planning for pilon fractures].

PubMed

Mittlmeier, Thomas; Wichelhaus, Alice

2017-08-01

Pilon fractures are mainly severe and prognostically serious injuries with a high rate of relevant soft tissue involvement. The adequate decision making and choice of treatment in the early phase of trauma are of paramount importance for the final outcome. This essentially encompasses the management of the soft tissue damage, the surgical planning and the differentiated selection of procedures. Most concepts of staged treatment nowadays offer a wide range of options which are integrated into expert-based algorithms. The aim of the present analysis was to display the strategy variations for the treatment of pilon fractures taking into account the advantages and disadvantages of the corresponding treatment concepts. A staged procedure including primary closed reduction employing ligamentotaxis and fixation of the joints of the hindfoot via tibiocalcaneal metatarsal fixation offers a safe basis for consecutive imaging and the selection of specific approaches for definitive reconstruction. A simultaneous reconstruction and fixation of the fibula during the primary intervention are generally not recommended in order to avoid any limitations for subsequent reconstructive procedures. A time frame for definitive reconstruction covers a period of up to 3 weeks after trauma and allows a detailed planning considering the individual dynamics of the soft tissue situation and any logistic requirements. For the choice of the definitive treatment concept a wide range of procedures and implants are available. There are also valid concepts for primary treatment of defined fracture constellations while primary arthrodesis represents a solution in cases of major destruction of the joint surface. Knowledge of the multiple procedural variations for pilon fracture treatment creates the basis to optimize the treatment modalities and to take into account individual parameters of the fracture.

Functional and radiological evaluations of high-energy tibial plateau fractures treated with double-buttress plate fixation.

PubMed

Yu, Z; Zheng, L; Zhang, Y; Li, J; Ma, Bao'an

2009-05-14

This study was designed to evaluate the functional and radiological outcomes of patients with complex tibial plateau fractures treated with double-buttress plate fixation. Sixty five cases of complex (Schatzker type V and VI) tibial plateau fractures were treated with double-buttress plate fixation in our centre from September 2001 to September 2006 through two separate plate incisions. Fifty four patients were followed up for a period ranging from 12 to 48 months and evaluated for the functional and radiological outcomes by a series of standard questionnaire and measurement. Due to the good exposure without any extensive soft-tissue dissection of the double-buttress plate fixation, the fractures in all 54 patients were healed and the treatment achieved greater than 90% of satisfactory-to-excellent rates of reduction. The mean time of bone union was 15.4 weeks (range, 12-30 weeks), and the mean time of full weight-bearing was 18.7 weeks (range, 14-26 weeks). At the final follow-up visit, no patients showed knee instability; the mean range of motion was 107.6 degrees (range, 85 degrees -130 degrees ). For all patients, no statistically significant difference in the functional outcomes was observed between their 6-months and final follow-up visits; or in the radiological findings between their immediate postoperative and final follow-up examinations. Double-buttress plate fixation is a feasible treatment option for bilcondylar and complex tibial plateau fractures. Although technically demanding, it offers reliable stability without additional postoperative adjuvant external fixation, and at the same time avoids extensive soft tissue dissection, allowing the early painless range of motion.

A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

PubMed

OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

2017-04-01

The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

Evaluation of functional outcome of the floating knee injury using multivariate analysis.

PubMed

Yokoyama, Kazuhiko; Tsukamoto, Tatsuro; Aoki, Shinichi; Wakita, Ryuji; Uchino, Masataka; Noumi, Takashi; Fukushima, Nobuaki; Itoman, Moritoshi

2002-11-01

The objective of this study is to evaluate significant contributing factors affecting the functional prognosis of floating knee injuries using multivariate analysis. A total of 68 floating knee injuries (67 patients) were treated at Kitasato University Hospital from 1986 to 1999. Both the femoral fractures and the tibial fractures were managed surgically by various methods. The functional results of these injuries were evaluated using the grading system of Karlström and Olerud. Follow-up periods ranged from 2 to 19 years (mean 50.2 months) after the original injury. We defined satisfactory (S) outcomes as those cases with excellent or good results and unsatisfactory (US) outcomes as those cases with acceptable or poor results. Logistic regression analysis was used as a multivariate analysis, and the dependent variables were defined as a satisfactory outcome or as an unsatisfactory outcome. The explanatory variables were predicting factors influencing the functional outcome such as age at trauma, gender, severity of soft-tissue injury in the femur and the tibia, AO fracture grade in the femur and the tibia, Fraser type (type I or type II), Injury Severity Score (ISS), and fixation time after injury (less than 1 week or more than 1 week) in the femur and the tibia. The final functional results were as follows: 25 cases had excellent results, 15 cases good results, 16 cases acceptable results, and 12 cases poor results. The predictive logistic regression equation was as follows: Log 1-p/p = 3.12-1.52 x Fraser type - 1.65 x severity of soft-tissue injury in the tibia - 1.31 x fixation time after injury in the tibia - 0.821 x AO fracture grade in the tibia + 1.025 x fixation time after injury in the femur - 0.687 x AO fracture grade in the femur ( p=0.01). Among the variables, Fraser type and the severity of soft-tissue injury in the tibia were significantly related to the final result. The multivariate analysis showed that both the involvement of the knee joint and the severity grade of soft-tissue injury in the tibia represented significant risk factors of poor outcome in floating knee injuries in this study.

Management of pediatric mandibular fractures using bioresorbable plating system - Efficacy, stability, and clinical outcomes: Our experiences and literature review.

PubMed

Singh, Mahinder; Singh, R K; Passi, Deepak; Aggarwal, Mohit; Kaur, Guneet

2016-01-01

The purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. Sixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5 mm diameter monocortical resorbable screws, 8 mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Adequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients.

Fixation of zygomatic and mandibular fractures with biodegradable plates

PubMed Central

Degala, Saikrishna; Shetty, Sujeeth; Ramya, S

2013-01-01

Context: In this prospective study, 13 randomly selected patients underwent treatment for zygomatic–complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. Aims: To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. Materials and Methods: In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champy's principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. Statistical Analysis Used: Descriptives, Frequencies, and Chi-square test were used. Results: In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. Conclusions: Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome. PMID:23662255

Primary Retrograde Tibiotalocalcaneal Nailing For Fragility Ankle Fractures

PubMed Central

Taylor, Benjamin C.; Hansen, Dane C.; Harrison, Ryan; Lucas, Douglas E; Degenova, Daniel

2016-01-01

Background Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures. Methods In this study, we retrospectively evaluated 31 patients treated with primary retrograde tibiotalocalcaneal nail without joint preparation for a mean of 13.6 months postoperatively from an urban Level I trauma center during the years 2006-2012. Results Overall, there were two superficial infections (6.5%) and three deep infections (9.7%) in the series. There were 28 (90.3%) patients that went on to radiographic union at a mean of 22.2 weeks with maintenance of foot and ankle alignment. There were three cases of asymptomatic screw breakage observed at a mean of 18.3 months postoperatively, which were all treated conservatively.. Conclusions This study shows that retrograde hindfoot nailing is an acceptable treatment option for treatment of ankle fragility fractures. Hindfoot nailing allows early weightbearing, limited soft tissue injury, and a relatively low rate of complications, all of which are advantages to conventional open reduction internal fixation techniques. Given these findings, larger prospective randomized trials comparing this treatment with conventional open reduction internal fixation techniques are warranted. PMID:27528840

A technique for correction of equinus contracture using a wire fixator and elastic tension.

PubMed

Melvin, J Stuart; Dahners, Laurence E

2006-02-01

Equinus contracture often is a complication of trauma, burns, or neurologic deficit. Many patients with contractures secondary to trauma or burns have poor soft tissue, which makes invasive correction a less appealing option. The Ilizarov external fixator has been used as a less invasive attempt to correct equinus contracture. We describe our "dynamic" technique and present a clinical patient series using a variation of the unconstrained Ilizarov technique, which uses elastic bands rather than threaded rods to supply the corrective force.

Resonant acoustic spectroscopy of soft tissues using embedded magnetomotive nanotransducers and optical coherence tomography

PubMed Central

Oldenburg, Amy L

2010-01-01

We present a new method for performing dynamic elastography of soft tissue samples. By sensing nanoscale displacements with optical coherence tomography, a chirped, modulated force is applied to acquire the mechanical spectrum of a tissue sample within a few seconds. This modulated force is applied via magnetic nanoparticles, named ‘nanotransducers’, which are diffused into the tissue, and which contribute negligible inertia to the soft tissue mechanical system. Using this novel system, we observed that excised tissues exhibit mechanical resonance modes which are well described by a linear damped harmonic oscillator. Results are validated by using cylindrical tissue phantoms of agarose in which resonant frequencies (30–400 Hz) are consistent with longitudinal modes and the sample boundary conditions. We furthermore show that the Young’s modulus can be computed from their measured resonance frequencies, analogous to resonant ultrasound spectroscopy for stiff material analysis. Using this new technique, named magnetomotive resonant acoustic spectroscopy (MRAS), we monitored the relative stiffening of an excised rat liver during a chemical fixation process. PMID:20124653

Skeletal Fixation in a Mutilated Hand.

PubMed

Bhardwaj, Praveen; Sankaran, Ajeesh; Sabapathy, S Raja

2016-11-01

Hand fracture fixation in mutilating injuries is characterized by multiple challenges due to possible skeletal disorganization and concomitant severe injury of soft tissue structures. The effects of skeletal disruption are best analyzed as divided into specific locales in the hand: radial, ulnar, proximal, and distal. Functional consequences of injuries in each of these regions are discussed. Although a variety of implants are now in vogue, K-wire fixation has stood the test of time and is especially useful in multiple fracture situations. Segmental bone loss is quite common in such injuries, which can be safely reconstructed in a staged manner. Copyright © 2016 Elsevier Inc. All rights reserved.

Pediatric facial fractures as a result of gunshot injuries: an examination of associated injuries and trends in management.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-03-01

Facial fractures are relatively uncommon in the pediatric population, especially those inflicted as a result of interpersonal violence in the form of gunshot injuries. Few studies have examined the unique management of such high-energy injuries in the pediatric population. Oftentimes the resultant damage to soft tissue and bony structures is so great that it challenges the previously accepted standards in the management of pediatric facial fractures. This study will examine a level 1 trauma center's experience with these unique injuries. A retrospective review of all facial fractures occurring in a pediatric population (those 18 years of age or younger) as a result of gunshot wounds in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Descriptive information was collected regarding each case as well as information regarding concomitant injuries, treatment modalities, and selected outcomes. During this time period, there were 3147 facial fractures treated at our institution, 353 of which were in pediatric patients. Of these, 17 were the results of gunshot wounds. Three patients were excluded due to insufficient data, leaving a total of 14 patients. The average age of patients was 16.5 (range 14-18); all patients were African-American males. The most common fracture was that of the mandible (n = 10), with 2 of those patients exhibiting panfacial fractures. The average Glasgow Coma Scale on admission was 13.5 (range 3-15). Six of the patients were intubated in the emergency department. The most common concomitant injury was a skull fracture (n = 3), followed by cervical spine fractures (n = 2) and intracranial hemorrhages (n = 2). All patients were admitted to the hospital for reasons other than fracture management. Seven patients ultimately went to the operating room for fracture management. The treatment modalities employed were conservative management with closed techniques (n = 11), rigid internal fixation (n = 2), and the use of an external fixator device (n = 1). Minimal to no soft-tissue debridement was performed in 10 of the 14 patients, 2 of which presented between 6 months and 10 years post-injury with soft-tissue complications related to retained material. The mean hospital length of stay was 8.2 days (range 1-18 days). One patient expired. Pediatric facial fractures as a result of gunshot wounds represent a unique and fortunately rare entity that presents a challenge to all disciplines involved in treatment. In our patients, there was a tendency towards conservative management, with only 3 patients undergoing some form of fixation and only 7 undergoing some form of operative debridement. Concomitant injuries and the high-energy nature of gunshot wounds often preclude traditional management with rigid fixation to ensure adequate bony healing. However, it is important to adequately debride devitalized soft tissue and remove all foreign material to avoid future soft tissue-related complications.

Role for Primary Repair of Deltoid Ligament Complex in Ankle Fractures.

PubMed

Rigby, Ryan B; Scott, Ryan T

2018-04-01

Acute deltoid injuries may occur with ankle fractures. They are often left to heal without repair, possibly leading to chronic medial ankle instability. Stress radiographs identify the need for surgical repair of fractures or soft tissue damage. Gravity stress views have benefits over manually stressing the ankle. MRI can explore the extent of medial soft tissue injuries. Arthroscopy can evaluate and potentially treat deltoid injuries. Interposition of the deltoid may preclude adequate fracture reduction. Except with deltoid tear, fractures should be reduced and fixated, then the deltoid assessed. With persistent instability, primary repair may prevent long-term sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

Novel on-demand bioadhesion to soft tissue in wet environments.

PubMed

Mogal, Vishal; Papper, Vladislav; Chaurasia, Alok; Feng, Gao; Marks, Robert; Steele, Terry

2014-04-01

Current methods of tissue fixation rely on mechanical-related technologies developed from the clothing and carpentry industries. Herein, a novel bioadhesive method that allows tuneable adhesion and is also applicable to biodegradable polyester substrates is described. Diazirine is the key functional group that allows strong soft tissue crosslinking and on-demand adhesion based on a free radical mechanism. Plasma post-irradiation grafting makes it possible to graft diazirine onto PLGA substrates. When the diazirine-PLGA films, placed on wetted ex vivo swine aortas, are activated with low intensity UV light, lap shear strength of up to 450 ± 50 mN cm(-2) is observed, which is one order of magnitude higher than hydrogel bioadhesives placed on similar soft tissues. The diazirine-modified PLGA thin films could be added on top of previously developed technologies for minimally invasive surgeries. The present work is focused on the chemistry, grafting, and lap shear strength of the alkyl diazirine-modified PLGA bioadhesive films. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The effect of the Tscherne injury pattern on the outcome of operatively treated Lisfranc fracture dislocations.

PubMed

Demirkale, Ismail; Tecimel, Osman; Celik, Ismail; Kilicarslan, Kasim; Ocguder, Ali; Dogan, Metin

2013-09-01

Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury. This study consisted of a retrospective analysis of patients with Lisfranc fracture dislocations who were treated by open reduction and internal fixation beween 2004 and 2009. Evaluation focused mainly on the severity of the soft tissue injury, age, fracture classification, time to operation, posttraumatic osteoarthritis, and the results were compared with American Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI). Eight patients had Tscherne Grade 1, 13 had Grade 2, and 11 had Grade 3 soft tissue injuries. Myerson classification revealed 11 type A, 8 type B and 13 type C fractures. Six patients' operations were delayed beyond 8h. Of the 38 patients treated in the study period, 32 patients (11 female, 21 male; <30 y-old: 14, >30 y-old: 18) were available for complete follow-up (average, 55.5 months). The comparison of treatment results revealed that those patients with high grade soft tissue injuries had lower AOFAS and FADI scores (43.8±15.9, 53.7±9.4, respectively) when compared to Tscherne Grade 1 injuries (82.8±6.1, 109±13.9, respectively) (p<0.001). The overall negative impact of the severity of soft tissue injury on functional outcomes had similar significance with regard to post-traumatic osteoarthritis, and fracture type. There was also a statistically significant difference between outcome measures and post-reduction quality (p=0.002). Patient age (p=0.9) and delayed surgery (p=0.5) had no statistically significant effect on the final outcome. Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

A bio-inspired swellable microneedle adhesive for mechanical interlocking with tissue

NASA Astrophysics Data System (ADS)

Yang, Seung Yun; O'Cearbhaill, Eoin D.; Sisk, Geoffroy C.; Park, Kyeng Min; Cho, Woo Kyung; Villiger, Martin; Bouma, Brett E.; Pomahac, Bohdan; Karp, Jeffrey M.

2013-04-01

Achieving significant adhesion to soft tissues while minimizing tissue damage poses a considerable clinical challenge. Chemical-based adhesives require tissue-specific reactive chemistry, typically inducing a significant inflammatory response. Staples are fraught with limitations including high-localized tissue stress and increased risk of infection, and nerve and blood vessel damage. Here inspired by the endoparasite Pomphorhynchus laevis, which swells its proboscis to attach to its host’s intestinal wall, we have developed a biphasic microneedle array that mechanically interlocks with tissue through swellable microneedle tips, achieving ~3.5-fold increase in adhesion strength compared with staples in skin graft fixation, and removal force of ~4.5 N cm-2 from intestinal mucosal tissue. Comprising a poly(styrene)-block-poly(acrylic acid) swellable tip and non-swellable polystyrene core, conical microneedles penetrate tissue with minimal insertion force and depth, yet high adhesion strength in their swollen state. Uniquely, this design provides universal soft tissue adhesion with minimal damage, less traumatic removal, reduced risk of infection and delivery of bioactive therapeutics.

A Bio-Inspired Swellable Microneedle Adhesive for Mechanical Interlocking with Tissue

PubMed Central

Yang, Seung Yun; O'Cearbhaill, Eoin D.; Sisk, Geoffroy C.; Park, Kyeng Min; Cho, Woo Kyung; Villiger, Martin; Bouma, Brett E.; Pomahac, Bohdan; Karp, Jeffrey M.

2013-01-01

Achieving significant adhesion to soft tissues while minimizing tissue damage poses a considerable clinical challenge. Chemical-based adhesives require tissue-specific reactive chemistry, typically inducing a significant inflammatory response. Staples are fraught with limitations including high-localized tissue stress and increased risk of infection, and nerve and blood vessel damage. Here, inspired by the endoparasite Pomphorhynchus laevis which swells its proboscis to attach to its host’s intestinal wall, we have developed a biphasic microneedle array that mechanically interlocks with tissue through swellable microneedle tips, achieving ~ 3.5 fold increase in adhesion strength compared to staples in skin graft fixation, and removal force of ~ 4.5 N/cm2 from intestinal mucosal tissue. Comprising a poly(styrene)-block-poly(acrylic acid) swellable tip and non-swellable polystyrene core, conical microneedles penetrate tissue with minimal insertion force and depth, yet high adhesion strength in their swollen state. Uniquely, this design provides universal soft tissue adhesion with minimal damage, less traumatic removal, reduced risk of infection and delivery of bioactive therapeutics. PMID:23591869

Observations on the preparation of sections of dental hard and soft tissues without conventional embedding procedures.

PubMed

Mok, Y C; Fearnhead, R W

1985-09-01

Inexpensive thin copper discs loaded with diamonds embedded in small slits around the periphery, may be used to cut sections from unembedded tooth samples without disrupting the cellular and extracellular components intimately associated with hard tissue interfaces. The tissue may be unfixed, fixed or cut using fixation or dye solutions as the lubricant. The use of these discs therefore opens up new avenues of histochemical investigation of hard tissue unrestricted by those artefacts associated with conventional or traditional methods of preparation.

Interrami intraoral fixation technique for severe mandibular rifle fragmented bullet injury management.

PubMed

Shuker, Sabri T

2013-07-01

Interrami intraoral Kirschner wire fixation technique is presented for the reduction, stabilization, and immobilization of a pulverized and avulsed lower jaw caused by rifle fragmented bullet injuries. This indirect mandibular war injury fixation technique was tolerated by the patients and tissue more than any indirect external fixation. In addition, it is easier than open reduction using large bone plates for disrupted ballistics mandibular injury defects. An interrami intraoral fixation is appropriate for severely disrupted mandibular hard and soft tissues, and has been adapted in cases of mass casualties and limited resources. Benefits of use include limited hospital beds and fewer follow-up visits. Rifle fragmented bullet injuries need more attention for several reasons: not only because of the higher mortality and devastating nature of the injuries, but also because these injuries are responsible for an unreported type of bullet biomechanism wounding in the craniofacial region. In turn, this necessitates specialized victim management. The survival rates depend on immediate proper execution of airway, breathing, and circulation, which become more complicated as it relates to airway compromise and oropharyngeal hemorrhage resuscitation. Survival is predicated on the implementation of feasible, sensible, life-saving techniques that are applied at the appropriate time.

Detection of titanium in human tissues after craniofacial surgery.

PubMed

Jorgenson, D S; Mayer, M H; Ellenbogen, R G; Centeno, J A; Johnson, F B; Mullick, F G; Manson, P N

1997-04-01

Generally, titanium fixation plates are not removed after osteosynthesis, because they have high biocompatability and high corrosion resistance characteristics. Experiments with laboratory animals, and limited studies of analyses of human tissues, have reported evidence of titanium release into local and distant tissues. This study summarizes our results of the analysis of soft tissues for titanium in four patients with titanium microfixation plates. Energy dispersive x-ray analysis, scanning electron microscopy, and electrothermal atomic absorption spectrophotometry were used to detect trace amounts of titanium in surrounding soft tissues. A single metal inclusion was detected by scanning electron microscopy and energy dispersive x-ray analysis in one patient, whereas, electrothermal atomic absorption spectrophotometry analyses revealed titanium present in three of four specimens in levels ranging from 7.92 to 31.8 micrograms/gm of dry tissue. Results from this study revealed trace amounts of titanium in tissues surrounding craniofacial plates. At the atomic level, electrothermal atomic absorption spectrophotometry appears to be a sensitive tool to quantitatively detect ultra-trace amounts of metal in human tissue.

Enhanced Soft Tissue Attachment and Fixation Using a Mechanically-Stimulated Cytoselective Tissue-Specific ECM Coating

DTIC Science & Technology

2013-01-01

of stimulation parameters . The deposited ECM was quantified. It was observed that the entirely strained stretching regime produced slightly higher... parameters (such as, % strain, strain duration, number of cycles, lag between cycles, etc.) that were commonly reported in the literature. There are many... hydroxyapatite . Biomaterials 2007;28(3):383-92. 18. Johnson GA, Tramaglini DM, Levine RE, Ohno K, Choi NY, Woo SL. Tensile and viscoelastic

Novel management of distal tibial and fibular fractures with Acumed fibular nail and minimally invasive plating osteosynthesis technique: A case report.

PubMed

Wang, Tie-Jun; Ju, Wei-Na; Qi, Bao-Chang

2017-03-01

Anatomical characteristics, such as subcutaneous position and minimal muscle cover, contribute to the complexity of fractures of the distal third of the tibia and fibula. Severe damage to soft tissue and instability ensure high risk of delayed bone union and wound complications such as nonunion, infection, and necrosis. This case report discusses management in a 54-year-old woman who sustained fractures of the distal third of the left tibia and fibula, with damage to overlying soft tissue (swelling and blisters). Plating is accepted as the first choice for this type of fracture as it ensures accurate reduction and rigid fixation, but it increases the risk of complications. Closed fracture of the distal third of the left tibia and fibula (AO: 43-A3). After the swelling was alleviated, the patient underwent closed reduction and fixation with an Acumed fibular nail and minimally invasive plating osteosynthesis (MIPO), ensuring a smaller incision and minimal soft-tissue dissection. At the 1-year follow-up, the patient had recovered well and had regained satisfactory function in the treated limb. The Kofoed score of the left ankle was 95. Based on the experience from this case, the operation can be undertaken safely when the swelling has been alleviated. The minimal invasive technique represents the best approach. Considering the merits and good outcome in this case, we recommend the Acumed fibular nail and MIPO technique for treatment of distal tibial and fibular fractures.

Management of pediatric mandibular fractures using bioresorbable plating system – Efficacy, stability, and clinical outcomes: Our experiences and literature review

PubMed Central

Singh, Mahinder; Singh, R.K.; Passi, Deepak; Aggarwal, Mohit; Kaur, Guneet

2015-01-01

Aims The purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. Methods Sixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5 mm diameter monocortical resorbable screws, 8 mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Results Adequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). Conclusion 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients. PMID:27195206

Independent Suture Tape Reinforcement of Small and Standard Diameter Grafts for Anterior Cruciate Ligament Reconstruction: A Biomechanical Full Construct Model.

PubMed

Bachmaier, Samuel; Smith, Patrick A; Bley, Jordan; Wijdicks, Coen A

2018-02-01

To compare the dynamic elongation, stiffness behavior, and ultimate failure load of standard with small diameter soft tissue grafts for anterior cruciate ligament (ACL) reconstruction with and without high-strength suture tape reinforcement. Both a tripled "small" diameter and a "standard" quadrupled tendon graft with and without suture tape reinforcement were tested using suspensory fixation (n = 8 each group). The suture tape was passed through the suspensory fixation button on the femur and tibia to ensure independent (safety belt) fixation from the graft in vitro. The testing of the constructs included position-controlled cyclic loading, force-controlled cyclic loading at 250 N and 400 N as well as pull to failure (50 mm/min). Reinforcement of a small diameter graft significantly reduced dynamic elongation of 38% (1.46 ± 0.28 mm vs 2.34 ± 0.44 mm, P < .001) and 50% (2.55 ± 0.44 mm vs 5.06 ± 0.67 mm, P < .001) after the 250 N and 400 N load protocol, respectively. Reinforcement of a standard diameter tendon graft decreased dynamic elongation of 15% (1.59 ± 0.34 mm vs 1.86 ± 0.17 mm, P = .066) and 26% (2.62 ± 0.44 mm vs 3.55 ± 0.44 mm, P < .001). No significant difference was found between both reinforced models. The ultimate failure loads of small and standard diameter reinforced grafts were 1592 ± 105 N and 1585 ± 265 N, resulting in a 64% (P < .001) and 40% (P < .001) increase compared with their respective controls. Independent suture tape reinforcement of soft tissue grafts for ACL reconstruction leads to significantly reduced elongation and higher ultimate failure load according to in vivo native ACL function data without stress-shielding the soft tissue graft. If in vitro results are translational to human knees in vivo, the suture tape reinforcement technique for ACL reconstruction may decrease the risk of graft tears, particularly in the case of small diameter soft tissue grafts. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Biomechanical evaluation of three different fixation methods of the Chevron osteotomy of the olecranon: an analysis with Roentgen Stereophotogrammatic Analysis.

PubMed

Wagener, Marc L; Driesprong, Marco; Heesterbeek, Petra J C; Verdonschot, Nico; Eygendaal, Denise

2013-08-01

In this study three different methods for fixating the Chevron osteotomy of the olecranon are evaluated. Transcortical fixed Kirschner wires with a tension band, a large cancellous screw with a tension band, and a large cancellous screw alone are compared using Roentgen Stereophotogrammatic Analysis (RSA). The different fixation methods were tested in 17 cadaver specimens by applying increasing repetitive force to the triceps tendon. Forces applied were 200N, 350N, and 500N. Translation and rotation of the osteotomy were recorded using Roentgen Stereophotogrammatic Analysis. Both the fixations with a cancellous screw with tension band and with bi-cortical placed Kirschner wires with a tension band provide enough stability to withstand the forces of normal daily use. Since fixation with a cancellous screw with tension band is a fast and easy method and is related to minimal soft tissue damage this method can preferably be used for fixation of a Chevron osteotomy of the olecranon. © 2013.

Tunable denture adhesives using biomimetic principles for enhanced tissue adhesion in moist environments.

PubMed

Gill, Simrone K; Roohpour, Nima; Topham, Paul D; Tighe, Brian J

2017-11-01

Nature provides many interesting examples of adhesive strategies. Of particular note, the protein glue secreted by marine mussels delivers high adhesion in wet and dynamic environments owing to existence of catechol moieties. As such, this study focuses on denture fixatives, where a non-zinc-containing commercial-based formulation has been judiciously modified by a biomimetic catechol-inspired polymer, poly(3,4-dihydroxystyrene/styrene-alt-maleic acid) in a quest to modulate adhesive performance. In vitro studies, in a lap-shear configuration, revealed that the catechol-modified components were able to enhance adhesion to both the denture base and hydrated, functional oral tissue mimic, with the resulting mode of failure prominently being adhesive rather than cohesive. These characteristics are desirable in prosthodontic fixative applications, for which temporary adhesion must be maintained, with ultimately an adhesive failure from the mucosal tissue surface preferred. These insights provide an experimental platform in the design of future biomimetic adhesive systems. Mussel adhesive proteins have proven to be promising biomimetic adhesive candidates for soft tissues and here for the first time we have adapted marine adhesive technology into a denture fixative application. Importantly, we have incorporated a soft tissue mimic in our in vitro adhesion technique that more closely resembles the oral mucosa than previously studied substrates. The novel biomimetic-modified adhesives showed the ability to score the highest adhesive bonding out of all the formulations included in this study, across all moisture levels. This paper will be of major interest to the Acta Biomaterialia readership since the study has illustrated the potential of biomimetic principles in the design of effective prosthodontic tissue adhesives in a series of purpose-designed in vitro experiments in the context of the challenging features of the oral environment. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures.

PubMed

Ma, Ching-Hou; Tu, Yuan-Kun; Yeh, Jih-Hsi; Yang, Shih-Chieh; Wu, Chin-Hsien

2011-09-01

The tibial segmental fractures usually follow high-energy trauma and are often associated with many complications. We designed a two-stage protocol for these complex injuries. The aim of this study was to assess the outcome of tibial segmental fractures treated according to this protocol. A prospective series of 25 consecutive segmental tibial fractures were treated using a two-stage procedure. In the first stage, a low-profile locking plate was applied as an external fixator to temporarily immobilize the fractures after anatomic reduction had been achieved followed by soft-tissue reconstruction. The second stage involved definitive internal fixation with a locking plate using a minimally invasive percutaneous plate osteosynthesis technique. The median follow-up was 32 months (range, 20-44 months). All fractures achieved union. The median time for the proximal fracture union was 23 weeks (range, 12-30 weeks) and that for distal fracture union was 27 weeks (range, 12-46 weeks; p = 0.08). Functional results were excellent in 21 patients and good in 4 patients. There were three cases of delayed union of distal fracture. Valgus malunion >5 degrees occurred in two patients, and length discrepancy >1 cm was observed in two patients. Pin tract infection occurred in three patients. Use of the two-stage procedure for treatment of segmental tibial fractures is recommended. Surgeons can achieve good reduction with stable temporary fixation, soft-tissue reconstruction, ease of subsequent definitive fixation, and high union rates. Our patients obtained excellent knee and ankle joint motion, good functional outcomes, and a comfortable clinical course.

Pain and functional improvement effects of methylene blue injection on the soft tissue around fusion site after traumatic thoracolumbar fixation: A double-blind, randomized placebo-controlled study.

PubMed

Farrokhi, Majid Reza; Yazdanpanah, Hamed; Gholami, Mehrnaz; Farrokhi, Farnaz; Mesbahi, Amir Reza

2016-11-01

Fractures of the thoracolumbar spine can cause pain, long-term reductions in quality of life (QOL), and neural deficits. The aim of this study was to investigate the effects of methylene blue (MB) on preventing postoperative pain and improving QOL in patients with throracolumbar fractures undergoing posterior pedicle screw fixation. Fifty patients underwent standard posterior pedicular screw fixation for stabilization of the thoracolumbar fractures: 25 received 1ml of MB solution at a concentration of 0.5% and 25 received normal saline on the soft tissue around fusion site. Primary outcomes were the control of pain, evaluated at 48h, 2 and 6 months after surgery with the use of a visual analog scale (VAS), and the improvement of QOL, assessed 2 and 6 months postoperatively by means of Oswestry Disability Index (ODI) questionnaire. The mean VAS scores for pain were significantly lower in the MB group compared with the control group at 2 months (1.30±0.45 vs. 2.60±1.19, P<0.001) and 6 months (1.17±0.37 vs. 1.60±0.87; P=0.028) after treatment. At 2 months after the surgery, the mean ODI score was significantly lower in the MB-treated patients than the control group (20.4±10.92 vs. 34.8±15.11; P=0.001). The ODI score in the MB-treated patients was better than the control group at 6 months after the surgery (12.2±11.66 vs. 20.8±11.14; P=0.016). A single dose of MB on the soft tissue around fusion site shows promising results in terms of safety, reduction of postoperative pain, and functional results when compared with placebo 6 months after surgery. Copyright © 2016 Elsevier B.V. All rights reserved.

Open fractures caused by high velocity missiles: the outcome of treatment of 39 fractures followed for 1-3 years.

PubMed

Khan, M A; Hussain, R; Khan, S H; Umar, M

1997-11-01

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well as the inherent limitations of the external fixator. Revision of the external fixator with internal fixation after healing of the soft tissues seems to be the direction of the future.

[Antegrade extended peroneal artery perforator flap for knee reconstruction].

PubMed

Ruan, Hongjiang; Cai, Peihua; Fan, Cunyi; Chai, Yimin; Liu, Shenghe

2009-03-01

To investigate the operative technique and clinical results of repairing the soft tissue defects of knee with antegrade extended peroneal artery perforator flap. From October 2007 to January 2008, 3 patients (2 men and 1 woman) with the soft tissue defects of knee were treated, with the ages of 18, 31 and 42 years, respectively. The first case sustained femur and pelvis fractures and soft tissue defect over his right popliteal fossa, which were treated with open reduction and internal fixation (ORIF) and debridement of knee joint 2 weeks ago. The second case was necrosis of skin 3 weeks after ORIF for fracture of tibial plateau. The third case suffered from open fracture of tibial plateau and soft tissue defect, which were treated with external fixation and debridement 3 weeks ago. The defect sizes were 16 cm x 9 cm, 11 cm x 6 cm and 14 cm x 7 cm. The flap was raised by dividing the peroneal artery and veins distally and elevating them proximally, which covered for the defects of knee. The flaps were designed with the size of 18 cm x 10 cm, 12 cm 7 cm and 15 cm x 8 cm. The pure vascular pedicle of the flap was 10 cm to 17 cm in length, including the peroneal vessels and one or two perforator branches. The donor site is covered by a split thickness skin graft. All flaps survived after surgery. The donor sites healed by first intention and the skin grafts survived. After following up for 6, 8 and 11 months, the appearance and function of the flaps were all satisfactory. Based on the modified HSS knee performance system, post-operative knee functional outcomes of three patients were excellent. The antegrade extended peroneal artery perforator flap supplied by a pure vascular pedicle can be a good alternative for reconstruction of knee. The flap, with a long and thin pure vascular pedicle, could provide good texture and contour matching the recipient area.

Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children?

PubMed

Refai, Mohamed Ahmed; Song, Sang-Heon; Song, Hae-Ryong

2012-07-01

Treatment of relapsed clubfoot after soft tissue release in children is difficult because of the high recurrence rate and related complications. Even though the Ilizarov method is used for soft tissue distraction, there is a high incidence of recurrence after removal of the Ilizarov frame owing to previous contracture of soft tissue and a skin scar. We asked (1) whether transfixation of midfoot joints by temporary K wires during the consolidation stage after short-term application of an Ilizarov frame would maintain correction of the relapsed clubfoot clinicoradiologically and (2) whether this method would reduce the rate of recurrence and related complications in patients with a skin scar from previous surgery. We retrospectively reviewed 18 patients (19 feet) with relapsed clubfeet who underwent correction by soft tissue distraction using an Ilizarov ring fixator, between March 2005 and June 2008. The mean age of the patients was 8 ± 2 years (range, 4-15 years). K wire fixation for the midfoot joints combined with a below-knee cast were used during the consolidation stage. The minimum followup was 2 years (mean, 4.5 years; range, 2-6 years). The average duration of frame application was 5 weeks; the mean duration of treatment was 11 weeks. At last followup, 16 of 19 feet were painless and plantigrade and only three of 19 feet had recurrence. The mean preoperative clinical American Foot and Ankle Society (AOFAS) score had increased at last followup (57 versus 81). The values of the AP talocalcaneal, AP talo-first metatarsal, and lateral calcaneo-first metatarsal angles improved after treatment. The three recurrent clubfeet were treated by corrective osteotomies and Ilizarov frame application. This method could maintain the correction of relapsed clubfoot in children and reduce the recurrence rate and complications regardless of the presence of a skin scar owing to previous surgery.

Soft tissue examination of the fetal rat and rabbit head by magnetic resonance imaging.

PubMed

French, Julian M; Woodhouse, Neil

2013-01-01

The use of magnetic resonance imaging of the fetal rat and rabbit head, as an alternative to the traditional methods of fixation and preparation of serial sections, is described. Labeled magnetic resonance images of normal head anatomy have been provided as a reference for use when evaluating the internal structures of the head.

Gradual digital lengthening with autologous bone graft and external fixation for correction of flail toe in a patient with Raynaud's disease.

PubMed

Lamm, Bradley M; Ades, Joe K

2009-01-01

Iatrogenic flail toe is a complication of hammertoe surgery that occurs when an overaggressive resection of the proximal phalanx occurs. This can cause both functional and cosmetic concerns for the patient. We present a case report of the correction of a flail second toe in a patient with Raynaud's disease. The correction was achieved by means of gradual soft tissue lengthening with external fixation and an interposition autologous bone graft digital arthrodesis. After 5 months, this 2-stage procedure lengthened, stabilized, and restored the function of the toe. 4.

Biologic fixation through bridge plating for comminuted shaft fracture of the clavicle: technical aspects and prospective clinical experience with a minimum of 12-month follow-up.

PubMed

Jung, Gu Hee; Park, Chang-Min; Kim, Jae-Do

2013-12-01

For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.

[The retrocapital osteotomy ("chevron") for correction of splayfoot with hallux valgus].

PubMed

Gabel, Michael

2008-12-01

Surgical treatment of hallux valgus deformity with a distal osteotomy of the first metatarsal to address an increased intermetatarsal angle (IMA) I-II. This procedure is combined with a soft-tissue procedure at the first metatarsophalangeal joint: realignment of the first ray, lateral displacement of the first metatarsal head above the sesamoids, rebalancing of the soft tissues at the metatarsophalangeal joint. Pain and soft-tissue inflammation at the bunion, impaired function of the metatarsophalangeal joint, and lateral deviation of the hallux. IMA I-II 10 degrees. Symptomatic osteoarthritis of the first metatarsophalangeal joint, assessed clinically or radiographically. Acute inflammation of the forefoot, osteoporosis of the first metatarsal. Vascular disturbance. Cosmetic indication only. Relative: hypermobility of the first ray, valgus malalignment of the hindfoot, previous retrocapital osteotomy. Lateral soft-tissue release. Resection of the medial pseudoexostosis. V-shaped osteotomy of the distal metatarsal I. Exostosectomy. Lateral displacement of the first metatarsal head. Screw fixation. Realignment of the metatarsophalangeal joint by tightening of the medial soft tissues. Postoperative shoe with full weight bearing. Active exercises of the foot and hallux. Physiotherapy. Prophylaxis of deep vein thrombosis depending on the degree of mobility. Radiographic control after 6 weeks. Bandage or orthosis to maintain toe alignment. IMA I-II was reduced from 13.6 degrees preoperatively to 6.6 degrees postoperatively. HVA decreased from 29.8 degrees to 8.2 degrees postoperatively.

[Diagnostic and Treatment Strategies in Morel-Lavallee Lesions in the Spinal Column and Pelvis].

PubMed

Becker, Christopher A; Kammerlander, Christian; Greiner, Axel; Sommer, Fabian; Linhart, Christoph; Böcker, Wolfgang; Rubenbauer, Bianka; Weidert, Simon

2018-04-12

The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment options of both spine and pelvic fractures combined with Morel-Lavallée lesions (MLL). An analysis of the literature was performed via PubMed and Medline. This revealed a total of 197 studies and case reports. After analysing the literature, 19 studies/case reports met our inclusion criteria. There are several diagnostic options for MLL, including ultrasound, computed tomography or MRI. In spinal and pelvic lesions, ultrasound is capable of detecting MLL. Some authors tend to perform open debridement of the MLL, whereas others recommend percutanous treatment. Open debridement and vacuum-assisted closure are recommended in late diagnosed MLL, where primary suture of the soft tissue is impossible. Fracture fixation should be performed simultaneously to treatment of the MLL. Broad-spectrum cephalosporins combined with an aminoglycoside or piperacilline/tazobactam should be initiated. Radical debridement and drainage are recommended, especially when MLL is diagnosed late. Repeated ultrasound examinations should be performed of the surrounding soft tissue of the fracture. When MLL is diagnosed within 2 days, percutanous fracture and MLL treatment should be performed. After more than 2 days, both fracture and MLL should be treated with open debridement, open fracture fixation and primary suture if possible. Georg Thieme Verlag KG Stuttgart · New York.

Treatment of type II and type III open tibia fractures in children.

PubMed

Bartlett, C S; Weiner, L S; Yang, E C

1997-07-01

To determine whether severe open tibial fractures in children behave like similar fractures in adults. A combined retrospective and prospective review evaluated treatment protocol for type II and type III open tibial fractures in children over a ten-year period from 1984 to 1993. Twenty-three fractures were studied in children aged 3.5 to 14.5 (18 boys and 5 girls). There were six type II, eight type IIIA, and nine type IIIB fractures. Type I fractures were not included. Seven fractures were comminuted with significant butterfly fragments or segmental patterns. Treatment consisted of adequate debridement of soft tissues, closure of dead space, and stabilization with external fixation. Bone debridement only included contaminated devitalized bone or devitalized bone without soft tissue coverage. Bone that could be covered despite periosteal stripping was preserved. Clinical and roentgenographic examinations were used to determine time to union. All fractures in this series healed between eight and twenty-six weeks. Wound coverage included two flaps, three skin grafts, and two delayed primary closures. No bone grafts were required. There were no deep infections, growth arrests, or malunions. Follow-up has ranged from six months to four years. Open tibia fractures in children differ from similar fractures in adults in the following ways: soft tissues have excellent healing capacity, devitalized bone that is not contaminated or exposed can be saved and will become incorporated, and external fixation can be maintained until the fracture has healed. Periosteum in young children can form bone even in the face of bone loss.

Arthroscopic Management of Tibial Spine Avulsion Fractures: Principles and Techniques.

PubMed

Strauss, Eric J; Kaplan, Daniel James; Weinberg, Maxwell E; Egol, Jonathan; Jazrawi, Laith M

2018-05-15

Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half of the avulsed fragment elevated, in patients who have undergone unsuccessful nonsurgical reduction and long leg casting or bracing, and in patients with completely displaced fractures. Arthroscopy offers reduced invasiveness and decreased morbidity. Suture fixation and screw fixation have produced successful results. Suture fixation can eliminate the risk of fracture fragment comminution during screw insertion, the risk of neurovascular injury, and the need for hardware removal. Suture fixation is ideal in cases in which existing comminution prevents screw fixation.

Soft tissue changes and its stability as a sequlae to mandibular advancement.

PubMed

Uppada, Uday Kiran; Sinha, Ramen; Reddy, D Sreenatha; Paul, Dushyanth

2014-01-01

To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging.

Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

PubMed Central

TAKETOMI, SHUJI; INUI, HIROSHI; NAKAMURA, KENSUKE; YAMAGAMI, RYOTA; TAHARA, KEITARO; SANADA, TAKAKI; MASUDA, HIRONARI; TANAKA, SAKAE; NAKAGAWA, TAKUMI

2015-01-01

Purpose the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence Level IV, therapeutic case series. PMID:26889465

Management of distal humeral coronal shear fractures

PubMed Central

Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

2015-01-01

Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

Operative treatment of early infection after internal fixation of limb fractures (exclusive of severe open fractures).

PubMed

Bonnevialle, P

2017-02-01

Early infection after open reduction and internal fixation (ORIF) of a limb bone is defined as bacteriologically documented, deep and/or superficial surgical-site infection (SSI) diagnosed within 6months after the surgical procedure. This interval is arbitrarily considered sufficient to obtain fracture healing. The treatment of early infection after ORIF should be decided by a multidisciplinary team. The principles are the same as for revision arthroplasty. Superficial SSIs should be differentiated from deep SSIs, based on the results of bacteriological specimens collected using flawless technique. A turning point in the local microbial ecology occurs around the third or fourth week, when a biofilm develops around metallic implants. This biofilm protects the bacteria. The treatment relies on both non-operative and operative measures, which are selected based on the time to occurrence of the infection, condition of the soft tissues, and stage of bone healing. Both the surgical strategy and the antibiotic regimen should be determined during a multidisciplinary discussion. When treating superficial SSIs after ORIF, soft-tissue management is the main challenge. The treatment differs according to whether the hardware is covered or exposed. Defects in the skin and/or fascia can be managed using reliable reconstructive surgery techniques, either immediately or after a brief period of vacuum-assisted closure. In deep SSIs, deciding whether to leave or to remove the hardware is difficult. If the hardware is removed, the fracture site can be stabilised provisionally using either external fixation or a cement rod. Once infection control is achieved, several measures can be taken to stimulate bone healing before the end of the classical 6-month interval. If the hardware was removed, then internal fixation must be performed once the infection is eradicated. Copyright © 2016. Published by Elsevier Masson SAS.

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

PubMed

Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2010-12-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures.

PubMed

Muzaffar, Nasir; Ahmad, Nawaz; Ahmad, Aejaz; Ahmad, Nissar

2012-01-01

We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury.

Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation.

PubMed

Veljkovic, Andrea; Le, Vu; Escudero, Mario; Salat, Peter; Wing, Kevin; Penner, Murray; Younger, Alastair

2018-03-21

Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

PubMed

Luo, Huasong; Chen, Liaobin; Liu, Kebin; Peng, Songming; Zhang, Jien; Yi, Yang

2016-01-01

The aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator. Thirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system. Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%. Arthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

Structural change of soft tissue anterior cruciate ligament reconstructions with cross-pin fixation between immediate and postoperative 8 weeks: a study with use of magnetic resonance imaging.

PubMed

Lee, Yong Seuk; Ahn, Jin Hwan; Lim, Hong Chul; Kim, Jin Goo; Yoo, Jae Ho; Wang, Joon Ho; Park, Joon Soo

2009-02-01

There is some controversy regarding the optional method for proximal fixation in anterior cruciate ligament reconstruction surgery using soft tissue grafts. Concern about the strength of fixation has limited rehabilitation during the early postoperative period. Graft slippage occurs after cross-pin femoral fixation during the early healing period when the strength of the tendon-to-bone interface is lowest. Case series; Level of evidence, 4. Coronal and sagittal T2-weighted magnetic resonance images of arthroscopically reconstructed anterior cruciate ligaments performed in 18 consecutive knees were evaluated. The images were taken along the tunnel direction an average of 4 days (after the hemovac removal) and 8 weeks (recovery >120 degrees range of motion) after surgery. The distance was measured from the uppermost point of the graft to the upper border of the superior cross pin. To reduce the intra- and interobserver bias, the measurements were taken twice by 2 orthopaedic surgeons for all patients. Interrater and intrarater reliability were determined twice by 2 orthopaedic surgeons. The intrarater (0.88 and 0.93) and interrater (0.79 and 0.81) agreement ranged from 0.79 to 0.93. One of the 18 patients showed complete breakage of the 2 cross pins 8 weeks after surgery, even though the pins were intact 4 days postoperatively. From an analysis of the remaining 17 patients, there was no significant difference in the coronal and sagittal measurements taken at postoperative 4 days and 8 weeks (P = .170-.737) and all individual cases showed less than 3 mm slippage. The expansion mechanism of the cross pin works well during the early healing period. However, further studies on the long-term outcomes are required. In addition, further study on the strength of this fixation technique is needed because 1 of the 18 patients showed broken pins.

Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle.

PubMed

Bajwa, Amarjit S; Gantz, D E

2005-01-01

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications.

PubMed

Vidović, Dinko; Matejčić, Aljoša; Ivica, Mihovil; Jurišić, Darko; Elabjer, Esmat; Bakota, Bore

2015-11-01

Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO. A total of 21 patients with closed distal tibial or pilon fractures were enrolled in the study between March 2008 and November 2013 and completed follow-up. Demographic characteristics, mechanism of injury, time required for union, ankle range of motion and complications were recorded. Fractures were classified according to the AO/OTA classification. Nineteen patients were initially managed with an ankle-spanning external fixator. When the status of the soft tissue had improved and swelling had subsided enough, a definitive internal fixation with MIPO was performed. Patients were invited for follow-up examinations at 3 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months. Mean age of the patients was 40.1 years (range 19-67 years). Eighteen cases were the result of high-energy trauma and three were the result of low-energy trauma. According to the AO/OTA classification there were extraarticular and intraarticular fractures, but only simple articular patterns without depression or comminution. The average time for fracture union was 19.7 weeks (range 12-38 weeks). Mean range of motion was 10° of dorsiflexion (range 5-15°) and 28.3° of plantar flexion (range 20-35°). Three cases were metalwork-related complications. Two patients underwent plate removal at 24 weeks because of plate impingement. There was one case of wound breakdown at 11 weeks. One patient had fracture union with tibial recurvatum of approximately 10°, without functional impairment. Two patients had delayed union. MIPO is a reliable method of treatment for distal tibial fractures; it provides a high union rate and good functional outcome with minimal soft tissue complications. Skin impingement remains a common complication with MIPO, but this can be solved by timely plate removal. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reconstruction of acquired oromandibular defects.

PubMed

Fernandes, Rui P; Yetzer, Jacob G

2013-05-01

Acquired defects of the mandible resulting from trauma, infection, osteoradionecrosis, and ablative surgery of the oral cavity and lower face are particularly debilitating. Familiarity with mandibular and cervical anatomy is crucial in achieving mandibular reconstruction. The surgeon must evaluate which components of the hard and soft tissue are missing in selecting a method of reconstruction. Complexity of mandibular reconstruction ranges from simple rigid internal fixation to microvascular free tissue transfer, depending on defect- and patient-related factors. Modern techniques for microvascular tissue transfer provide a wide array of reconstructive options that can be tailored to patients' specific needs. Copyright © 2013 Elsevier Inc. All rights reserved.

The Future of Biologic Coatings for Orthopaedic Implants

PubMed Central

Goodman, Stuart B.; Yao, Zhenyu; Keeney, Michael; Yang, Fan

2013-01-01

Implants are widely used for othopaedic applications such as fixing fractures, repairing nonunions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery. PMID:23391496

Use of piezoelectric bone scalpel in hand and reconstructive microsurgery.

PubMed

Arnez, Z; Papa, G; Renzi, N; Ramella, V; Panizzo, N; Toffanetti, F

2009-01-01

Performing osteotomies with piezoelectric bone scalpel is also possible with bones of larger diameter/thickness. At the same time, adjacent soft tissues are not in danger from cutting or thermal damage, reducing the risk of damaging neurovascular structures - which is of primary importance in hand and reconstructive microsurgery. These features contribute to the safety and easy execution of the procedure. The resulting bony cut is precise and permits immediate and safe bone fixation. Osteotomy of bones of >1 cm thickness takes 20-30% longer than when using a conventional oscillating saw, though the increased safety of the procedure more than compensates for this. Three cases are presented, illustrating of the use of Genera Ultrasonic for cutting bones of major thickness (metacarpal, fibula and rib) without any complication. Because of its selectivity for bony tissue, precision and ability to protect soft tissues we also advocate the use of the Genera piezoelectric bone scalpel in hand and reconstructive microsurgery.

Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss.

PubMed

Ochman, Sabine; Evers, Julia; Raschke, Michael J; Vordemvenne, Thomas

2012-01-01

The treatment of complex fractures of the distal tibia, ankle, and talus with soft tissue damage, bone loss, and nonreconstructable joints for which the optimal timing for reduction and fixation has been missed is challenging. In such cases primary arthrodesis might be a treatment option. We report a series of multi-injured patients with severe soft tissue damage and bone loss, who were treated with a retrograde tibiotalocalcaneal arthrodesis nail as a minimally invasive treatment option for limb salvage. After a median follow-up of 5.4 years, all patients returned to their former profession. The ankle and bone fusion was complete, with moderate functional results and quality of life. Calcaneotibial arthrodesis using a retrograde nail is a good treatment option for nonreconstructable fractures of the ankle joint with severe bone loss and poor soft tissue quality in selected patients with multiple injuries, in particular, those involving both lower extremities, as a salvage procedure. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Surgical treatment of intra-articular calcaneal fractures.

PubMed

Stapleton, John J; Zgonis, Thomas

2014-10-01

Most intra-articular calcaneal fractures are a result of high-energy trauma. The operative management of calcaneal fractures has been based on achieving anatomic reduction and minimizing complications of the compromised soft tissue envelope. The traditional extensile lateral approach offers advantages of achieving adequate fracture reduction with the risk of wound-healing complications and infection. Limited open reduction and internal fixation techniques with or without using external fixation focuses on achieving fracture reduction with less risk of wound complications but higher risk of malunion. This article discusses key points of operative management for various intra-articular calcaneal fracture patterns and clinical presentations. Copyright © 2014 Elsevier Inc. All rights reserved.

Surgical management for avulsion fracture of the calcaneal tuberosity.

PubMed

Yu, Guang-rong; Pang, Qing-jiang; Yu, Xiao; Chen, Da-wei; Yang, Yun-feng; Li, Bing; Zhou, Jia-qian

2013-08-01

To discuss the operative methods and curative effect of calcaneal tuberosity fracture. A retrospective study was done to analyze 15 patients with calcaneal tuberosity fracture who received surgical management between January 2008 and June 2011. There were nine males and six females, with the age ranging from 31 to 68 years (average, 51.4 years). All the patients had unilateral acute injury, with the left foot in 7 cases and the right foot in 8 cases. According to the Beavis classification, there were three cases in type I and 12 cases in type II. All the cases in type I and 10 cases in type II were treated with open reduction and screw fixation. The other two cases in type II with larger fragment involving a portion of the subtalar joint were treated with plate and screw fixation. The effect of the treatment was assessed according to the ankle and hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS) after the operation. Ten patients were followed up for 12 to 36 months (average, 20 months). The healing time in these patients ranged from 8 to 25 weeks (average, 12 weeks). The postoperative score ranged from 47 to 100 points (average, 91.1 points). Seven cases were rated as excellent, two as good, and one as poor. The rate of excellent and good was 90%. Necrosis of skin and soft tissue and exposure of the plate happened in one patient, who eventually healed after 3 weeks by debridement with plate preserved and peroneal artery perforator flap transplantation. Loss of reduction happened to another patient, who was treated with revision surgery by open reduction and screw fixation again. To patients with obvious fracture displacement, whose soft tissues are irritated severely, emergency open reduction and internal fixation operation should be offered to prevent the necrosis of the flaps as far as possible. To patients with small fractures, it is advisable to choose open reduction and large diameter screw fixation, while plate and screw fixation may be better for the patients with large fragments, especially for those with the fracture line extending to the subtalar joint. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

[Total hip arthroplasty through anterior "minimal invasive" approach].

PubMed

Moerenhout, Kevin G; Cherix, Stéphane; Rüdiger, Hannes A

2012-12-19

Total hip replacement has seen a tremendous development and has become one of the most successful surgical interventions in orthopaedics. While during the first decades of development of total hip arthroplasty the fixation of the implant into the bone was the main concern, the focus has shifted towards surgical technique and soft tissue handling. In order to avoid permanent soft tissue damage, muscular dysfunction and concerns in regards to cosmetics, minimal invasive and anatomic approaches have been developed. We here provide a short overview on various methods of total hip replacements and we describe our technique through a minimal invasive direct anterior approach. While muscle and nerve damage is minimal, this technique allows for a rapid rehabilitation and is associated with an excellent functional outcome and a minimal risk for dislocation.

Soft tissue changes and its stability as a sequlae to mandibular advancement

PubMed Central

Uppada, Uday Kiran; Sinha, Ramen; Reddy, D. Sreenatha; Paul, Dushyanth

2014-01-01

Purpose of the Study: To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Materials and Methods: Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. Results: It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. Conclusion: The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging. PMID:25593860

Scapular thickness--implications for fracture fixation.

PubMed

Burke, Charity S; Roberts, Craig S; Nyland, John A; Radmacher, Paula G; Acland, Robert D; Voor, Michael J

2006-01-01

The purpose of this study was to measure and map scapula osseous thickness to identify the optimal areas for internal fixation. Eighteen (9 pairs) scapulae from 2 female and 7 male cadavers were used. After harvest and removal of all soft tissues, standardized measurement lines were made based on anatomic landmarks. For consistency among scapulae, measurements were taken at standard percentage intervals along each line approximating the distance between two consecutive reconstruction plate screw holes. Two-mm-diameter drill holes were made at each point, and a standard depth gauge was used to measure thickness. The glenoid fossa (25 mm) displayed the greatest mean osseous thickness, followed by the lateral scapular border (9.7 mm), the scapula spine (8.3 mm), and the central portion of the body of the scapula (3.0 mm). To optimize screw purchase and internal fixation strength, the lateral border, the lateral aspect of the base of the scapula spine, and the scapula spine itself should be used for anatomic sites of internal fixation of scapula fractures.

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles.

PubMed

Sosin, Michael; Ceradini, Daniel J; Hazen, Alexes; Levine, Jamie P; Staffenberg, David A; Saadeh, Pierre B; Flores, Roberto L; Brecht, Lawrence E; Bernstein, G Leslie; Rodriguez, Eduardo D

2016-05-01

The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency. Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard- and soft-tissue elements. Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes. This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.

Cement technique for reducing post-operative bursitis after trochanteric fixation.

PubMed

Derman, Peter B; Horneff, John G; Kamath, Atul F; Garino, Jonathan

2013-02-01

Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy. We present a simple technique for use with a bolt-washer system or grip plate in which trochanteric components are covered in bone wax followed by a layer of cement to decrease friction and to diminish the risk of post-operative bursitis.

Salvage of infected total knee fusion: the last option.

PubMed

Wiedel, Jerome D

2002-11-01

Currently the most common indication for an arthrodesis of the knee is a failed infected total knee prosthesis. Other causes of a failed total knee replacement that might necessitate a knee fusion include aseptic loosening, deficient extensor mechanism, poor soft tissues, and Charcot joint. Techniques available for achieving a knee fusion are external fixation and internal fixation methods. The external fixation compression devices have been the most widely used for knee fusion and have been successful until the indications for fusion changed to mostly failed prosthetic knee replacement. With failed total knee replacement, the problem of severe bone loss became an issue, and the external fixation compression devices, even including the biplane external fixators, have been the least successful method reported for gaining fusion. The Ilizarov technique has been shown to achieve rigid fixation despite this bone loss, and a review of reports are showing high fusion rates using this method. Internal fixation methods including plate fixation and intramedullary nails have had the best success in gaining fusion in the face of this bone loss and have replaced external fixation methods as the technique of choice for knee fusion when severe bone loss is present. A review of the literature and a discussion of different fusion techniques are presented including a discussion of the influence that infection has on the success of fusion.

Predictors of the postoperative range of finger motion for comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate.

PubMed

Shimizu, Takamasa; Omokawa, Shohei; Akahane, Manabu; Murata, Keiichi; Nakano, Kenichi; Kawamura, Kenji; Tanaka, Yasuhito

2012-06-01

Plate and screw fixation was introduced for complex fractures of the hand. Several risk factors for a poor functional outcome have been identified, but there is a paucity of evidence regarding predictors of finger stiffness in difficult hand fractures. The purpose of this prospective cohort study was to identify independent prognostic factors of the postoperative total active motion (%TAM) in the treatment of metacarpal and phalangeal fractures. Seventy-two patients (62 males, 10 females; 37±15 years) with periarticular fractures involving metaphyseal comminution and displacement were evaluated at a minimum of 1 year following surgery. There were 49 phalangeal bone fractures, 30 intra-articular fractures and 20 associated soft-tissue injuries. The locations of plate placement were lateral in 42 patients and dorsal in 30. The mean duration from injury to surgery was 7.6 days (range, 0-40 days). There were eight examined variables related to patient characteristics (age, gender and hand dominance), fracture characteristics (fracture location, joint involvement and associated soft-tissue injury) and surgical variables (location of plate placement and duration from injury to surgery). Univariate and multivariate linear regression analysis were used to identify the degree to which variables affect %TAM at the final follow-up. Univariate analysis indicated moderate correlations of %TAM with fracture location, associated soft-tissue injury and age. Multiple linear regression modelling including fracture location, age and associated soft-tissue injury resulted in formulae that could account for 46.3% of the variability in %TAM: fracture location (β=-0.388, p<0.001), age (β=-0.339, p<0.001) and associated soft-tissue injury (β=-0.296, p=0.002). Phalangeal fracture, increasing age and associated soft-tissue injury were important risk factors to identify the postoperative %TAM in the treatment of comminuted periarticular metacarpal or phalangeal fracture with a titanium plate. Copyright © 2012 Elsevier Ltd. All rights reserved.

Correction of complex equino cavo varus foot deformity in skeletally mature patients by Ilizarov external fixation versus staged external-internal fixation.

PubMed

Emara, Khaled; El Moatasem, El Hussein; El Shazly, Ossama

2011-12-01

Complex foot deformity is a multi-planar foot deformity with many etiologic factors. Different corrective procedures using Ilizarov external fixation have been described which include, soft tissue release, V-osteotomy, multiple osteotomies and triple fusion. In this study we compare the results of two groups of skeletally mature patients with complex foot deformity who were treated by two different protocols. The first group (27 patients, 29 feet) was treated by triple fusion fixed by Ilizarov external fixator until union. The second group (29 patients, 30 feet), was treated by triple fusion with initial fixation by Ilizarov external fixation until correction of the deformity was achieved clinically, and then the Ilizarov fixation was replaced by internal fixation using percutaneous screws. Both groups were compared as regard the surgical outcome and the incidence of complications. There was statistically significant difference between the two groups regarding duration of external fixation and duration of casting with shorter duration in the group 2. Also there was statistically significant difference between both groups regarding pin tract infection with less incidence in group 2. Early removal of Ilizarov external fixation after correction of the deformity and percutaneous internal fixation using 6.5 cannulated screws can shorten the duration of treatment and be more comfortable for the patient with a low risk of recurrence or infection. Copyright © 2010 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Gaze-contingent control for minimally invasive robotic surgery.

PubMed

Mylonas, George P; Darzi, Ara; Yang, Guang Zhong

2006-09-01

Recovering tissue depth and deformation during robotically assisted minimally invasive procedures is an important step towards motion compensation, stabilization and co-registration with preoperative data. This work demonstrates that eye gaze derived from binocular eye tracking can be effectively used to recover 3D motion and deformation of the soft tissue. A binocular eye-tracking device was integrated into the stereoscopic surgical console. After calibration, the 3D fixation point of the participating subjects could be accurately resolved in real time. A CT-scanned phantom heart model was used to demonstrate the accuracy of gaze-contingent depth extraction and motion stabilization of the soft tissue. The dynamic response of the oculomotor system was assessed with the proposed framework by using autoregressive modeling techniques. In vivo data were also used to perform gaze-contingent decoupling of cardiac and respiratory motion. Depth reconstruction, deformation tracking, and motion stabilization of the soft tissue were possible with binocular eye tracking. The dynamic response of the oculomotor system was able to cope with frequencies likely to occur under most routine minimally invasive surgical operations. The proposed framework presents a novel approach towards the tight integration of a human and a surgical robot where interaction in response to sensing is required to be under the control of the operating surgeon.

Navigation-aided visualization of lumbosacral nerves for anterior sacroiliac plate fixation: a case report.

PubMed

Takao, Masaki; Nishii, Takashi; Sakai, Takashi; Sugano, Nobuhiko

2014-06-01

Anterior sacroiliac joint plate fixation for unstable pelvic ring fractures avoids soft tissue problems in the buttocks; however, the lumbosacral nerves lie in close proximity to the sacroiliac joint and may be injured during the procedure. A 49 year-old woman with a type C pelvic ring fracture was treated with an anterior sacroiliac plate using a computed tomography (CT)-three-dimensional (3D)-fluoroscopy matching navigation system, which visualized the lumbosacral nerves as well as the iliac and sacral bones. We used a flat panel detector 3D C-arm, which made it possible to superimpose our preoperative CT-based plan on the intra-operative 3D-fluoroscopic images. No postoperative complications were noted. Intra-operative lumbosacral nerve visualization using computer navigation was useful to recognize the 'at-risk' area for nerve injury during anterior sacroiliac plate fixation. Copyright © 2013 John Wiley & Sons, Ltd.

Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities.

PubMed

Wen, Gen; Wang, Chun-Yang; Chai, Yi-Min; Cheng, Liang; Chen, Ming; Yi-Min, L V

2013-11-01

The complex wound with the exposed hardware and infection is one of the common complications after the internal fixation of the tibia fracture. The salvage of hardware and reconstruction of soft tissue defect remain challenging. In this report, we presented our experience on the use of the distally based saphenous neurocutaneous perforator flap combined with vacuum-assisted closure (VAC) therapy for the coverage of the soft tissue defect and the exposed hardware in the lower extremity with fracture. Between January 2008 and July 2010, seven patients underwent the VAC therapy followed by transferring a reversed saphenous neurocutaneous perforator flap for reconstruction of the wound with exposed hardware around the distal tibia. The sizes of the flaps ranged from 6 × 3 cm to 15 × 6 cm. Six flaps survived completely. Partial necrosis occurred in one patient. There were no other complications of repair and donor sites. Bone healing was achieved in all patients. In conclusion, the reversed saphenous neurocutaneous perfortor flaps combined with the VAC therapy might be one of the options to cover the complex wound with exposed hardware in the lower extremities. © 2013 Wiley Periodicals, Inc.

Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases.

PubMed

Borens, Olivier; Kloen, Peter; Richmond, Jeffrey; Roederer, Goetz; Levine, David S; Helfet, David L

2009-05-01

To determine the results of "biologic fixation" with a minimally invasive plating technique using a newly designed low profile "Scallop" plate in the treatment of pilon fractures. Retrospective case series. A tertiary referral center. Seventeen patients were treated between 1999 and 2001 for a tibial plafond fracture at the Hospital for Special Surgery with a newly designed low-profile plate. Eleven of the fractures (65%) were high-energy injuries. Two fractures were open. Staged surgical treatment with open reduction and fixation of the fibular fracture and application of an external fixator was performed in 12 cases. As soon as the soft tissues and swelling allowed, i.e. skin wrinkling, the articular surface was reconstructed and simply reduced, if necessary through an small incision, and the articular block was fixed to the diaphysis using a medially placed, percutaneously introduced flat scallop plate. In the remaining five cases the operation was performed in one session. Time to healing and complications including delayed union, non-union, instrument failure, loss of fixation, infection, quality of reduction and number of reoperations were evaluated. Quality of results and outcome were graded using the ankle-hindfoot-scale and a modified rating system. All patients went on to bony union at an average time of 14 weeks. There were no plate failures or loss of fixation/reduction. Two superficial wound-healing problems resolved with local wound care. At an average follow up of 17 months (range 6-29 months) eight patients (47%) had an excellent result; seven (41%) had a fair result whereas two (12%) had a poor result. The average ankle-hindfoot-score was 86.1 (range 61-100). Four patients have had the hardware removed and one of them is awaiting an ankle arthrodesis. Based on these initial results, it appears that a minimally invasive surgical technique including new low profile plate can decrease soft tissue problems while leading to fracture healing and obtaining results comparable with other more recent series. We believe that this new "Scallop Plate" is effective for the treatment of pilon fractures and should be used in conjunction with a staged procedure in the acute trauma setting.

[Modified chevron osteotomy with lateral release and screw fixation for treatment of severe hallux deformity].

PubMed

Hofstaetter, S G; Schuh, R; Trieb, K; Trnka, H J

2012-12-01

This prospective study examined the clinical and radiological results of the Chevron osteotomy with screw fixation and distal soft tissue release up to an intermetatarsal angle of 19°. Furthermore, the results are presented for patients over the age of 70 years, and whether or not there is a higher complication rate. 86 feet of patients between 23 and 81 years were included in the study. Apart from the overall group, a group with an intermetatarsal angle of 16° to 19° and a group of patients over 70 years old were eavaluated. They were evaluated preoperatively and at follow-up after an average of 3.3 years according to the American Orthopaedic Foot and Ankle Society score. The AOFAS score showed a significant improvement from 55 points preoperatively to 90 points at follow-up. The preoperative hallux valgus angle decreased significantly from 32° to 5° and the preoperative intermetatarsal angle decreased from 14° to 6°. Patient satisfaction in the overall group was rated in 92 % as excellent or good. Also, the patient group with 16° to 19° angles and the patients over 70 years showed a significant improvement of clinical and radiological parameters. The complication rate was very low in all groups. The results show that the Chevron osteotomy is a very good surgical technique with few complications for the correction of splay foot with hallux valgus deformity. We showed that by using the modified technique with a long plantar arm, an excessive soft tissue release and screw fixation, the indication can be extended up to an intermetatarsal angle of 19° when using screw fixation. Furthermore the patients over 70 years of age showed a significant improvement of clinical and radiological parameters without serious complications such as avascular necrosis or dislocation of the metatarsal head. Georg Thieme Verlag KG Stuttgart · New York.

Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability.

PubMed

Lind, Martin; Enderlein, Ditte; Nielsen, Torsten; Christiansen, Svend Erik; Faunø, Peter

2016-03-01

Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique. Twenty-four MPFL reconstructions in 20 operated children aged 8-16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year follow-up and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique. Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20%) experienced redislocation within the first postoperative year compared with 5% in an adult patient population. Five patients (25%) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients. There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients. Case-Control study, Level III.

Potential biomedical applications of ion beam technology

NASA Technical Reports Server (NTRS)

Banks, B. A.; Weigand, A. J.; Babbush, C. A.; Vankampen, C. L.

1976-01-01

Electron bombardment ion thrusters used as ion sources have demonstrated a unique capability to vary the surface morphology of surgical implant materials. The microscopically rough surface texture produced by ion beam sputtering of these materials may result in improvements in the biological response and/or performance of implanted devices. Control of surface roughness may result in improved attachment of the implant to soft tissue, hard tissue, bone cement, or components deposited from blood. Potential biomedical applications of ion beam texturing discussed include: vascular prostheses, artificial heart pump diaphragms, pacemaker fixation, percutaneous connectors, orthopedic pros-thesis fixtion, and dental implants.

A prospective study on 284 digital fractures of the hand.

PubMed

Pun, W K; Chow, S P; So, Y C; Luk, K D; Ip, F K; Chan, K C; Ngai, W K; Crosby, C; Ng, C

1989-05-01

We report a prospective study on 284 digital fractures of the hand in 235 patients. Management followed clear guidelines set out in a protocol. Important factors in the selection of the treatment method were, acceptable alignment, functional stability, and associated "significant" soft tissue injuries. "Functionally" stable fractures treated by free mobilization had satisfactory results. Unstable fractures treated by splints or Kirschner wire fixation produced unsatisfactory results. "Open fracture," "comminuted fracture," and "associated significant soft tissue injuries" were identified as unfavorable prognostic factors. The anatomic site of the fractures was not important in determining the final outcome. About 15% of the displaced fractures became functionally stable after closed reduction and their results were comparable with the undisplaced fractures. About 30% of the patients had various degrees of difficulty after they returned to work. About 14% of the patients eventually changed their jobs because of their residual disability.

Osseocutaneous integration of an intraosseous transcutaneous amputation prosthesis implant used for reconstruction of a transhumeral amputee: case report.

PubMed

Kang, Norbert V; Pendegrass, Catherine; Marks, Linda; Blunn, Gordon

2010-07-01

Exoprosthetic replacement with an artificial limb is the main option for reconstruction after traumatic amputation of an upper limb. Direct skeletal attachment using an osseointegrated implant improves the ease of fixation of the exoprosthesis to the amputation stump. We now report the use of an intraosseous transcutaneous amputation prosthesis that is designed to achieve osseocutaneous integration. Osseocutaneous integration differs from osseointegration because the aim is to create a stable interface among the implant, the bone, and the soft tissues. This reduces the risk of soft tissue infection and troublesome discharge, which are problems encountered with current osseointegrated implants that focus largely on the bone-implant interface. We describe our experience with an intraosseous transcutaneous amputation prosthesis in a case of transhumeral amputation with 2 years of follow-up. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Alveolar distraction osteogenesis: revive and restore the native bone.

PubMed

Sant, Sumedha; Jagtap, Amit

2009-12-01

In prosthodontics, knife-edge bony alveolar ridges can cause a problem in their rehabilitation. The distraction osteogenesis process raises the medullary component of the alveolus, allowing the labial plate of the existing natural bone to be displaced. This process involves mobilization, transport, and fixation of a healthy segment of bone adjacent to the deficient site. It entails use of the gradual controlled displacement of surgically created fractures, which results in simultaneous expansion of soft tissue and bone volume. A mechanical device, the alveolar distraction device, is used for this purpose. This modality of treatment can be used in implant dentistry cases for rehabilitation of resorbed ridges. The objective of this overview is to explain this procedure wherein the alveolar housing, including the osseous and soft-tissue components, is enlarged in a single, simultaneous process, which makes creation of an appropriate alveolar morphology possible.

3D-Printed Simulation Device for Orbital Surgery.

PubMed

Lichtenstein, Juergen Thomas; Zeller, Alexander Nicolai; Lemound, Juliana; Lichtenstein, Thorsten Enno; Rana, Majeed; Gellrich, Nils-Claudius; Wagner, Maximilian Eberhard

Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures. Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D-printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]). Group 1 gave an average mark of 4.0 (±0.9) versus 4.6 (±0.6) by group 2. The haptics were rated as 3.6 (±1.1) [1] and 4.2 (±0.8) [2]. The surgical approach was graded 3.7 (±1.2) [1] and 4.0 (±1.0) [2]. Handling of the models was rated 3.5 (±1.1) [1] and 4 (±0.7) [2]. The insertion of the implants was marked as 3.7 (±0.8) [1] and 4.2 (±0.8) [2]. Fixation of the implants was also perceived to be realistic with 3.6 (±0.9) [1] and 4.2 (±0.45) [2]. Lastly, surgical navigation was rated 3.8 (±0.8) [1] and 4.6 (±0.56) [2]. In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Intra-oral soft tissue expansion and volume stability of onlay bone grafts.

PubMed

Abrahamsson, Peter

2011-01-01

Insufficient regeneration of missing bone and soft-tissue may present aesthetic or functional problems in patients indicated for dental implant surgery. Several techniques such as bone grafts, bone substitutes and guided tissue regeneration (GTR) have been described to rebuild a compromised alveolar ridge. Adequate soft-tissue coverage of grafted bone and titanium-mesh is important to avoid exposure which may result in loss of the bone graft. The general aim of this thesis was to evaluate use of an osmotic tissue expander for expanding intra-oral soft tissue--creating a surplus of soft tissue-- in preparation for onlay bone grafting. An experimental rabbit model was used in studies (I), (II) and (III). In (I) an osmotic soft-tissue expander was placed bilaterally on the lateral wall of the mandible via an extra-oral approach. After two weeks of expansion the rabbits were killed and specimens were collected for histology. No inflammatory reaction and no resorbtion of the cortical bone occured. The periosteum was expanded and new bone formation was seen in the edges of the expander. In (II) and (III) the expander was placed under the periosteum in the same way as in (I): bilaterally in 13 rabbits in (II) and unilaterally in 11 rabbits in (III). After two weeks of expansion the expander was identified and removed. In (II) particulated bone was placed at the recipient site protected by a titanium mesh in one site and a bio-resorbable mesh on the other site. In (III), DBBM particles and bone particles collected from the lateral border of the mandible separated by a collagen membrane was placed at the recipient site. The graft was protected by a pre-bent titanium mesh covered by a collagen membrane. After a healing period of 3 months specimens were collected for histological and SEM examination. New bone was growing in direct contact with the titanium mesh and bio resorbable mesh. The newly formed bone had the same calcium content as the mature bone in the base of the mandible. In the clinical study (IV) 20 patients were consecutively recruited and randomised into two groups. The experimental group (ten patients) had an osmotic soft tissue expander implanted. After two weeks of expansion the expander was removed and a particulated bone graft protected by a titanium mesh and a collagen membrane was fixed to the recipient site. Titanium implants were installed after a healing period of 6 months. The patients in the reference group had a bone block grafted from the anterior ramus fixated to the recipient site with one or two titanium mini screws. Implants were installed after a healing period of 6 months. A three dimensional optical measuring device was used to measure alterations in the soft tissue profile before each surgical procedure. The three-dimensional changes were then analysed on a PC. The results from the clinical study in patients confirmed the results from the experimental rabbit studies. The osmotic tissue expander expanded the soft tissue. Expander perforations of the soft tissue occurred in two patients. The optical measurements demonstrated a positive volume gain after soft tissue expansion and bone grafting. The expanded tissue could be used to cover a bone graft. There still was a risk of mesh exposure, even after soft tissue expansion, which occurred in two patients. In both groups, implants could be installed in the grafted bone in positions that would allow the crowns to fit aesthetically into the dental arch.

The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review

PubMed Central

Bemelman, Michael; van Baal, Mark; Yuan, Jian Zhang; Leenen, Luke

2016-01-01

More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950’s, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO) technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has become available suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation. PMID:26889439

Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee.

PubMed

Völlner, Florian; Pilsl, Ulrike; Craiovan, Benjamin; Zeman, Florian; Schneider, Michael; Wörner, Michael; Grifka, Joachim; Weber, Markus

2017-07-01

The first biomechanical evaluation of new implants is usually carried out with cadavers. Fixation of Thiel-embalmed cadavers is supposed to preserve the histological structure, colour and consistency of the tissue and has a low risk of infection and toxicity. However, the biomechanical properties of Thiel-fixated tissue are still unknown. The aim of this study was to quantify the effect of the Thiel-embalming method on the elastic properties of the ligament complex of the knee compared to in vivo knees during total knee arthroplasty. The results of biomechanical tensile tests with 10 Thiel-embalmed knees were compared with the findings of 10 patients who underwent total knee arthroplasty with a standardised knee balancer at our department. We reconstructed the force-elongation curves of the medial and lateral ligament complex and calculated the stiffness in direct correlation with overall soft tissue stability in full extension and in 90° of flexion. All curves consisted of a non-linear part at the beginning and a linear part from about 80N onwards. In full extension, median stiffness in the cadavers was 26.6N/mm for the medial compartment and 31.6N/mm for the lateral compartment. The values for in vivo were 25.7N/mm for the medial compartment and 25.3N/mm for the lateral compartment (p=0.684 for the medial compartment and p=0.247 for the lateral compartment). In 90° of flexion, median stiffness in the cadaver group was 24.7N/mm for the medial compartment and 22.2N/mm for the lateral compartment. In vivo, median stiffness was 30.3N/mm for the medial compartment and 29.2N/mm for the lateral compartment (p=0.009 for the medial compartment and p=0.143 for the lateral compartment). Stiffness of the medial and lateral ligament complex in the knee was comparable between Thiel-embalmed cadavers and in vivo patients during total knee arthroplasty. Thiel fixation seems to preserve the soft tissue properties similar to those in vivo. Copyright © 2017 Elsevier Ltd. All rights reserved.

Advantages and disadvantages of pinless external fixation.

PubMed

Thomas, S R; Giele, H; Simpson, A H

2000-12-01

The AO pinless external fixator (PEF) uses trocar tipped clamps to grip the outer tibial cortex rather than pins to transfix it. Its main advantage is to avoid further contamination of the medullary canal in open tibial fractures where a nail may subsequently be used. We tested the anatomical safety of this device and its effect on plastic surgical procedures compared with a standard unilateral external fixator (UEF).The PEF and UEF were placed on two amputated limbs which were then dissected. Structures at risk were traced on ten cadaver limbs. We found that important anatomical structures were endangered by the PEF and that safe zones could not always be defined. The UEF avoided these structures. Plastic surgical approaches were made more difficult by the PEF which imposed limitations on local flap design and endangered the arterial perforators which supply them. We conclude that safety is compromised by the PEF because margins for error are small. It poses additional problems in soft tissue reconstruction and highlights the need for co-operation between plastic surgical and orthopaedic teams in choice of fixation device.

Tibial plafond fractures: limited incision reduction with percutaneous fixation.

PubMed

Salton, Heather L; Rush, Shannon; Schuberth, John

2007-01-01

This study was a retrospective review of 18 patients with 19 pilon fractures treated with limited incision reduction and percutaneous plate fixation of the tibia. Patients were treated with either a 1- or 2-stage protocol. The latter consisted of placement of an external fixator followed by definitive reduction. The emphasis of analysis was placed on the identification of complications to the soft tissue envelope or bone-healing problems within the first 6 months after surgery. A major complication was defined as an unplanned operation within the first 6 months. Minor complications were any superficial wound defects that did not require operative intervention to resolve or any malunion or delayed union. With this protocol, no major complications were encountered. Minor complications were identified in 4 patients (4 fractures) of which 2 were minor wound problems. One patient developed a malunion, and the other had a delayed union. Four patients requested removal of prominent hardware. These results indicate that limited incision reduction and percutaneous plate fixation lead to safe methods of stabilization. The authors also provide guidance and strategies for the consistent execution of this technique.

Vacuum sealing drainage therapy in the presence of an external fixation device

PubMed Central

Sun, Dahui; Ju, Weina; Wang, Tiejun; Yu, Tiecheng; Qi, Baochang

2016-01-01

Abstract Rationale: Vacuum sealing drainage (VSD) is widely utilized for treating traumatic wounds. Patient concerns: It is particularly difficult and time consuming to use in combination with an external fixator. Diagnoses: This is because the hardware or pins used for fixation interfere with maintaining a seal, resulting in poor adhesion and subsequent air leakage. Interventions: To resolve this problem, we have devised a new method for sealing the wound dressing, while maintaining the required vacuum.When using this technique, a rubber strip is wrapped around each pin in 3 circles outside the plastic drape, and then tightly tied. Outcomes: After completing this procedure, a vacuum is obtained, and any air leakage stops. We employed this technique to treat a cohort of patients in our department over a period of two years, and obtained good healing of soft tissue without air leakage, as well as good clinical outcomes. Lessons: We have observed that patients treated with this method experienced good clinical outcomes without air leakage, and we recommend its use in treating cases where an external fixation device is present. PMID:27861393

The Complicated Facial War Injury: Pitfalls and Mismanagement.

PubMed

Abu-Sittah, Ghassan S; Baroud, Joe; Hakim, Christopher; Wakil, Cynthia

2017-01-01

The aim of this paper is to share the authors' experience in the management of complicated facial war injuries using free tissue transfer. A discussion on the most commonly encountered pitfalls in management during the acute and complicated settings is presented in an effort to raise insight on facial war wound complications. Two patients of complicated facial war injuries are presented to exemplify the pitfalls in acute and chronic management of the mandibular region in the first patient and the orbito-maxillary region in the second. The examples demonstrate free tissue transfer for early as well as late definitive reconstructions. A reconstruction algorithm or consensus regarding the optimal management plan of complicated facial war injuries is not attainable. The main principles of treatment, however, remain to decrease bacterial burden by adequate aggressive debridement followed by revisit sessions, remove of all infected hardware followed by replacement with external bony fixation if necessary and reviving the affected area by coverage with well-vascularized tissues and bone. The later is feasible via local, regional, or distant tissue transfer depending on the extent of injury, surgeon's experience, and time and personnel available. Free tissue transfer has revolutionized the management of complicated facial war injuries associated with soft tissue or bone loss as it has allowed the introduction of well-vascularized tissues into a hostile wound environment. The end result is a reduced infection rate, faster recovery time, and better functional outcome compared with when loco-regional soft tissue coverage or bone grafting is used. When soft tissue or bone loss is present, free tissue transfer should be the first management plan if time and personnel are available. The ultimate treatment of a complicated war wound remains prevention by accurate initial management.

A Prospective Randomized Study on Operative Treatment for Simple Distal Tibial Fractures-Minimally Invasive Plate Osteosynthesis Versus Minimal Open Reduction and Internal Fixation.

PubMed

Kim, Ji Wan; Kim, Hyun Uk; Oh, Chang-Wug; Kim, Joon-Woo; Park, Ki Chul

2018-01-01

To compare the radiologic and clinical results of minimally invasive plate osteosynthesis (MIPO) and minimal open reduction and internal fixation (ORIF) for simple distal tibial fractures. Randomized prospective study. Three level 1 trauma centers. Fifty-eight patients with simple and distal tibial fractures were randomized into a MIPO group (treatment with MIPO; n = 29) or a minimal group (treatment with minimal ORIF; n = 29). These numbers were designed to define the rate of soft tissue complication; therefore, validation of superiority in union time or determination of differences in rates of delayed union was limited in this study. Simple distal tibial fractures treated with MIPO or minimal ORIF. The clinical outcome measurements included operative time, radiation exposure time, and soft tissue complications. To evaluate a patient's function, the American Orthopedic Foot and Ankle Society ankle score (AOFAS) was used. Radiologic measurements included fracture alignment, delayed union, and union time. All patients acquired bone union without any secondary intervention. The mean union time was 17.4 weeks and 16.3 weeks in the MIPO and minimal groups, respectively. There was 1 case of delayed union and 1 case of superficial infection in each group. The radiation exposure time was shorter in the minimal group than in the MIPO group. Coronal angulation showed a difference between both groups. The American Orthopedic Foot and Ankle Society ankle scores were 86.0 and 86.7 in the MIPO and minimal groups, respectively. Minimal ORIF resulted in similar outcomes, with no increased rate of soft tissue problems compared to MIPO. Both MIPO and minimal ORIF have high union rates and good functional outcomes for simple distal tibial fractures. Minimal ORIF did not result in increased rates of infection and wound dehiscence. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study.

PubMed

Meena, Umesh Kumar; Bansal, Mahesh Chand; Behera, Prateek; Upadhyay, Rahul; Gothwal, Gyan Chand

2017-11-01

The management of pilon fractures is controversial primarily due to the high rate of complications irrespective of the mode of treatment. Limited internal fixation with external fixation is associated with minimal soft tissue handling. This may reduce the chances of wound dehiscence and infection. This study was designed to evaluate the functional and clinical outcomes in patients treated with limited internal fixation combined with external fixation in pilon fractures. This study was conducted as a prospective clinical study on 56 skeletally mature patients with closed fractures with poor skin condition, and with open grade 1 and grade 2 distal tibial intra-articular fractures. All patients were treated with combined limited internal fixation and ankle spanning external fixation. All fractures in this series united with an average time period of union of 18.3weeks (ranging from 13 weeks to 30 weeks). There was no non-union in any case. There was malunion in 4 cases, varus malunion (>5 degree) in 2 cases and recurvatum in another 2 cases). Excellent to good functional results were observed in 88% cases based on the modified Ovadia and Beals score. The mean ankle dorsiflexion and planter flexion movements were 10.2±5.3 degrees and 27.4±7.2 degrees respectively. infections occurred in 6 patients which included 4 pin tract infections and 2 superficial wound infection, all 6 healed after removal of pin tract and with oral antibiotics. The technique of combined external fixation with internal fixation is safe and effective management option for intra-articular distal tibial fractures.

Comparing Different Surgical Techniques for Addressing the Posterior Malleolus in Supination External Rotation Ankle Fractures and the Need for Syndesmotic Screw Fixation.

PubMed

Li, Mengnai; Collier, Rachel C; Hill, Brian W; Slinkard, Nathaniel; Ly, Thuan V

Trimalleolar ankle fractures are unstable injuries with possible syndesmotic disruption. Recent data have described inherent morbidity associated with screw fixation of the syndesmosis, including the potential for malreduction, hardware irritation, and post-traumatic arthritis. The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. We hypothesized that fixation of a sizable posterior malleolar (PM) fracture in supination external rotation type IV (SER IV) ankle fractures would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. A retrospective review of trimalleolar ankle fractures surgically treated from October 2006 to April of 2011 was performed. A total of 143 trimalleolar ankle fractures were identified, and 97 were classified as SER IV. Of the 97 patients, 74 (76.3%) had a sizable PM fragment. Syndesmotic fixation was required in 7 of 34 (20%) and 27 of 40 (68%), respectively, when the PM was fixed versus not fixed (p = .0002). When the PM was indirectly reduced using an anterior to posterior screw, 7 of 15 patients (46.7%) required syndesmotic fixation compared with none of 19 patients when the PM fragment was fixated with direct posterior lateral plate fixation (p = .0012). Fixation of the PM fracture in SER IV ankle fractures can restore syndesmotic stability and, thus, lower the rate of syndesmotic fixation. We found that fixation of a sizable PM fragment in SER IV or equivalent injuries through posterolateral plating can eliminate the need for syndesmotic screw fixation. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Comminuted mandibular fracture in child victim of dog bite.

PubMed

de Carvalho, Matheus Furtado; Hardtke, Luiz Augusto Paixão; de Souza, Max Filipe Cota; de Oliveira Araujo, Vasco

2012-08-01

Dog bites represent lesions commonly found in Hospital Emergency Clinic. This type of lesion may cause severe harm to patients, but it rarely affects the underlying bone structure causes facial fracture. This study aims to illustrate a rare clinical case in which a pediatric patient presented a comminuted fracture in the mandible which evolved into a unilateral avulsion of the mandibular condyle, body fractures as well as a mandibular ramus and hemiface that had been deformed, with multiple lacerations and loss of soft-tissue mass. Intermaxillary fixation was performed using the Ivy method, followed by internal rigid fixation using miniplates and screws in attempt to reconstruct the child's mandible. After 2 years of follow-up, a satisfactory esthetics and functional results could be observed. © 2011 John Wiley & Sons A/S.

[Experimental study on the treatment of serious soft tissue injuries with strengthening the spleen and replenishing qi].

PubMed

Chen, Xun-wen; Zhu, Yong-zhan; Chen, Zhi-wei; Wu, Zheng-jie; He, Li-lei

2008-09-01

To study the effects of Chinese drugs based on strengthening the spleen and replenishing qi treatment rule on neoformative capillaries and fibroblast during the soft tissue repair after serious trauma in rats, so as to explore the biological basis of the TCM theory "the spleen dominate extremities and muscles" applied to the treatment of soft tissue injuries. The model rats were established by bleeding from femoral artery and lancing method, and the rats were randomly divided into the control group, strengthening the spleen group and activating blood and resolving stasis group. The samples were got from the tissue of the wounded area at the 5th, 10th and 15th days after oral administration of the traditional Chinese medicine. After fixation and section, the tissues were stained by CD31 and PCNA staining. The amount of the capillaries and fibroblasts in the tissue of the wounded area were observed through multi-purpose microscope (ZEISS Axioskop2). Quantitative analysis was carried out on Image-ProPlus image analyzer. The amount of the capillaries and fibroblasts in the wounded tissue in the strengthening the spleen group were larger than that in the control group at the 5th, 10th and 15th day. And the proliferation speed of capillaries and fibroblasts was faster than those in the control group or the activating blood and resolving stasis group. The Chinese drugs according to strengthening the spleen and replenishing qi treatment rule were effective to promote growth of the granulation tissue and facilitate healing of the wounded area. And it has better effect than the treatment of promoting blood circulation and removing stasis.

Histopathological observations of human periimplantitis lesions.

PubMed

Berglundh, Tord; Gislason, Orn; Lekholm, Ulf; Sennerby, Lars; Lindhe, Jan

2004-05-01

The aim of the present study was to analyze some characteristics of advanced and progressive periimplantitis lesions in man. Soft tissue biopsies were obtained from 12 implants in six patients. The implants had been in function between 4 and 21 years and were, with one exception, located in the maxilla. The radiographic examination performed prior to biopsy revealed that all sites exhibited advanced bone loss. Further, clinical signs of severe inflammation, such as suppuration, swelling and/or fistula formation were detected in the majority of sites and seven of the 12 implants were found to be mobile at biopsy. Each biopsy was following fixation embedded in epoxy resin and sections were prepared for histometric and morphometric analysis. It was demonstrated (i). that all soft tissue units harbored large inflammatory cell infiltrates (ICT) that extended to a position apical of a pocket epithelium and (ii). that about 60% of the lesions were occupied by inflammatory cells, among which plasma cells dominated. Numerous amounts of PMN cells occurred not only in the pocket epithelium and adjacent connective tissue areas, but were also present in peri-vascular compartments in more central areas of the ICT.

Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects.

PubMed

Röhner, Eric; Pfitzner, Tilman; Preininger, Bernd; Zippelius, Timo; Perka, Carsten

2016-01-01

The present study describes a new temporary arthrodesis procedure, which aims for septic knee prosthesis replacement, in particular for larger bone and soft tissue defects. Our technique offers high stability and full weight-bearing capacity of the knee joint. The study included 16 patients with major bone defects (AORI type IIb or greater) after receiving a radical debridement and a septic two-stage revision total knee arthroplasty. After removing the infected prosthesis and debridement, two AO fixator rods were positioned into the intramedullary space of the femur and tibia. Subsequently, both rods were joined tube-to-tube and adjusted in the center of the knee joint. Finally, the whole cavity of the knee joint was filled with PMMA. The number of previous surgeries, bacterial spectrum, risk factors for further infection and reinfection rates was recorded. Immediately after the temporary arthrodesis, radiographs of the knee with the enclosed spacers were taken in order to compare to previous radiographs and avoiding to miss possible spacer loosening. Nine of sixteen patients underwent more than two revision surgeries before receiving our new arthrodesis technique. No cases of spacer loosening were observed in all 16 patients; further, there were no peri-implant fractures, and four persistent infections were noted. Temporary arthrodesis using AO fixator rods offers a high stability without loosening. Its potential to replace conventional augmentation techniques should be taken into account, particularly in the case of larger bone and tissue defects. In clinical practice, the cemented spacer using AO fixator rods could be an alternative technique for temporary knee arthrodesis after septic debridement. Retrospective case series, Level IV.

Casting materials and their application in research and teaching.

PubMed

Haenssgen, Kati; Makanya, Andrew N; Djonov, Valentin

2014-04-01

From a biological point of view, casting refers to filling of anatomical and/or pathological spaces with extraneous material that reproduces a three-dimensional replica of the space. Casting may be accompanied by additional procedures such as corrosion, in which the soft tissue is digested out, leaving a clean cast, or the material may be mixed with radiopaque substances to allow x-ray photography or micro computed topography (µCT) scanning. Alternatively, clearing of the surrounding soft tissue increases transparency and allows visualization of the casted cavities. Combination of casting with tissue fixation allows anatomical dissection and didactic surgical procedures on the tissue. Casting materials fall into three categories namely, aqueous substances (India ink, Prussian blue ink), pliable materials (gelatins, latex, and silicone rubber), or hard materials (methyl methacrylates, polyurethanes, polyesters, and epoxy resins). Casting has proved invaluable in both teaching and research and many phenomenal biological processes have been discovered through casting. The choice of a particular material depends inter alia on the targeted use and the intended subsequent investigative procedures, such as dissection, microscopy, or µCT. The casting material needs to be pliable where anatomical and surgical manipulations are intended, and capillary-passable for ultrastructural investigations.

Microwave-Assisted Tissue Preparation for Rapid Fixation, Decalcification, Antigen Retrieval, Cryosectioning, and Immunostaining

PubMed Central

2016-01-01

Microwave irradiation of tissue during fixation and subsequent histochemical staining procedures significantly reduces the time required for incubation in fixation and staining solutions. Minimizing the incubation time in fixative reduces disruption of tissue morphology, and reducing the incubation time in staining solution or antibody solution decreases nonspecific labeling. Reduction of incubation time in staining solution also decreases the level of background noise. Microwave-assisted tissue preparation is applicable for tissue fixation, decalcification of bone tissues, treatment of adipose tissues, antigen retrieval, and other special staining of tissues. Microwave-assisted tissue fixation and staining are useful tools for histological analyses. This review describes the protocols using microwave irradiation for several essential procedures in histochemical studies, and these techniques are applicable to other protocols for tissue fixation and immunostaining in the field of cell biology. PMID:27840640

Vibration Testing Procedures for Bone Stiffness Assessment in Fractures Treated with External Fixation.

PubMed

Mattei, Lorenza; Longo, Antonia; Di Puccio, Francesca; Ciulli, Enrico; Marchetti, Stefano

2017-04-01

A bone healing assessment is crucial for the successful treatment of fractures, particularly in terms of the timing of support devices. However, in clinical practice, this assessment is only made qualitatively through bone manipulation and X-rays, and hence cannot be repeated as often as might be required. The present study reconsiders the quantitative method of frequency response analysis for healing assessments, and specifically for fractures treated with an external fixator. The novelty consists in the fact that bone excitation and response are achieved through fixator pins, thus overcoming the problem of transmission through soft-tissues and their damping effect. The main objective was to develop and validate a test procedure in order to characterize the treated bone. More than 80 tests were performed on a tibia phantom alone, a phantom with pins, and a phantom with a complete fixator. Different excitation techniques and input-output combinations were compared. The results demonstrated the effectiveness of a procedure based on impact tests using a micro-hammer. Pins and fixator were demonstrated to influence the frequency response of the phantom by increasing the number of resonant frequencies. This procedure will be applied in future studies to monitor healing both in in vitro and in vivo conditions.

Fracture healing in mice under controlled rigid and flexible conditions using an adjustable external fixator.

PubMed

Röntgen, Viktoria; Blakytny, Robert; Matthys, Romano; Landauer, Mario; Wehner, Tim; Göckelmann, Melanie; Jermendy, Philipp; Amling, Michael; Schinke, Thorsten; Claes, Lutz; Ignatius, Anita

2010-11-01

Mice are increasingly used to investigate mechanobiology in fracture healing. The need exists for standardized models allowing for adjustment of the mechanical conditions in the fracture gap. We introduced such a model using rigid and flexible external fixators with considerably different stiffness (axial stiffnesses of 18.1 and 0.82 N/mm, respectively). Both fixators were used to stabilize a 0.5 mm osteotomy gap in the femur of C57BL/6 mice (each n = 8). Three-point bending tests, µCT, and histomorphometry demonstrated a different healing pattern after 21 days. Both fixations induced callus formation with a mixture of intramembranous and enchondral ossification. Under flexible conditions, the bending stiffness of the callus was significantly reduced, and a larger but qualitatively inferior callus with a significantly lower fraction of bone but a higher fraction of cartilage and soft tissue was formed. Monitoring of the animal movement and the ground reaction forces demonstrated physiological loading with no significant differences between the groups, suggesting that the differences in healing were not based on a different loading behavior. In summary, flexible external fracture fixation of the mouse femur led to delayed fracture healing in comparison to a more rigid situation. © 2010 Orthopaedic Research Society.

Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures.

PubMed

Zwipp, Hans; Paša, Libor; Žilka, Luboš; Amlang, Michael; Rammelt, Stefan; Pompach, Martin

2016-03-01

To reduce the complication rate associated with open reduction and internal fixation of displaced intraarticular calcaneal fractures through extensile approaches, a locking nail system (C-Nail) was developed for internal fixation. Prospective case-control study. Two level I trauma centers (university hospital) and 1 large regional hospital in the Czech Republic and Germany. One hundred three patients (89 male and 14 female; mean age, 45.6 years) with 106 calcaneal fractures were treated between February 2011 and October 2013. In all 106 cases, the stainless steel C-Nail with a length of 65 mm, a diameter of 8 mm, and 7 locking options was used for internal fixation. Previous reduction of the posterior facet was performed in 15 cases percutaneously, assisted by arthroscopy and fluoroscopy, and in 91 cases by a sinus tarsi approach. The reduced joint surface was fixed by 1 or 2 compression screws. All other fragments were fixed after reduction and temporary K-wire fixation with the C-Nail introduced percutaneously through the tuberosity and 5 to 6 interlocking screws. The latter were introduced into the sustentacular, the tuberosity, and the anterior process fragments with an aiming device consisting of 3 arms. Patients were assessed for complications, restoration of Böhler angle, posterior facet reduction with postoperative computed tomography, and weight-bearing radiographs at 6 months. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale after 6 and 12 months for all patients. Wound edge necrosis was seen in 2 cases (1.9%), and soft tissue infection was observed in 1 case (0.9%). Böhler angle improved from 7.3 degree preoperatively to 28.7 degree at 6 months. The posterior facet step-off was reduced from 5.3 mm preoperatively to 0.7 mm postoperatively. The average AOFAS score averaged 89.5 at 6-month and 92.6 at 12-month follow-up. The C-Nail is a new locking system for treatment of displaced intraarticular calcaneal fractures combining a primary stability with reduced soft tissue complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Propeller Flap for Complex Distal Leg Reconstruction: A Versatile Alternative when Reverse Sural Artery Flap is Not Feasible.

PubMed

Ademola, Samuel A; Michael, Afieharo I; Oladeji, Femi J; Mbaya, Kefas M; Oyewole, O

2015-01-01

Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator-based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained Gustilo 3B injuries from gunshot. The donor area for reversed sural artery flap was involved in the injuries. They had early debridement, external fixation, and wound coverage with perforator-based propeller flaps. The donor sites were covered with skin graft. All flaps survived. There were minor wound edge ulcers due to the pressure of positioning that did not affect flap survival and the ulcers healed with conservative management. Perforator-based propeller flap is a versatile armamentarium for reconstruction of soft tissue defects of the distal leg in resource-constrained settings, especially when the donor area for a reverse flow sural flap artery is involved in the injury.

Coupled external fixator and skin flap transposition for treatment of exposed and nonunion bone.

PubMed

Zhao, Yong-gang; Ding, Jing; Wang, Neng

2011-02-01

To discuss the effect of coupled external fixator and skin flap transposition on exposed and nonunion bones. The data of 12 cases of infected nonunion and exposed bone following open fracture treated in our hospital during the period of March 1998 to June 2008 were analysed. There were 10 male patients, 2 female patients, whose age were between 19-52 years and averaged 28 years. There were 10 tibial fractures and 2 femoral fractures. The course of diseases lasted for 12-39 months with the mean period of 19 months. All the cases were treated by the coupled external fixator and skin flap transposition. Primary healing were achieved in 10 cases and delayed healing in 2 cases in whom the tibia was exposed due to soft tissue defect and hence local flap transposition was performed. All the 12 cases had bony union within 6-12 months after operation with the average time of 8 months. They were followed up for 1-3 years and all fractures healed up with good function and no infection recurrence. The coupled external fixator and skin flap transposition therapy have shown optimal effects on treating infected, exposed and nonunion bones.

Stress Fractures of Tibia Treated with Ilizarov External Fixator.

PubMed

Górski, Radosław; Żarek, Sławomir; Modzelewski, Piotr; Górski, Ryszard; Małdyk, Paweł

2016-08-30

Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

A Biomechanical Comparison of Distal Fixation for Bridge Plating in a Distal Radius Fracture Model.

PubMed

Alluri, Ram K; Bougioukli, Sofia; Stevanovic, Milan; Ghiassi, Alidad

2017-09-01

To compare the biomechanical properties of second versus third metacarpal distal fixation when using a radiocarpal spanning distraction plate in an unstable distal radius fracture model. Biomechanical evaluation of the radiocarpal spanning distraction plate comparing second versus third metacarpal distal fixation was performed using a standardized model of an unstable wrist fracture in 10 matched-pair cadaveric specimens. Each fixation construct underwent a controlled cyclic loading protocol in flexion and extension. The resultant displacement and stiffness were calculated at the fracture site. After cyclic loading, each specimen was loaded to failure. The stiffness, maximum displacement, and load to failure were compared between the 2 groups. Cyclic loading in flexion demonstrated that distal fixation to the third metacarpal resulted in greater stiffness compared with the second metacarpal. There was no significant difference between the 2 groups with regards to maximum displacement at the fracture site in flexion. Cyclic loading in extension demonstrated no significant difference in stiffness or maximum displacement between the 2 groups. The average load to failure was similar for both groups. Fixation to the third metacarpal resulted in greater stiffness in flexion. All other biomechanical parameters were similar when comparing distal fixation to the second or third metacarpal in distal radius fractures stabilized with a spanning internal distraction plate. The treating surgeon should choose distal metacarpal fixation primarily based on fracture pattern, alignment, and soft tissue integrity. If a stiffer construct is desired, placement of the radiocarpal spanning plate at the third metacarpal is preferred. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The perfuming of paper - technical and safety problems.

PubMed

Lawton, P D; Forbes, D M

1980-12-01

Synopsis This paper describes the rapid growth and diversity of consumer products based on cellulose fibres since the second world war, paying particular attention to soft tissue. The early use of perfumes as reodorants, based on traditional reodorisation knowledge, quickly gave way to the more sophisticated use of perfumes in their own right as a valuable and sometimes indispensable aid to the marketer of soft tissue. Special attention is devoted to the problem of selecting from the very wide range of perfumery ingredients available to perfumers, those which may be suitable for paper perfumery. The tests to evaluate their suitability are described and some of the results presented. The importance of the phenomena of fixation is examined in view of the nature of the product to be perfumed and its unusually long shelf life. The limitations of odour types available for paper products is discussed and a typical paper perfume formula studied. The paper concludes with an illustrated description of the general methods used today for the manufacture of soft tissue. An appraisal of the various methods that have been tried, and are used today to incorporate perfume into the products is also described. During this latter part of the presentation attention will be focused on the advantages and disadvantages of the methods selected with regard to their efficiency, installation, maintenance commitment and safety considerations.

The effect of soft tissue distraction on deformity recurrence after centralization for radial longitudinal deficiency.

PubMed

Manske, M Claire; Wall, Lindley B; Steffen, Jennifer A; Goldfarb, Charles A

2014-05-01

To assess recurrence and complications in children with radial longitudinal deficiency treated with or without external fixator soft tissue distraction prior to centralization. Thirteen upper extremities treated with centralization alone were compared with 13 treated with ring fixator distraction followed by centralization. Resting wrist position between the 2 groups was compared before surgery, approximately 2 years after surgery (midterm), and at final follow-up, which was at a mean of 10 years for the centralization-alone group and 6 years for the distraction group. Radiographs were reviewed for hand-forearm angle, hand-forearm position, volar carpal subluxation, ulnar length, and physeal integrity. The clinical resting wrist position was improved significantly after surgery and at final follow-up in both groups, but recurrence was worse at final follow-up in the distraction group patients. Radiographically, in the centralization alone group, the hand-forearm angle improved from 53° before surgery to 13° at midterm but worsened to 27° at final follow-up. In the distraction group, the hand-forearm angle improved from 53° before surgery to 21° at midterm but worsened to 36° at final follow-up. The hand-forearm position improved between preoperative and final assessment in both groups, but at final follow-up, the centralization-alone group had a significantly better position. Volar subluxation was 4 mm improved in the centralization alone group and 2 mm worse in the distraction group at final follow-up. Centralization, with or without distraction with an external fixator, resulted in improved alignment of the wrist. Distraction facilitated centralization, but it did not prevent deformity recurrence and was associated with a worse final radial deviation and volar subluxation position compared with wrists treated with centralization alone. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Fixation of fractures of the condylar head of the mandible with a new magnesium-alloy biodegradable cannulated headless bone screw.

PubMed

Leonhardt, H; Franke, A; McLeod, N M H; Lauer, G; Nowak, A

2017-07-01

It is difficult to fix fractures of the condylar head of the mandible. Several techniques have been described which show satisfactory outcomes, but stability can be questionable, and some can cause irritation of the soft tissues. We describe a technique and first results of treating such fractures with resorbable magnesium-based headless bone screws (Magnezix ® 2.7mm CS; Syntellix AG, Hanover, Germany). Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

An Osteoinductive Polymer Composite for Cranial and Maxillofacial Bone Repair,

DTIC Science & Technology

1985-01-01

soft tissues were gently reflected laterally and a 15 mm diameter craniotomy was created using a trephine in a slow-speed dental handpiece CFig. 2a, 2b...and JeFfrey 0. Hollinger D.D.S., PhD. *U.S. Army Institute of Dental Research Walter Reed Army Medical Center Washington D.C. 20307-5300 ]S ELE on...removed from the fixative, placed dura-side down on Kodak Ultraspeed Dental X-ray Film and radiographed at 90 KvP, 10 Ma, 0.4 seconds using a long

A review of 10 years of scapula injuries sustained by UK military personnel on operations.

PubMed

Roberts, Darren C; Power, D M; Stapley, S A

2018-02-01

Scapula fractures are relatively uncommon injuries, mostly occurring due to the effects of high-energy trauma. Rates of scapula fractures are unknown in the military setting. The aim of this study is to analyse the incidence, aetiology, associated injuries, treatment and complications of these fractures occurring in deployed military personnel. All UK military personnel returning with upper limb injuries from Afghanistan and Iraq were retrospectively reviewed using the Royal Centre for Defence Medicine database and case notes (2004-2014). Forty-four scapula fractures out of 572 upper limb fractures (7.7%) were sustained over 10 years. Blast and gunshot wounds (GSW) were leading causative factors in 85%. Over half were open fractures (54%), with open blast fractures often having significant bone and soft tissue loss requiring extensive reconstruction. Multiple injuries were noted including lung, head, vascular and nerve injuries. Injury Severity Scores (ISS) were significantly higher than the average upper limb injury without a scapula fracture (p<0.0001). Brachial plexus injuries occurred in 17%. While military personnel with GSW have a favourable chance of nerve recovery, 75% of brachial plexus injuries that are associated with blast have poorer outcomes. Fixation occurred with either glenoid fractures or floating shoulders (10%); these were as a result of high velocity GSW or mounted blast ejections. There were no cases of deep soft tissue infection or osteomyelitis and all scapula fractures united. Scapula fractures have a 20 times higher incidence in military personnel compared with the civilian population, occurring predominantly as a result of blast and GSW, and a higher than average ISS. These fractures are often associated with multiple injuries, including brachial plexus injuries, where those sustained from blast have less favourable outcome. High rates of union following fixation and low rates of infection are expected despite significant contamination and soft tissue loss. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ascorbate-apatite composite and ascorbate-FGF-2-apatite composite layers formed on external fixation rods and their effects on cell activity in vitro.

PubMed

Wang, Xiupeng; Ito, Atsuo; Sogo, Yu; Li, Xia; Tsurushima, Hideo; Oyane, Ayako

2009-09-01

Ascorbate-apatite and ascorbate-fibroblast growth factor-2 (FGF-2)-apatite composite layers were successfully formed on anodically oxidized Ti rods clinically used for external fixation by a one-step procedure at 25 degrees C, using a metastable supersaturated calcium phosphate solution supplemented with l-ascorbic acid phosphate magnesium salt n-hydrate (AsMg) and FGF-2. The AsMg-apatite and AsMg-FGF-2-apatite composite layers were evaluated in vitro using fibroblastic NIH3T3 and osteoblastic MC3T3-E1 cells. The AsMg-FGF-2-apatite composite layer markedly enhanced the NIH3T3 cell proliferation and procollagen type capital I, Ukrainian gene expression. Without FGF-2, the AsMg-apatite composite layer whose ascorbate content was 3.64+/-1.27microgcm(-2) obviously enhanced osteoblastic proliferation and differentiation. However, the AsMg-FGF-2-apatite composite layers whose FGF-2 contents were from 0.15+/-0.03 to 0.31+/-0.04microgcm(-2) inhibited osteoblastic differentiation in vitro. Thus, the AsMg-FGF-2-apatite composite layer should be precipitated on the surface of external fixators attached to skin and soft tissue. On the other hand, the AsMg-apatite composite layer should be precipitated at the part attached to bone tissue.

Surgery in the air--evacuating Finnish tsunami victims from Thailand.

PubMed

Leppäniemi, A; Vuola, J; Vornanen, M

2005-01-01

In connection with the Asian tsunami disaster on December 26, 2004, a specially equipped Finnair B-757 airplane capable of evacuating badly injured patients was remodeled into an ambulance airplane. The vehicle could take up to 22 severely injured or ill patients and intensive care and limited surgical procedures could be provided to the patients. The plane was manned with a civilian medical team of 37 physicians and nurses. The plane left for Thailand to evacuate the most severely injured Finnish citizens within 10 hours of the evacuation decision. A total of 14 patients including 4 critically ill (two on ventilator) were transferred to Helsinki within 32 hours of takeoff. The medical team included a general, an orthopedic and a plastic surgeon. Soft tissue wounds, some of them severely infected, were the most common injuries, followed by extremity fractures and head injuries. The surgical procedures that were performed mid-air included wound surgery, to remove necrotic tissue, and external fixation and fasciotomy for a lower extremity fracture. The facilities under these circumstances would allow performing life-saving procedures to maintain airway and breathing, and surgical procedures of the soft tissues, extremity and pelvic fractures. Cavitary surgery would require additional equipment and resources.

PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound.

PubMed

Vogels, J; Pommier, N; Cursolle, J-C; Belin, C; Tournier, C; Durandeau, A

2014-10-01

Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Clinical practice guideline on closed tibial plateau fractures in adulthood].

PubMed

Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

2013-01-01

Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

Treatment of close-range, low-velocity gunshot fractures of tibia and femur diaphysis with consecutive compression-distraction technique: a report of 11 cases.

PubMed

Ateşalp, A Sabri; Kömürcü, Mahmut; Demiralp, Bahtiyar; Bek, Dogan; Oğuz, Erbil; Yanmiş, Ibrahim

2004-01-01

Lower extremity injuries secondary to close-range, low-velocity gunshot wounds are frequently seen in both civilian and military populations. A close-range, low-velocity injury produces high energy and often results in comminuted and complicated fractures with significant morbidity. In this study, four femoral, four tibial, and three combined tibia and fibular comminuted diaphyseal fractures secondary to close-range, low-velocity gunshot wounds in 11 military personnel were treated with debridement followed by compression-distraction lengthening using a circular external fixator frame. Fracture union was obtained in all without significant major complications. Fracture consolidation occurred at a mean of 3.5 months. At follow-up of 46.8 months, there were no delayed unions, nonunions, or malunions. Minor complications included four pin-tract infections and knee flexion limitation in two femur fractures. Osteomyelitis and deep soft tissue infection were not observed. This technique provided an alternative to casting, open reduction internal fixation, or intermedullary fixation with an acceptable complication rate.

Comparison of volumetric bone mineral density in the tibial region of interest for ACL reconstruction.

PubMed

Klein, Scott A; Nyland, John; Caborn, David N M; Kocabey, Yavuz; Nawab, Akbar

2005-12-01

Adequate tibial bone mineral density (BMD) is essential to soft tissue graft fixation during anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare volumetric bone plug density measurements at the tibial region of interest for ACL reconstruction using a standardized immersion technique and Archimedes' principle. Cancellous bone cores were harvested from the proximal, middle, and distal metaphyseal regions of the lateral tibia and from the standard tibial tunnel location used for ACL reconstruction of 18 cadaveric specimens. Proximal tibial cores displayed 32.6% greater BMD than middle tibial cores and 31.8% greater BMD than distal tibial cores, but did not differ from the BMD of the tibial tunnel cores. Correlational analysis confirmed that the cancellous BMD in the tibial tunnel related to the cancellous BMD of the proximal and distal lateral tibial metaphysis. In conjunction with its adjacent cortical bone, the cancellous BMD of the region used for standard tibial tunnel placement provides an effective foundation for ACL graft fixation. In tibia with poor BMD, bicortical fixation that incorporates cortical bone from the distal tibial tunnel region is recommended.

Late Complications of Chest Wall Reconstruction: Management of Painful Sternal Nonunion

PubMed Central

Chepla, Kyle J.; Salgado, Christopher J.; Tang, Cathy J.; Mardini, Samir; Evans, Karen K.

2011-01-01

Although rare, sternal nonunion after median sternotomy or traumatic injury is associated with a high rate of morbidity. Pain and sternal clicking are two of the most common complaints and reasons these patients seek evaluation and treatment. Diagnosis of sternal nonunion is based on a thorough history and physical examination and can be confirmed with subsequent radiographic imaging. The treatment for symptomatic sternal nonunion requires stable fixation of the bony fragments and chest wall after the debridement of all nonviable bony and soft tissue by the cardiothoracic or reconstructive surgery team. Multiple fixation techniques have been described and incorporate a wide variety of materials including combinations of wires, cables, pins, bands, staples, and plates. Most recently, several new commercially available plating systems have demonstrated low recurrence and complication rates and resolution of the patient's symptoms on follow-up evaluation. Included in this review are three cases demonstrating the management of symptomatic sternal nonunion using these new techniques and review the history, diagnosis, risk factor, and classification, as well as several of the previously described fixation methods. PMID:22294948

Porcine Intestinal Mast Cells. Evaluation of Different Fixatives for Histochemical Staining Techniques Considering Tissue Shrinkage

PubMed Central

Rieger, J.; Twardziok, S.; Huenigen, H.; Hirschberg, R.M.; Plendl, J.

2013-01-01

Staining of mast cells (MCs), including porcine ones, is critically dependent upon the fixation and staining technique. In the pig, mucosal and submucosal MCs do not stain or stain only faintly after formalin fixation. Some fixation methods are particularly recommended for MC staining, for example the fixation with Carnoy or lead salts. Zinc salt fixation (ZSF) has been reported to work excellently for the preservation of fixation-sensitive antigens. The aim of this study was to establish a reliable histological method for counting of MCs in the porcine intestinum. For this purpose, different tissue fixation and staining methods that also allow potential subsequent immunohistochemical investigations were evaluated in the porcine mucosa, as well as submucosa of small and large intestine. Tissues were fixed in Carnoy, lead acetate, lead nitrate, Zamboni and ZSF and stained subsequently with either polychromatic methylene blue, alcian blue or toluidine blue. For the first time our study reveals that ZSF, a heavy metal fixative, preserves metachromatic staining of porcine MCs. Zamboni fixation was not suitable for histochemical visualization of MCs in the pig intestine. All other tested fixatives were suitable. Alcian blue and toluidine blue co-stained intestinal goblet cells which made a prima facie identification of MCs difficult. The polychromatic methylene blue proved to be the optimal staining. In order to compare MC counting results of the different fixation methods, tissue shrinkage was taken into account. As even the same fixation caused shrinkagedifferences between tissue from small and large intestine, different factors for each single fixation and intestinal localization had to be calculated. Tissue shrinkage varied between 19% and 57%, the highest tissue shrinkage was found after fixation with ZSF in the large intestine, the lowest one in the small intestine after lead acetate fixation. Our study emphasizes that MC counting results from data using different fixation techniques can only be compared if the respective studyimmanent shrinkage factor has been determined and quantification results are adjusted accordingly. PMID:24085270

Management of Lower Extremity Long-bone Fractures in Spinal Cord Injury Patients.

PubMed

Schulte, Leah M; Scully, Ryan D; Kappa, Jason E

2017-09-01

The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.

Fractures of the Talus: State of the Art.

PubMed

Vallier, Heather A

2015-09-01

Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits. Delayed definitive fixation may reduce the risks of wound complications and infections. Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. Osteonecrosis is reported in up to half of talar neck fractures, although many of these injuries will revascularize without collapse of the talar dome. Initial fracture displacement and presence of open fractures increase the risk of osteonecrosis. Talar process fractures may be subtle and easily missed on plain radiographs. Advanced imaging will provide detail to facilitate treatment planning. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Negative pressure wound therapy for the treatment of infected wounds with exposed knee joint after patellar fracture.

PubMed

Lee, Sang Yang; Niikura, Takahiro; Miwa, Masahiko; Sakai, Yoshitada; Oe, Keisuke; Fukazawa, Takahiro; Kawakami, Yohei; Kurosaka, Masahiro

2011-06-14

Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint.To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added to the growing evidence that negative pressure wound therapy is a useful adjunctive treatment for open wounds around the knee joint. Copyright 2011, SLACK Incorporated.

Transfer of free fillet lateral arm flap for facial reconstruction.

PubMed

Bayram, Fazli Cengiz; Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep

2014-07-01

We describe a 16-year-old male patient who had a major right facial degloving injury resulting in a soft-tissue defect with exposed zygoma as well as temporal and frontal bones. Multiple operations were undertaken in a staged manner for reconstruction. Lateral arm free fillet flap transfer was initially performed with fixation of bones with miniplates, which is followed by flap debulking, lateral canthopexy, scalp tissue expansion for hairline reconstruction, as well as ear reconstruction with costal cartilage and local flap techniques. After a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures after a successful free fillet flap transfer from an amputated part.

Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method.

PubMed

Milenković, Sasa; Mitković, Milorad; Micić, Ivan; Mladenović, Desimir; Najman, Stevo; Trajanović, Miroslav; Manić, Miodrag; Mitković, Milan

2013-09-01

Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

Titanium Mesh Shaping and Fixation for the Treatment of Comminuted Mandibular Fractures.

PubMed

Dai, Jiewen; Shen, Guofang; Yuan, Hao; Zhang, Wenbin; Shen, Shunyao; Shi, Jun

2016-02-01

Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures. Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up. Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis. We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Self-reinforced bioresorbable poly-L/DL-lactide [SR-P(L/DL)LA] 70/30 miniplates and miniscrews are reliable for fixation of anterior mandibular fractures: a pilot study.

PubMed

Ylikontiola, Leena; Sundqvuist, Kai; Sàndor, George K B; Törmälä, Pertti; Ashammakhi, Nureddin

2004-03-01

Bioresorbable osteofixation devices are being increasingly used in orthognathic surgery and in cases of trauma to avoid problems associated with conventional metal osteofixation devices. The aim of this clinical study was to assess the reliability and efficacy of bioresorbable self-reinforced poly-L/DL-lactide (SR-P(L/DL)LA 70/30) plates and screws in the fixation of mandibular fractures in adults. Ten patients (20 to 49 years old) with isolated anterior mandibular parasymphyseal fractures were treated by means of open reduction and internal fixation using SR-P(L/DL)LA 70/30 bioresorbable plates and screws. During the minimum of 6 months of follow-up, no problems were encountered except for 1 case where a plate became exposed intraorally and infected. This required debridement and later excision of the exposed part of the plate. Despite this setback the fractured bone healed well. SR-P(L/DL)LA 70/30 plates and screws are reliable for internal fixation of anterior mandibular fractures in adults. Proper soft tissue coverage should be ensured to avoid plate exposure. Should implant exposure occur, it might be necessary to excise the exposed part after fracture healing (6-8 weeks postoperatively).

Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

PubMed Central

Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

2016-01-01

Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments. PMID:26894217

[Treatment of bacterial infection in the interphalangeal joints of the hand].

PubMed

Vorderwinkler, K-P; Mühldorfer, M; Pillukat, T; van Schoonhoven, J

2011-07-01

Radical debridement of joint infection, prevention of further infection-related tissue destruction. Septic arthritis of interphalangeal joints in the thumb and fingers. Extensive soft tissue defects. Severe impairment of blood circulation, finger gangrene. Noncompliance for immobilization or for treatment with external fixator. Arthrotomy and irrigation with isotonic solution. Radical tissue debridement. Joint preservation possible only in the absence of infection-related macroscopic cartilage damage. Otherwise, resection of the articular surfaces and secondary arthrodesis. Insertion of antibiotic-coated devices. Temporary immobilization with external fixator. Inpatient postoperative treatment with 5-day intravenous administration of a second-generation cephalosporine (e.g., Cefuroxim®) followed by 7-10 days oral application. Adaptation of antibiotics according to antibiogram results. In joint-preserving procedures, radiographs and fixator removal after 4 weeks, active joint mobilization. If joint surfaces were resected, removal of fixator after 6 weeks; arthrodesis under 3-day intravenous broad-band antibiotic prophylaxis. Splint immobilization until consolidation (6-8 weeks). In 10 of 40 patients, the infected joint could be preserved. All infections healed. After an average duration of therapy of 6 (3-11) weeks, 4 individuals were free of complaints, and 6 patients had minor symptoms. Overall range of motion in the affected finger was reduced by 25-50° in 5 patients. All patients could return to work after 6.6 (4-11) weeks. A total of 30 patients were treated with joint resection and external fixator. After 5.6 (4-8) weeks, arthrodesis was performed, leading to consolidation in 29 patients. One patient underwent amputation after 4 months due to delayed gangrene. Treatment duration was 15.7 (7-25) weeks. Eight patients reported no complaints, 14 suffered mild symptoms, 5 had moderate, and 3 had severe symptoms in daily life. In 15 cases, range of motion was diminished by 10-80° in the remaining joints of the affected finger. Patients could return to work after 16.2 (6-28) weeks.

FIXATION OF FISH TISSUES. IN: THE LABORATORY FISH.

EPA Science Inventory

This chapter deals with the fixation of fish tissues and whole fish. Traditionally, fixation has been applied to animal tissues mainly for histological or pathological studies. Development of new molecular and immunologic tools now allows tissue and cellular localization of nucle...

Broken Pieces of Circlage Wire Lying in Soft Tissue Envelope Around Knee Joint: A Case Report and Review of Literature

PubMed Central

Kalia, Anoop; Khatri, Kavin; Singh, Jagdeep; Bansal, Kapil; Sagy, Mohammed

2016-01-01

Introduction: The migration of circlage wires used in tension band wiring construct of patella fractures in the posterior soft tissue envelope surrounding the knee joint has been rarely reported. Case Presentation: A 60-year-old woman presented to us with pain over medial aspect of right knee joint. She underwent open reduction and internal fixation for a patellar fracture which she sustained 4 years back and subsequently underwent kirschner wire(k wire) removal for the same around 2 years back. X-rays of the knee joint shows that the circlage wire used in tension band construct which was left in place had broken into multiple pieces and was lying in the soft tissue envelope surrounding the knee joint and one piece migrate to the popliteal fossa. On examination patient did not had distal neuro-vascular deficit. The pain of the patient was due to the osteo-arthritic changes in her medial side of knee joint rather than broken wire pieces. Patient was advised to undergo total knee replacement along with subsequent removal of broken wires but patient refused for any type of surgery and is kept on regular follow up Conclusion: This case report summarizes a rare complication resulting from hardware failure used for fixing patella fractures and throws a light on potential unwarned complications due to broken wires along with early recogonition and removal of broken hardware by surgeons. PMID:28116277

Inner ear tissue preservation by rapid freezing: Improving fixation by high-pressure freezing and hybrid methods

PubMed Central

Bullen, A.; Taylor, R.R.; Kachar, B.; Moores, C.; Fleck, R.A.; Forge, A.

2014-01-01

In the preservation of tissues in as ‘close to life’ state as possible, rapid freeze fixation has many benefits over conventional chemical fixation. One technique by which rapid freeze-fixation can be achieved, high pressure freezing (HPF), has been shown to enable ice crystal artefact-free freezing and tissue preservation to greater depths (more than 40 μm) than other quick-freezing methods. Despite increasingly becoming routine in electron microscopy, the use of HPF for the fixation of inner ear tissue has been limited. Assessment of the quality of preservation showed routine HPF techniques were suitable for preparation of inner ear tissues in a variety of species. Good preservation throughout the depth of sensory epithelia was achievable. Comparison to chemically fixed tissue indicated that fresh frozen preparations exhibited overall superior structural preservation of cells. However, HPF fixation caused characteristic artefacts in stereocilia that suggested poor quality freezing of the actin bundles. The hybrid technique of pre-fixation and high pressure freezing was shown to produce cellular preservation throughout the tissue, similar to that seen in HPF alone. Pre-fixation HPF produced consistent high quality preservation of stereociliary actin bundles. Optimising the preparation of samples with minimal artefact formation allows analysis of the links between ultrastructure and function in inner ear tissues. PMID:25016142

[Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients].

PubMed

Liu, Yin-Wen; Kuang, Yong; Gu, Xin-Feng; Zheng, Yu-Xin; Li, Zhi-Qiang; Wei, Xiao-En; Zhang, Ming-Cai; Zhan, Hong-Sheng; Shi, Yin-yu

2013-03-01

To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures. From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated. The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair. Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue injury, less blood loss, reliable fixation, which is effective method in treating proximal and distal tibial fractures and corresponds with the standpoint of biological fixation.

The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy.

PubMed

El-Mowafi, Hani; El-Hawary, Ahmed; Kandil, Yasser

2015-12-01

Pilon fractures usually result from high energy trauma, and are commonly associated with extensive soft tissue damage which prevents the use of open reduction and internal fixation. This study was designed to evaluate the use of the Ilizarov external fixator in the treatment of pilon fractures of the ankle, and to determine whether arthroscopy of the ankle could improve the outcome. From February 2011 to May 2013 a total of 23 patients with unilateral closed pilon fractures were divided into two groups treated with and without arthroscopy during fixation with the Ilizarov external fixator. The fractures were classified according to the AO Rüdi and Allgőwer classification. Follow up ranged from 10 to 37 months with a mean of 18 months. All cases were evaluated at follow up by the AOFAS and the Bone et al. grading system. According to Bone et al. there were 3 cases excellent, 4 cases good, 2 cases fair, and 2 cases poor in Group A (without arthroscopy), whereas there were 4 cases excellent, 6 cases good, 2 cases fair in Group B (with arthroscopy). The AOFAS score for Group A was 77.8±5.8, and for Group B was 78.4±6.9. We concluded that the Ilizarov external fixator is an excellent method in treating pilon fractures as it minimizes the need for extensive surgery. We also conclude that the use of arthroscopy during pilon fracture fixation did not add statistically significant improvement to our results and it needs longer term investigation to assess its advantage - if any - to the final outcome. level 2. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases.

PubMed

Kiene, J; Schulz, Arndt P; Hillbricht, S; Jürgens, Ch; Paech, A

2009-01-28

The methods for ankle arthrodesis differ significantly, probably a sign that no method is clearly superior to others. In the last ten years there is a clear favour toward internal fixation. We retrospectively evaluate the technique and evaluate the clinical long term results of external fixation in a triangular frame. From 1994 to 2001 a consecutive series of 95 patients with end stage arthritis of the ankle joint were treated. Retrospectively the case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues and the clinical examination before arthrodesis. Mean age at the index procedure was 45.4 years (18-82), 67 patients were male (70.5%). Via a bilateral approach the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted with approximately 8 cm distance in the distal tibia, one in the neck of the talus and one in the dorsal calcaneus. The fixator was removed after approximately 12 weeks. Follow up examination at mean 4.4 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. Due to different complications, 8 (8.9%) further surgical procedures were necessary including 1 below knee amputation. In 4 patients a non-union of the ankle arthrodesis developed (4.5%). The mean AOFAS score improved from 20.8 to 69.3 points. Non-union rates and clinical results of arthrodesis by triangular external fixation of the ankle joint do not differ to internal fixation methods. The complication rate and the reduced patient comfort reserve this method mainly for infected arthritis and complicated soft tissue situations.

Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

PubMed Central

2009-01-01

The methods for ankle arthrodesis differ significantly, probably a sign that no method is clearly superior to others. In the last ten years there is a clear favour toward internal fixation. We retrospectively evaluate the technique and evaluate the clinical long term results of external fixation in a triangular frame. Patients and Methods From 1994 to 2001 a consecutive series of 95 patients with end stage arthritis of the ankle joint were treated. Retrospectively the case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues and the clinical examination before arthrodesis. Mean age at the index procedure was 45.4 years (18-82), 67 patients were male (70.5%). Via a bilateral approach the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted with approximately 8 cm distance in the distal tibia, one in the neck of the talus and one in the dorsal calcaneus. The fixator was removed after approximately 12 weeks. Follow up examination at mean 4.4 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. Results: Due to different complications, 8 (8.9%) further surgical procedures were necessary including 1 below knee amputation. In 4 patients a non-union of the ankle arthrodesis developed (4.5%). The mean AOFAS score improved from 20.8 to 69.3 points. Conclusion Non-union rates and clinical results of arthrodesis by triangular external fixation of the ankle joint do not differ to internal fixation methods. The complication rate and the reduced patient comfort reserve this method mainly for infected arthritis and complicated soft tissue situations. PMID:19258207

Evaluation of a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography of scaphoid fixation screws.

PubMed

Filli, Lukas; Marcon, Magda; Scholz, Bernhard; Calcagni, Maurizio; Finkenstädt, Tim; Andreisek, Gustav; Guggenberger, Roman

2014-12-01

The aim of this study was to evaluate a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography (FDCT) of scaphoid fixation screws. FDCT has gained interest in imaging small anatomic structures of the appendicular skeleton. Angiographic C-arm systems with flat detectors allow fluoroscopy and FDCT imaging in a one-stop procedure emphasizing their role as an ideal intraoperative imaging tool. However, FDCT imaging can be significantly impaired by artefacts induced by fixation screws. Following ethical board approval, commercially available scaphoid fixation screws were inserted into six cadaveric specimens in order to fix artificially induced scaphoid fractures. FDCT images corrected with the algorithm were compared to uncorrected images both quantitatively and qualitatively by two independent radiologists in terms of artefacts, screw contour, fracture line visibility, bone visibility, and soft tissue definition. Normal distribution of variables was evaluated using the Kolmogorov-Smirnov test. In case of normal distribution, quantitative variables were compared using paired Student's t tests. The Wilcoxon signed-rank test was used for quantitative variables without normal distribution and all qualitative variables. A p value of < 0.05 was considered to indicate statistically significant differences. Metal artefacts were significantly reduced by the correction algorithm (p < 0.001), and the fracture line was more clearly defined (p < 0.01). The inter-observer reliability was "almost perfect" (intra-class correlation coefficient 0.85, p < 0.001). The prototype correction algorithm in FDCT for metal artefacts induced by scaphoid fixation screws may facilitate intra- and postoperative follow-up imaging. Flat detector computed tomography (FDCT) is a helpful imaging tool for scaphoid fixation. The correction algorithm significantly reduces artefacts in FDCT induced by scaphoid fixation screws. This may facilitate intra- and postoperative follow-up imaging.

Sternal plate fixation for sternal wound reconstruction: initial experience (Retrospective study)

PubMed Central

2011-01-01

Background Median sternotomy infection and bony nonunion are two commonly described complications which occur in 0.4 - 5.1% of cardiac procedures. Although relatively infrequent, these complications can lead to significant morbidity and mortality. The aim of this retrospective study is to evaluate the initial experience of a transverse plate fixation system following wound complications associated with sternal dehiscence with or without infection following cardiac surgery. Methods A retrospective chart review of 40 consecutive patients who required sternal wound reconstruction post sternotomy was performed. Soft tissue debridement with removal of all compromised tissue was performed. Sternal debridement was carried using ronguers to healthy bleeding bone. All patients underwent sternal fixation using three rib plates combined with a single manubrial plate (Titanium Sternal Fixation System®, Synthes). Incisions were closed in a layered fashion with the pectoral muscles being advanced to the midline. Data were expressed as mean ± SD, Median (range) or number (%). Statistical analyses were made by using Excel 2003 for Windows (Microsoft, Redmond, WA, USA). Results There were 40 consecutive patients, 31 males and 9 females. Twenty two patients (55%) were diagnosed with sternal dehiscence alone and 18 patients (45%) with associated wound discharge. Thirty eight patients went on to heal their wounds. Two patients developed recurrent wound infection and required VAC therapy. Both were immunocompromised. Median post-op ICU stay was one day with the median hospital stay of 18 days after plating. Conclusion Sternal plating appears to be an effective option for the treatment of sternal wound dehiscence associated with sternal instability. Long-term follow-up and further larger studies are needed to address the indications, benefits and complications of sternal plating. PMID:21529357

Dental occlusion ties: A rapid, safe, and non‐invasive maxillo‐mandibular fixation technology

PubMed Central

2017-01-01

Objectives For decades, Erich arch bars have been a standard in establishing maxillo‐mandibular fixation (MMF). While reliable, the approach risks sharps injury, consumes operating room time, and inflicts gingival trauma. Newer technologies including screw‐based techniques and “hybrid” techniques have improved MMF by reducing sharps injuries and operating room time, but risk injury to tooth roots, nerves, and gingiva. This study aims to establish the application, strengths, and limitations of dental occlusion ties as a novel alternative in maxillo‐mandibular fixation. Study Design Prospective, non‐blinded, human feasibility clinical trial. Materials and Methods An iterative prototyping process was used to invent dental occlusion ties (brand name: Minne Ties). Development included 3D printing, cadaver prototype testing, human apical embrasure measurement, and ultimately non‐significant risk human clinical trial testing. In the IRB‐approved feasibility clinical trial, the devices were applied to mandible and maxilla fracture candidates with fractures amenable to intra‐operative MMF with open reduction with internal fixation. The ties were removed prior to extubation. Pre‐teens, comminuted fracture patients, and patients requiring post‐operative MMF were excluded. Results Manufactured, sterile prototypes secured MMF successfully in management of unilateral and bilateral mandible and maxilla fractures. All patients reported correction of pre‐operative malocclusion. Application times were typically 12–15 minutes for a single surgeon to achieve MMF. Patients incurred negligible gingival trauma from the technology as the ties require no tissue penetration for application. Conclusions Dental occlusion ties offer a non‐invasive solution featuring operating room efficiency, minimized sharps risk, and less bony and soft tissue trauma than current commercialized solutions. Level of Evidence Therapeutic, IV PMID:28894837

Surgical treatment of open pilon fractures.

PubMed

Zeng, Xian-tie; Pang, Gui-gen; Ma, Bao-tong; Mei, Xiao-long; Sun, Xiang; Wang, Jia; Jia, Peng

2011-02-01

To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures. From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score. All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis. It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications. © 2011 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future.

PubMed

Lerner, A; Stahl, S; Stein, H

2000-12-01

Severe, high-energy, periarticular elbow injuries producing a "floating joint" are a major surgical challenge. Their reconstruction and rehabilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds. Seven adults with compound open peri- and intra-articular elbow fractures were treated in hybrid ring tubular fixation frames. After debridement, bone stabilization, and neurovascular reconstructions, early controlled daily movements were started in the affected joint. These seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfayan functional score were excellent in two, good in one, and fair in four of these severely mangled upper extremities. None was amputated. The Mangled Extremity Severity Score has been shown to be unable to provide a reliable assessment for severe high-energy limb injuries surgically managed with the modular hybrid thin wire tubular external fixation system. This hybrid system is a very useful addition to the surgical armamentarium of orthopedic trauma surgeons. It both allows complex surgical reconstructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation system is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of the elbow joint (floating elbow) with severe damage to soft tissues. This fixation system allows individual fixation of forearm bone fractures, thus allowing the preservation of pronation-supination movements.

Microwave fixation versus formalin fixation of surgical and autopsy tissue.

PubMed

Login, G R

1978-05-01

Microwave irradiation of surgical and autopsy tissue penetrates, fixes, and hardens the tissue almost immediately (the fluid media used in the microwave consisted of saline, ten percent phosphate buffered formalin, and distilled water). Tissue sections from a representative sample of organs were tested. Comparable sections were simultaneously fixed in a phosphate buffered ten percent formalin bath in a vaccum oven as a control. Hematoxylin and eosin were used to stain the sections. Results equal to and superior to the control method were obtained. Saline microwave fixation was superior to formalin microwave fixation. Tissues placed in Zenker's solution and fixed in standard microwave oven (for approximately one minute) yielded results at least equal to conventional Zenker fixation (approximately two hours). No tissue hardening resulted from Zenker microwave fixation. A unique time versus temperature graph (microwave heating curve) reduces individual variation with this technique.

Bidirectional lift of the anterior midcheek with Gore-Tex cable sutures.

PubMed

Sasaki, Gordon H; Oberg, Kerby C; Kim, E Yoonah

2003-01-01

The reader is presumed to have a broad understanding of the anatomy of the anterior midface. After reading this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination on the basis of material covered in this article. The examination begins on page 257. We have previously described a technique of anterior midface soft tissue repositioning using 2 cable sutures directed only in a superolateral direction. This technique achieves a more normal distribution of subcutaneous fat laterally over the malar bag prominence but does little to overcome central and medial hollowness in the palpebromalar and tear-trough areas. We describe an alteration of our original technique that introduces a vertical lift of the anterior midface soft tissue utilizing Gore-Tex, (W.L. Gore & Associates, Flagstaff, AZ) cable sutures while elevating the preperiosteal soft tissue. We used a transconjunctival approach to expose the postseptal fat, orbital rim, and arcus marginalis. Subperiosteal dissection over the orbital rim was performed to prepare a pocket for the malar fat pads. Using 6.5-cm Keith needles, we placed a braided suture medially, lateral to the location of the infraorbital nerve and foramen, and maneuvered it through the soft tissue until all signs of dimpling at the nasolabial line or upward distortion of the upper lip were removed. A Gore-Tex graft was introduced and seated in a cupped configuration that anchored the caudal fat pad at the nasolabial line. The medial fat pad and vascular pedicle were transposed over the orbital rim into the predissected pocket; the central fat pad was also fashioned into a pedicle and moved into its pocket. The Gore-Tex sutures were tightened, elevating the supraperiosteal soft tissue vertically. A second set of Gore-Tex sutures elevated the anterior midface soft tissue toward the deep temporal fascia. Between 1999 and 2002, 197 patients underwent bidirectional anterior midface lift with Gore-Tex sutures, combined with ancillary procedures. Use of the Gore-Tex cable sutures enabled improvement in the periorbitum, midcheek, and neck, as well as a more harmonious facial appearance in all patients, with few complications. The bidirectional cable-suture technique is simple, effective, and safe. It provides secure fixation and filling of the nasojugal hollow and improvement of the malar eminence. It is less effective in the periorbitum and does not seem to correct the recalcitrant nasolabial fold.

Multimodal noninvasive monitoring of soft tissue wound healing.

PubMed

Bodo, Michael; Settle, Timothy; Royal, Joseph; Lombardini, Eric; Sawyer, Evelyn; Rothwell, Stephen W

2013-12-01

Here we report results of non-invasive measurements of indirect markers of soft tissue healing of traumatic wounds in an observational swine study and describe the quantification of analog physiological signals. The primary purpose of the study was to measure bone healing of fractures with four different wound treatments. A second purpose was to quantify soft tissue wound healing by measuring the following indirect markers: (1) tissue oxygenation, (2) fluid content, and (3) blood flow, which were all measured by non-invasive modalities, measured with available devices. Tissue oxygenation was measured by near infrared spectroscopy; fluid content was measured by bipolar bio-impedance; and blood flow was measured by Doppler ultrasound. Immediately after comminuted femur fractures were produced in the right hind legs of thirty anesthetized female Yorkshire swine, one of four wound treatments was instilled into each wound. The four wound treatments were as follows: salmon fibrinogen/thrombin-n = 8; commercial bone filler matrix-n = 7; bovine collagen-n = 8; porcine fibrinogen/thrombin-n = 7. Fractures were stabilized with an external fixation device. Immediately following wound treatments, measurements were made of tissue oxygenation, fluid content and blood flow; these measurements were repeated weekly for 3 weeks after surgery. Analog signals of each modality were recorded on both the wounded (right) hind leg and the healthy (left) hind leg, for comparison purposes. Data were processed off-line. The mean values of 10-s periods were calculated for right-left leg comparison. ANOVA was applied for statistical analysis. Results of the bone healing studies are published separately (Rothwell et al. in J Spec Oper Med 13:7-18, 2013). For soft tissue wounds, healing did not differ significantly among the four wound treatments; however, regional oxygenation of wounds treated with salmon fibrinogen/thrombin showed slightly different time trends. Further studies are needed to establish standards for healthy wound healing and for detection of pathological alterations such as infection. Non-invasive measurement and quantification of indirect markers of soft tissue wound healing support the goals and principles of evidence-based medicine and show potential as easy to administer tools for clinicians and battlefield medical personnel to apply when procedures such as the PET scan are not available or affordable. The method we developed for storing analog physiological signals could be used for maintaining electronic health records, by incorporating vital signs such as ECG and EEG, etc.

Anterior Cruciate Ligament-Derived Stem Cells Transduced With BMP2 Accelerate Graft-Bone Integration After ACL Reconstruction.

PubMed

Kawakami, Yohei; Takayama, Koji; Matsumoto, Tomoyuki; Tang, Ying; Wang, Bing; Mifune, Yutaka; Cummins, James H; Warth, Ryan J; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H; Huard, Johnny

2017-03-01

Strong graft-bone integration is a prerequisite for successful graft remodeling after reconstruction of the anterior cruciate ligament (ACL) using soft tissue grafts. Novel strategies to accelerate soft tissue graft-bone integration are needed to reduce the need for bone-tendon-bone graft harvest, reduce patient convalescence, facilitate rehabilitation, and reduce total recovery time after ACL reconstruction. The application of ACL-derived stem cells with enhanced expression of bone morphogenetic protein 2 (BMP2) onto soft tissue grafts in the form of cell sheets will both accelerate and improve the quality of graft-bone integration after ACL reconstruction in a rat model. Controlled laboratory study. ACL-derived CD34+ cells were isolated from remnant human ACL tissues, virally transduced to express BMP2, and embedded within cell sheets. In a rat model of ACL injury, bilateral single-bundle ACL reconstructions were performed, in which cell sheets were wrapped around tendon autografts before reconstruction. Four groups containing a total of 48 rats (96 knees) were established (n = 12 rats; 24 knees per group): CD34+BMP2 (100%), CD34+BMP2 (25%), CD34+ (untransduced), and a control group containing no cells. Six rats from each group were euthanized 2 and 4 weeks after surgery, and each graft was harvested for immunohistochemical and histological analyses. The remaining 6 rats in each group were euthanized at 4 and 8 weeks to evaluate in situ tensile load to failure in each femur-graft-tibia complex. In vitro, BMP2 transduction promoted the osteogenic differentiation of ACL-derived CD34+ cells while retaining their intrinsic multipotent capabilities. Osteoblast densities were greatest in the BMP2 (100%) and BMP2 (25%) groups. Bone tunnels in the CD34+BMP2 (100%) and CD34+BMP2 (25%) groups had the smallest cross-sectional areas according to micro-computed tomography analyses. Graft-bone integration occurred most rapidly in the CD34+BMP2 (25%) group. Tensile load to failure was significantly greater in the groups containing stem cells at 4 and 8 weeks after surgery. Tensile strength was greatest in the CD34+BMP2 (100%) group at 4 weeks, and in the CD34+BMP2 (25%) group at 8 weeks. ACL-derived CD34+ cells transduced with BMP2 accelerated graft-bone integration after ACL reconstruction using soft tissue autografts in a rat model, as evidenced by improved histological appearance and graft-bone interface biology along with tensile load to failure at each time point up to 8 weeks after surgery. A primary disadvantage of using soft tissue grafts for ACL reconstruction is the prolonged time required for bony ingrowth, which delays the initiation of midsubstance graft remodeling. The lack of consistent correlation between the appearance of a "healed" ACL on postoperative magnetic resonance imaging and readiness to return to sport results in athletes being released to sport before the graft is ready to handle high-intensity loading. Therefore, it is desirable to identify strategies that accelerate graft-bone integration, which would reduce the time to biologic fixation, improve the reliability of biologic fixation, allow for accelerated rehabilitation, and potentially reduce the incidence of early graft pullout and late midsubstance failure.

Inner ear tissue preservation by rapid freezing: improving fixation by high-pressure freezing and hybrid methods.

PubMed

Bullen, A; Taylor, R R; Kachar, B; Moores, C; Fleck, R A; Forge, A

2014-09-01

In the preservation of tissues in as 'close to life' state as possible, rapid freeze fixation has many benefits over conventional chemical fixation. One technique by which rapid freeze-fixation can be achieved, high pressure freezing (HPF), has been shown to enable ice crystal artefact-free freezing and tissue preservation to greater depths (more than 40 μm) than other quick-freezing methods. Despite increasingly becoming routine in electron microscopy, the use of HPF for the fixation of inner ear tissue has been limited. Assessment of the quality of preservation showed routine HPF techniques were suitable for preparation of inner ear tissues in a variety of species. Good preservation throughout the depth of sensory epithelia was achievable. Comparison to chemically fixed tissue indicated that fresh frozen preparations exhibited overall superior structural preservation of cells. However, HPF fixation caused characteristic artefacts in stereocilia that suggested poor quality freezing of the actin bundles. The hybrid technique of pre-fixation and high pressure freezing was shown to produce cellular preservation throughout the tissue, similar to that seen in HPF alone. Pre-fixation HPF produced consistent high quality preservation of stereociliary actin bundles. Optimising the preparation of samples with minimal artefact formation allows analysis of the links between ultrastructure and function in inner ear tissues. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Analysis of energy dispersive x-ray diffraction profiles for material identification, imaging and system control

NASA Astrophysics Data System (ADS)

Cook, Emily Jane

2008-12-01

This thesis presents the analysis of low angle X-ray scatter measurements taken with an energy dispersive system for substance identification, imaging and system control. Diffraction measurements were made on illicit drugs, which have pseudo- crystalline structures and thus produce diffraction patterns comprising a se ries of sharp peaks. Though the diffraction profiles of each drug are visually characteristic, automated detection systems require a substance identification algorithm, and multivariate analysis was selected as suitable. The software was trained with measured diffraction data from 60 samples covering 7 illicit drugs and 5 common cutting agents, collected with a range of statistical qual ities and used to predict the content of 7 unknown samples. In all cases the constituents were identified correctly and the contents predicted to within 15%. Soft tissues exhibit broad peaks in their diffraction patterns. Diffraction data were collected from formalin fixed breast tissue samples and used to gen erate images. Maximum contrast between healthy and suspicious regions was achieved using momentum transfer windows 1.04-1.10 and 1.84-1.90 nm_1. The resulting images had an average contrast of 24.6% and 38.9% compared to the corresponding transmission X-ray images (18.3%). The data was used to simulate the feedback for an adaptive imaging system and the ratio of the aforementioned momentum transfer regions found to be an excellent pa rameter. Investigation into the effects of formalin fixation on human breast tissue and animal tissue equivalents indicated that fixation in standard 10% buffered formalin does not alter the diffraction profiles of tissue in the mo mentum transfer regions examined, though 100% unbuffered formalin affects the profile of porcine muscle tissue (a substitute for glandular and tumourous tissue), though fat is unaffected.

Calibration and standardization of microwave ovens for fixation of brain and peripheral nerve tissue.

PubMed

Login, G R; Leonard, J B; Dvorak, A M

1998-06-01

Rapid and reproducible fixation of brain and peripheral nerve tissue for light and electron microscopy studies can be done in a microwave oven. In this review we report a standardized nomenclature for diverse fixation techniques that use microwave heating: (1) microwave stabilization, (2) fast and ultrafast primary microwave-chemical fixation, (3) microwave irradiation followed by chemical fixation, (4) primary chemical fixation followed by microwave irradiation, and (5) microwave fixation used in various combinations with freeze fixation. All of these methods are well suited to fix brain tissue for light microscopy. Fast primary microwave-chemical fixation is best for immunoelectron microscopy studies. We also review how the physical characteristics of the microwave frequency and the dimensions of microwave oven cavities can compromise microwave fixation results. A microwave oven can be calibrated for fixation when the following parameters are standardized: irradiation time; water load volume, initial temperature, and placement within the oven; fixative composition, volume, and initial temperature; and specimen container shape and placement within the oven. Using two recently developed calibration tools, the neon bulb array and the agar-saline-Giemsa tissue phantom, we report a simple calibration protocol that identifies regions within a microwave oven for uniform microwave fixation. Copyright 1998 Academic Press.

Management of gunshot wounds to the mandible.

PubMed

Peleg, Michael; Sawatari, Yoh

2010-07-01

The gunshot wound to the mandible is a unique traumatic injury. The resultant injury from the gunshot wound is diverse because of the variability of the projectile, motion, velocity, and tissue characteristics. When a high-velocity projectile strikes the mandible, often times the wound will consist of a severely comminuted mandible surrounded by nonvital soft tissues and the implantation of multiple foreign bodies. This represents a challenge for the treating surgeon. The anatomy and function of the mandible make it such that the care of the gunshot wound requires a combination of trauma and reconstructive surgeries. There are varying techniques advocated for the management of gunshot wound to the face. However, for the comminuted mandible fracture sustained from a gunshot wound, an approach involving the fabrication of an occlusal splint, intermaxillary fixation, aggressive debridement of hard and soft tissues, and immediate reconstruction with a titanium plate is a comprehensive approach that can restore the appropriate function and contour of the patient. At the Division of Oral and Maxillofacial Surgery, University of Miami, this approach to the comminuted mandible fracture secondary to the gunshot wound has led to the effective management of this specific subset of injury. The complication rate is comparable with the current literature and provides an advantage as a 1-stage management to restore appropriate function and cosmesis to the patient.

Mechanical aspects of a multidirectional, angular stable osteosynthesis system and comparison with four conventional systems.

PubMed

Gbara, Ali; Heiland, Max; Schmelzle, Rainer; Blake, Felix

2008-04-01

Following open reduction, internal fixation of fractures of the mandible is predominantly achieved using plates and screws. Today, a multitude of osteosynthesis systems are available on the market. One therapy modality, primarily developed for orthopaedic surgery, is using angular stable osteosynthesis plate systems. The dominating principle of these is the bond between screw and plate following insertion. This principle of an "internal fixateur" results in a more stable fixation of the fragments associated with less compression of the bone surfaces. A new multidirectional osteosynthesis system (TiFix=Smartlock, Hamburg - Germany) was modified to fit the maxillofacial region and compared with four other well established osteosynthesis systems developed by Mondial, Medicon, Synthes, Leibinger-Stryker, one of these (Unilock by Synthes) being also angular stable. The resistance to deformation in varying directions was investigated following fixation in four different materials. The TiFix system proved more resistant to deformation even when mounted with fewer screws than the non-angular stable systems. This system results in greater stability even when fewer screws are used. For the clinician this means smaller access incisions, less soft tissue trauma, better aesthetic results, decreased duration of operation and a reduction of costs.

The role of arthroscopy in trapeziometacarpal arthritis.

PubMed

Slutsky, David Joseph

2014-04-01

Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty. This paper describes (1) the arthroscopic ligamentous anatomy of the TM joint, (2) the portal anatomy and methodology behind TM arthroscopy, and (3) the arthroscopic treatment for TM OA, including the current clinical indications for TM arthroscopy and the expected outcomes from the literature. A MEDLINE(®) search was used to retrieve papers using the search terms trapeziometacarpal, carpometacarpal, portal anatomy, arthroscopy portals, arthroscopy, arthroscopic, resection arthroplasty, and arthroscopic resection arthroplasty. Eighteen citations satisfied the search terms and were summarized. Careful wound spread technique is needed to prevent iatrogenic injury to the surrounding superficial radial nerve branches. Traction is essential to prevent chondral injury. Fluoroscopy should be used to help locate portals as necessary. Cadaver training is desirable before embarking on a clinical case. Questions regarding the use of temporary K-wire fixation or thermal shrinkage or the need for a natural or synthetic interposition substance cannot be answered at this time. Longitudinal prospective studies are needed to answer these lingering questions. An intimate knowledge of the portal and arthroscopic anatomy is needed to perform TM arthroscopy. Minimally invasive techniques for resection arthroplasty in TM OA with and without soft tissue interposition can yield good outcomes in the treatment of TM OA.

Treatment of hardware infection after osteosynthesis of lower leg using negative pressure wound therapy and transforming powder dressing.

PubMed

Marinović, Marin; Ivandcić, Aldo; Spanjol, Josip; Pina, Maja; Bakota, Bore; Bandalović, Ante; Cukeljs, Fabijan

2014-12-01

Fractures of the distal part of the lower leg are more common in everyday practice and traumatology. In young and active patients these injuries are mainly caused by high energy trauma. They are treated with external fixator in first step, and in second step, after sanation of the soft tissue, with open reduction and internal fixation (ORIF). It is very safe and effective method of treatment. Treatment of the infections that occur in the early postoperative period after open reduction and internal fixation represents a great problem and challenge for surgeons. It is widely accepted that the presence of deep infection can't be cured in the presence of hardware. However, removal of hardware in the presence of unhealed fractures significantly complicates sanation of infection and fracture itself We have decided to present a 35-years-old patient with a hardware infection with present chronic wound with hardware exposed eight months after the first operation and six months after second operation. The wound measured one centimeter in diameter with cell detritus and bad granulations tissue inside the wound. Hardwre was exposed in the depth of the wound.The secretion was minimal. Negative Pressure Wound Therapy (NPWT) was applicated after debridemet and lavage performed in ambulatory conditions. The starting therapy was continuously -125 mm Hg of vacuum. After five days of NPWT the defect was partially filled with granula- tion tissue. For another five days we continue with NPWT with the same values of-125 mm Hg pressure but in the inter- mitent mode. After that period we used transforming powder dressing for covering and protection of the wound with was filled with granulation tissue. Five days later, wound was completely healed with epithelisation. After four months of patient follow-up, we found the wound is completely repaired. The patient denies pain and has continued orderly flow of fracture healing, with no signs of infection.

Treatment Approach for Infection of Healed Fractures After Internal Fixation.

PubMed

Lawrenz, Joshua M; Frangiamore, Salvatore J; Rane, Ajinkya A; Cantrell, William Alex; Vallier, Heather A

2017-11-01

To review the efficacy of a treatment approach for patients with infection and colonized implants after open reduction and internal fixation of fractures. Retrospective case series. Level one trauma center. Twenty patients were treated for wound infection with colonized implants after open reduction and internal fixation. Surgical debridement, removal of implants, and a short postoperative oral antibiotic course. The course of patients after surgical debridement and removal of implants, including culture results, antibiotic administration, and presence of recurrent clinical infection and radiographic union. Twenty patients had clinical presentations, including skin breakdown, serous drainage, purulent drainage and/or exposed implants, most commonly of the tibia (15 of 20). Mean time from index procedure to debridement with implant removal was 19.7 months. At the time of debridement and implant removal, 18 of 20 (90%) patients had a positive intraoperative culture (16 routine cultures and 2 broth cultures). The most common bacteria were Enterobacter cloacae (5/17) and methicillin-sensitive Staphylococcus aureus (4/17). All patients had soft tissue healing without signs of recurrent infection after mean follow up of 40 months after implant removal. Surgical debridement with implant removal plus a short oral antibiotic course is effective to resolve wound infection with a colonized implant in the setting of healed fracture after internal fixation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

In vivo impact testing on a lengthened femur with external fixation: a future option for the non-invasive monitoring of fracture healing?

PubMed

Mattei, Lorenza; Di Puccio, Francesca; Marchetti, Stefano

2018-05-01

Non-invasive methods for assessing fracture healing are crucial for biomedical engineers. An approach based on mechanical vibrations was tried out in the 1990s, but was soon abandoned due to insufficiently advanced technologies. The same approach is re-proposed in the present study in order to monitor the healing process of a lengthened femur with an external fixator. The pins screwed into the bone were exploited for the impact testing (IT) to excite the bone and capture its response. Transmission through the soft tissues was thus prevented, and the quality of the signals was improved. Impact tests were performed every three to four weeks for five months. Unfortunately, after seven weeks, some pins were removed due to infection, and thus, the system was modified. Two different configurations were considered: before and after pin removal. An additional configuration was examined in the last two sessions, when the fixator body was removed, while four pins were left in the femur. The evolution of the frequency response function and of the resonant frequencies of the system were analysed for the duration of the monitoring period. The IT results were compared to the indications provided by X-ray images. During the evolution of the callus from the soft phase to the woven bone, the resonant frequencies of the system were found to increase by approximately 2-3% per week. The largest increase (approx. 22%) was observed for the first resonant frequency. After formation of the woven bone, the vibratory response remained almost the same, suggesting that the healing assessment could be related to the relative variation in the resonant frequencies. The results presented support the application of the IT approach for fracture healing assessment. © 2018 The Author(s).

Enhanced bone-integration capability of alkali- and heat-treated nanopolymorphic titanium in micro-to-nanoscale hierarchy.

PubMed

Ueno, Takeshi; Tsukimura, Naoki; Yamada, Masahiro; Ogawa, Takahiro

2011-10-01

This study introduces nanopolymorphic features of alkali- and heat-treated titanium surfaces, comprising of tuft-like, plate-like, and nodular structures that are smaller than 100 nm and determines whether and how the addition of these nanofeatures to a microroughened titanium surface affects bone-implant integration. A comprehensive assessment of biomechanical, interfacial, and histological analyses in a rat model was performed for machined surfaces without microroughness, sandblasted-microroughened surfaces, and micro-nano hybrid surfaces created by sandblasting and alkali and heat treatment. The microroughened surface accelerated the establishment of implant biomechanical fixation at the early healing stage compared with the non-microroughened surface but did not increase the implant fixation at the late healing stage. The addition of the nanopolymorphic features to the microroughened surface further increased implant fixation throughout the healing time. The area of the new bone within 50 μm proximity of the implant surfaces, which was increased 2-3-fold using microroughened surfaces, was further increased 2-fold using nanopolymorphic surfaces. In contrast, the bone area in a 50-200 μm zone was not influenced by either microroughened or nanopolymorphic surfaces. The percentage of bone-implant contact, which was increased 4-5-fold, using microroughened surfaces, was further increased substantially by over 2-fold throughout the healing period. The percentage of soft tissue intervention between bone and implant surfaces, which was reduced to half by microroughened surfaces, was additionally reduced by the nanopolymorphic surfaces to between one-third and one-fourth, resulting in only 5-7% soft tissue intervention compared with 60-75% for the non-microroughened surface. Thus, using an exemplary alkali- and heat-treated nanopolymorphic surface, this study identified critical parameters necessary to describe the process and consequences of bone-implant integration, for which nanofeatures have specific and substantial roles beyond those of microfeatures. Nanofeature-enhanced osteoconductivity, which resulted in both the acceleration and elevation of bone-implant integration, has clearly been demonstrated. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Use of Mouse Models of Breast Cancer and Quantitative Image Analysis to Evaluate Hormone Receptor Antigenicity after Microwave-assisted Formalin Fixation

PubMed Central

Engelberg, Jesse A.; Giberson, Richard T.; Young, Lawrence J.T.; Hubbard, Neil E.

2014-01-01

Microwave methods of fixation can dramatically shorten fixation times while preserving tissue structure; however, it remains unclear if adequate tissue antigenicity is preserved. To assess and validate antigenicity, robust quantitative methods and animal disease models are needed. We used two mouse mammary models of human breast cancer to evaluate microwave-assisted and standard 24-hr formalin fixation. The mouse models expressed four antigens prognostic for breast cancer outcome: estrogen receptor, progesterone receptor, Ki67, and human epidermal growth factor receptor 2. Using pathologist evaluation and novel methods of quantitative image analysis, we measured and compared the quality of antigen preservation, percentage of positive cells, and line plots of cell intensity. Visual evaluations by pathologists established that the amounts and patterns of staining were similar in tissues fixed by the different methods. The results of the quantitative image analysis provided a fine-grained evaluation, demonstrating that tissue antigenicity is preserved in tissues fixed using microwave methods. Evaluation of the results demonstrated that a 1-hr, 150-W fixation is better than a 45-min, 150-W fixation followed by a 15-min, 650-W fixation. The results demonstrated that microwave-assisted formalin fixation can standardize fixation times to 1 hr and produce immunohistochemistry that is in every way commensurate with longer conventional fixation methods. PMID:24682322

Comparison of a novel fixation device with standard suturing methods for spinal cord stimulators.

PubMed

Bowman, Richard G; Caraway, David; Bentley, Ishmael

2013-01-01

Spinal cord stimulation is a well-established treatment for chronic neuropathic pain of the trunk or limbs. Currently, the standard method of fixation is to affix the leads of the neuromodulation device to soft tissue, fascia or ligament, through the use of manually tying general suture. A novel semiautomated device is proposed that may be advantageous to the current standard. Comparison testing in an excised caprine spine and simulated bench top model was performed. Three tests were performed: 1) perpendicular pull from fascia of caprine spine; 2) axial pull from fascia of caprine spine; and 3) axial pull from Mylar film. Six samples of each configuration were tested for each scenario. Standard 2-0 Ethibond was compared with a novel semiautomated device (Anulex fiXate). Upon completion of testing statistical analysis was performed for each scenario. For perpendicular pull in the caprine spine, the failure load for standard suture was 8.95 lbs with a standard deviation of 1.39 whereas for fiXate the load was 15.93 lbs with a standard deviation of 2.09. For axial pull in the caprine spine, the failure load for standard suture was 6.79 lbs with a standard deviation of 1.55 whereas for fiXate the load was 12.31 lbs with a standard deviation of 4.26. For axial pull in Mylar film, the failure load for standard suture was 10.87 lbs with a standard deviation of 1.56 whereas for fiXate the load was 19.54 lbs with a standard deviation of 2.24. These data suggest a novel semiautomated device offers a method of fixation that may be utilized in lieu of standard suturing methods as a means of securing neuromodulation devices. Data suggest the novel semiautomated device in fact may provide a more secure fixation than standard suturing methods. © 2012 International Neuromodulation Society.

Diagnosis of extraskeletal myxoid chondrosarcoma in the thigh using EWSR1-NR4A3 gene fusion: a case report.

PubMed

Kobayashi, Hiroki; Kikuta, Kazutaka; Sekita, Tetsuya; Susa, Michiro; Nishimoto, Kazumasa; Sasaki, Aya; Kameyama, Kaori; Sugita, Shintaro; Hasegawa, Tadashi; Nakamura, Masaya; Matsumoto, Morio; Morioka, Hideo

2016-11-10

Extraskeletal myxoid chondrosarcoma is a rare soft tissue sarcoma that has unusual ultrastructural and molecular features. However, unlike other soft tissue sarcomas, it does not have specific clinical symptoms or radiological features, which can make its diagnosis difficult. Nevertheless, extraskeletal myxoid chondrosarcoma has a rare gene fusion (EWSR1-NR4A3) that is useful for making a differential diagnosis. A 43-year-old Japanese man presented with a soft tissue mass in his right thigh. A physical examination and radiography revealed a large soft tissue mass. During magnetic resonance imaging, the mass exhibited isointensity on T1-weighted images and high intensity on T2-weighted images, as well as gadolinium enhancement at the side edge of the partition structure. Thus, we considered a possible diagnosis of a malignant myxoid soft tissue tumor, such as myxoid liposarcoma, myxofibrosarcoma, or metastatic carcinomas, including myoepithelial tumor and neuroendocrine tumor, and performed an incisional biopsy to make a definitive diagnosis. The pathological findings revealed a lobulated tumor with a myxoid structure and atypical spindle-shaped cells that created eosinophilic cord-like forms. Immunohistochemistry revealed that the tumor was positive for S-100 and negative for synaptophysin, chromogranin A, and pan keratin (AE1/AE3). The percentage of Ki-67 was 10 % in the hot spot area. Based on these clinicopathological findings, we initially considered the possibility of a myxoid liposarcoma, although we did not observe any lipoblasts. Therefore, we considered the possibility of an extraskeletal myxoid chondrosarcoma. As this tumor is very rare, we searched for the EWSR1-NR4A3 gene fusion using fluorescence in situ hybridization, which confirmed the diagnosis of extraskeletal myxoid chondrosarcoma. Positron emission tomography-computed tomography did not identify any obvious metastases, and we performed radical resection of our patient's vastus medialis and femur with a 3 cm margin. After the resection, we treated his resected femur using liquid nitrogen, and reconstructed his femur using autogenous fibula and plate fixation. No local recurrence or metastasis was observed at the 1-year follow-up. Genetic testing is useful for diagnosing extraskeletal myxoid chondrosarcoma based on the presence of the EWSR1-NR4A3 gene fusion.

Changing the facial features of patients with Treacher Collins syndrome: protocol for 3-stage treatment of hard and soft tissue hypoplasia in the upper half of the face.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Satoh, Kaneshige

2014-07-01

Treacher Collins syndrome is a disorder characterized by various congenital soft tissue anomalies involving hypoplasia of the zygoma, maxilla, and mandible. A variety of treatments have been reported to date. These treatments can be classified into 2 major types. The first type involves osteotomy for hard tissue such as the zygoma and mandible. The second type involves plastic surgery using bone grafting in the malar region and soft tissue repair of eyelid deformities. We devised a new treatment to comprehensively correct hard and soft tissue deformities in the upper half of the face of Treacher Collins patients. The aim was to "change facial features and make it difficult to tell that the patients have this disorder." This innovative treatment strategy consists of 3 stages: (1) placement of dermal fat graft from the lower eyelid to the malar subcutaneous area, (2) custom-made synthetic zygomatic bone grafting, and (3) Z-plasty flap transposition from the upper to the lower eyelid and superior repositioning and fixation of the lateral canthal tendon using a Mitek anchor system. This method was used on 4 patients with Treacher Collins syndrome who had moderate to severe hypoplasia of the zygomas and the lower eyelids. Facial features of these patients were markedly improved and very good results were obtained. There were no major complications intraoperatively or postoperatively in any of the patients during the series of treatments. In synthetic bone grafting in the second stage, the implant in some patients was in the way of the infraorbital nerve. Thus, the nerve was detached and then sutured under the microscope. Postoperatively, patients had almost full restoration of sensory nerve torpor within 5 to 6 months. We devised a 3-stage treatment to "change facial features" of patients with hypoplasia of the upper half of the face due to Treacher Collins syndrome. The treatment protocol provided a very effective way to treat deformities of the upper half of the face in patients with Treacher Collins syndrome.

[New techniques in the operative treatment of calcaneal fractures].

PubMed

Rammelt, S; Amlang, M; Sands, A K; Swords, M

2016-03-01

The ideal treatment of displaced intra-articular calcaneal fractures is still controversially discussed. Because of the variable fracture patterns and the vulnerable soft tissue coverage an individual treatment concept is advisable. In order to minimize wound edge necrosis associated with extended lateral approaches, selected fractures may be treated percutaneously or in a less invasive manner while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are slid in subcutaneously. A thorough knowledge of the three dimensional calcaneal anatomy and open reduction maneuvers is a prerequisite for good results with less invasive techniques. Early functional follow-up treatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.

Reconstruction of Long Bone Infections Using the Induced Membrane Technique: Tips and Tricks.

PubMed

Mauffrey, Cyril; Hake, Mark E; Chadayammuri, Vivek; Masquelet, Alain-Charles

2016-06-01

The management of posttraumatic long bone osteomyelitis remains a challenging clinical problem. A systematic approach is necessary, beginning with eradication of the infected bone and soft tissue. There are a number of options for reconstruction of the remaining bone defect, including the induced membrane technique developed by Masquelet. We describe our technique for the 2-stage treatment of long bone osteomyelitis. The first stage involves a radical debridement, stabilization of the bone with either external fixation or an antibiotic-coated intramedullary nail, and placement of a polymethylmethacrylate spacer. The second stage includes excision of the spacer and placement of autologous bone graft. Various resection methods, fixation strategies, antibiotic additives, and types of bone grafts or substitutes can be used. The purpose of our technical article is to share our personal experience and describe several nuances that are critical for the success of this treatment strategy. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Application of alternative fixatives to formalin in diagnostic pathology

PubMed Central

Gatta, L. Benerini; Cadei, M.; Balzarini, P.; Castriciano, S.; Paroni, R.; Verzeletti, A.; Cortellini, V.; De Ferrari, F.; Grigolato, P.

2012-01-01

Fixation is a critical step in the preparation of tissues for histopathology. The aim of this study was to investigate the effects of different fixatives vs formalin on proteins and DNA, and to evaluate alternative fixation for morphological diagnosis and nucleic acid preservation for molecular methods. Forty tissues were fixed for 24 h with six different fixatives: the gold standard fixative formalin, the historical fixatives Bouin and Hollande, and the alternative fixatives Greenfix, UPM and CyMol. Tissues were stained (Haematoxylin-Eosin, Periodic Acid Schiff, Trichromic, Alcian-blue, High Iron Diamine stainings), and their antigenicity was determined by immunohistochemistry (performed with PAN-CK, CD31, Ki-67, S100, CD68, AML antibodies). DNA extraction, KRAS sequencing, FISH for CEP-17, and flow cytometry analysis of nuclear DNA content were applied. For cell morphology the alternative fixatives (Greenfix, UPM, CyMol) were equivalent to formalin. As expected, Hollande proved to be the best fixative for morphology. The morphology obtained with Bouin was comparable to the one with formalin. Hollande was the best fixative for histochemistry. Bouin proved to be equivalent to formalin. The alternative fixatives were equivalent to formalin, although with greater variability in haematoxylin-eosin staining. It proved the possibility to obtain immunohistochemical staining largely equivalent to that following formalin-fixation with the following fixatives: Greenfix, Hollande, UPM and CyMol. The tissues fixed in Bouin did not provide results comparable to those obtained with formalin. The DNA extracted from samples fixed with alternative fixatives was found to be suitable for molecular analysis. PMID:22688293

Collecting and Storing Tissue, Blood, and Bone Marrow Samples From Patients With Rhabdomyosarcoma or Other Soft Tissue Sarcoma

ClinicalTrials.gov

2017-12-11

Adult Rhabdomyosarcoma; Childhood Desmoplastic Small Round Cell Tumor; Chordoma; Desmoid Tumor; Metastatic Childhood Soft Tissue Sarcoma; Nonmetastatic Childhood Soft Tissue Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Previously Untreated Childhood Rhabdomyosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Stage I Adult Soft Tissue Sarcoma; Stage II Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma

[Local fixation of antibiotics by fibrin spray : In bone defects with soft tissue involvement].

PubMed

Janko, Maren; Nau, Christoph; Marzi, Ingo; Frank, Johannes

2017-02-01

In acute and chronic bone infections with concomitant soft tissue involvement the current gold standard is radical surgical debridement including explantation of the infected prosthetic devices. This is followed by initiation of systemic antibiotic therapy appropriate for the antibiogram. Several revision operations are often necessary to achieve complete healing. Additional treatment with local antibiotics or antibiotic-containing substances is routinely used in bone surgery. Apart from the typical procedures with commercially available products, we have conducted a study with 21 patients by application of local antibiotic treatment in combination with the fibrin glue spray technique and evaluated the results. Out of nine wounds of the lower extremities with bone involvement, total healing could be achieved in eight cases. We were also successful in two out of three very complex pelvic wounds; however, as expected the implant infections were complicated. Out of the seven desolate cases we were only able to achieve complete long-term healing in two cases. In the meantime we routinely use the described method in such special disastrous infection situations; however, this is carried out only in combination with established surgical procedures in sepsis surgery and anti-infection management.

An effective fixative for glucocorticoid receptors in fetal tissues

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koga, T.; Kurisu, K.

1982-01-01

As a preliminary study in an autoradiographic study of glucocorticoid (GC) receptor localization in orofacial tissues of mouse fetuses, a search was made to determine the most effective fixative for preservation of the GC-receptor complex. Twelve-day-old mouse fetuses were administered tritiated triamcinolone acetonide (/sup 3/H-TAC) intraamniotically and subsequently processed by one of the following three procedures: freeze-drying, prefixation with Karnovsky's fixative, or the catechin fixative (Karnovsky's fixative containing 1% D-catechin) and postfixation with osmium tetroxide. Light microscopic autoradiography and liquid scintillation counting of the specimens revealed that the catechin fixative gave the best results for fixation of the steroid-receptor complexmore » and preservation of tissue structure. Light and electron microscopic autoradiographic studies of the time course of the localization of /sup 3/H-TAC in palatal shelves supported the catechin fixative as being the most effective in preservation of GC-receptor or ligand complexes.« less

Protocol for HER2 FISH Using a Non-cross-linking, Formalin-free Tissue Fixative to Combine Advantages of Cryo-preservation and Formalin Fixation

PubMed Central

Loibner, Martina; Oberauner-Wappis, Lisa; Viertler, Christian; Groelz, Daniel; Zatloukal, Kurt

2017-01-01

Morphologic assessment of formalin-fixed, paraffin-embedded (FFPE) tissue samples has been the gold standard for cancer diagnostics for decades due to its excellent preservation of morphology. Personalized medicine increasingly provides individually adapted and targeted therapies for characterized individual diseases enabled by combined morphological and molecular analytical technologies and diagnostics. Performance of morphologic and molecular assays from the same FFPE specimen is challenging because of the negative impact of formalin due to chemical modification and cross-linking of nucleic acids and proteins. A non-cross-linking, formalin-free tissue fixative has been recently developed to fulfil both requirements, i.e., to preserve morphology like FFPE and biomolecules like cryo-preservation. Since FISH is often required in combination with histopathology and molecular diagnostics, we tested the applicability of FISH protocols on tissues treated with this new fixative. We found that formalin post-fixation of histological sections of non-cross-linking, formalin-free and paraffin-embedded (NCFPE) breast cancer tissue generated equivalent results to those with FFPE tissue in human epidermal growth factor receptor 2 (HER2) FISH analysis. This protocol describes how a FISH assay originally developed and validated for FFPE tissue can be used for NCFPE tissues by a simple post-fixation step of histological sections. PMID:29364207

Effects of tissue fixation and dehydration on tendon collagen nanostructure.

PubMed

Turunen, Mikael J; Khayyeri, Hanifeh; Guizar-Sicairos, Manuel; Isaksson, Hanna

2017-09-01

Collagen is the most prominent protein in biological tissues. Tissue fixation is often required for preservation or sectioning of the tissue. This may affect collagen nanostructure and potentially provide incorrect information when analyzed after fixation. We aimed to unravel the effect of 1) ethanol and formalin fixation and 2) 24h air-dehydration on the organization and structure of collagen fibers at the nano-scale using small and wide angle X-ray scattering. Samples were divided into 4 groups: ethanol fixed, formalin fixed, and two untreated sample groups. Samples were allowed to air-dehydrate in handmade Kapton pockets during the measurements (24h) except for one untreated group. Ethanol fixation affected the collagen organization and nanostructure substantially and during 24h of dehydration dramatic changes were evident. Formalin fixation had minor effects on the collagen organization but after 12h of air-dehydration the spatial variation increased substantially, not evident in the untreated samples. Generally, collagen shrinkage and loss of alignment was evident in all samples during 24h of dehydration but the changes were subtle in all groups except the ethanol fixed samples. This study shows that tissue fixation needs to be chosen carefully in order to preserve the features of interest in the tissue. Copyright © 2017 Elsevier Inc. All rights reserved.

The innovative safe fixative for histology, histopathology, and immunohistochemistry techniques: "pilot study using shellac alcoholic solution fixative".

PubMed

Ali Jamal, Awatif; Abd El-Aziz, Gamal Said; Hamdy, Raid Mahmoud; Al-Hayani, Abdulmonem; Al-Maghrabi, Jaudah

2014-05-01

The concerns over health and workplace hazards of formalin fixative, joined to its cross-linking of molecular groups that results in suboptimal immunohistochemistry, led us to search for an innovative safe fixative. Shellac is a natural material which is used as a preservative in foods and pharmaceutical industries. This study was undertaken to evaluate the fixation adequacy and staining quality of histopathological specimens fixed in the "shellac alcoholic solution" (SAS), and also to determine the validity of immunohistochemical staining of SAS-fixed material in comparison to those fixed in formalin. Fresh samples from 26 cases from various human tissues were collected at the frozen section room of King Abdulaziz University Hospital, and fixed in SAS fixative or in neutral buffered formaldehyde (NBF) for 12, 18, 24, and 48 h, and processed for paraffin sectioning. Deparaffinized sections were stained with hematoxylin and eosin (H&E) and immunostained for different antigens. The tissues fixed in SAS for >18 h showed best staining quality of H&E comparable to NBF-fixed tissues. Comparison of the immunohistochemical staining of different tissues yielded nearly equivalent readings with good positive nuclear staining quality in both fixatives. These findings support the fixation and preservation adequacy of SAS. Furthermore, it was concluded that the good staining quality obtained with SAS-fixed tissues, which was more or less comparable with the quality obtained with the formalin fixed tissues, supports the validity of this new solution as a good innovative fixative. Copyright © 2014 Wiley Periodicals, Inc.

Isolated Limb Perfusion of Melphalan With or Without Tumor Necrosis Factor in Treating Patients With Soft Tissue Sarcoma of the Arm or Leg

ClinicalTrials.gov

2012-03-14

Stage IVB Adult Soft Tissue Sarcoma; Stage IIB Adult Soft Tissue Sarcoma; Stage IIC Adult Soft Tissue Sarcoma; Recurrent Adult Soft Tissue Sarcoma; Stage IVA Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma

Revision ulnar collateral ligament reconstruction using a suspension button fixation technique.

PubMed

Lee, Gregory H; Limpisvasti, Orr; Park, Maxwell C; McGarry, Michelle H; Yocum, Lewis A; Lee, Thay Q

2010-03-01

Revision ulnar collateral ligament reconstruction remains a challenging problem. The objective of this study was to biomechanically evaluate an ulnar collateral ligament reconstruction technique using a suspension button fixation technique that can be used even in the case of ulnar cortical bone loss. An ulnar suspension fixation technique for ulnar collateral ligament reconstruction can restore elbow kinematics and demonstrate failure strength comparable to that of currently available techniques. Controlled laboratory study. Nine pairs of cadaveric elbows were dissected free of soft tissue and potted. After simulating ulnar cortical bone loss, ulnar collateral ligament reconstruction was performed in 1 elbow of each pair using palmaris longus autograft and a 30-mm RetroButton suspended from the far (lateralmost) ulnar cortex. A docking technique was used for humeral fixation of the graft. Elbow valgus angle was quantified using a Microscribe 3DLX digitizer at multiple elbow flexion angles. Valgus angle was measured with the ulnar collateral ligament intact, transected, and reconstructed. In addition, load-to-failure testing was performed in 1 elbow of each pair. Release of the ulnar collateral ligament caused a significant increase in valgus angle at each flexion angle tested (P < .002). Reconstructed elbows demonstrated no significant differences in valgus angle from the intact elbow at all flexion angles tested. Load-to-failure tests showed that reconstructed elbows had an ultimate torque (10.3 + or - 5.7 N x m) significantly less than intact elbows (26.4 + or - 10.6 N x m) (P = .001). Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. Load-to-failure testing demonstrated comparable fixation strength to several historic controls of primary reconstruction techniques despite the simulated ulnar cortical bone loss. Ulnar collateral ligament reconstruction using a suspension button fixation technique can be considered in the case of ulnar cortical bone loss in a primary or revision setting.

Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

PubMed

Vesnaver, Ales

2008-10-01

Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

The concept and method of closed reduction and internal fixation: a new approach for the treatment of simple zygoma fractures.

PubMed

Uda, Hirokazu; Kamochi, Hideaki; Sugawara, Yasushi; Sarukawa, Syunji; Sunaga, Ataru

2013-11-01

The authors have developed a new minimally invasive surgical procedure for simple zygoma fractures, a closed reduction and internal fixation method, that uses a cannulated cortical screw system. From 2007 to 2012, 42 selected patients with simple zygoma fractures without ocular problems or shear at the zygomatic frontal portion were treated with this method. The mean age of the patients was 33 years (range, 13 to 77 years). The authors achieved good repositioning, equivalent to results achieved with conventional procedures in all cases. No notable complication occurred except for minor infection in two cases. Mean operative time was 32 minutes (range, 19 to 58 minutes). Postoperative relapse was found only in the posterior direction (p<0.001), but the distance of that was so small (mean, 0.47 mm) that it did not cause any problem clinically. Although further improvement might be needed, such as screw specification, the closed reduction and internal fixation method has many advantages: short operative time, less effect on soft tissue, maintenance of bone healing potential, and decreased postoperative pain and swelling. The authors concluded that this method has the potential to become a future surgical procedure for simple zygoma fractures. Therapeutic, IV.

Soft tissue management of children's open tibial fractures – a review of seventy children over twenty years

PubMed Central

Rao, P; Schaverien, MV; Stewart, KJ

2010-01-01

INTRODUCTION The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluate the management of paediatric open tibial fractures with particular regard to soft tissue management. PATIENTS AND METHODS A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005. RESULTS Seventy children were reviewed of whom 41 were males and 29 females. Overall, 91% (n = 64) of children suffered their injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was: Grade I, 42% (n = 29); Grade II, 24% (n = 17); Grade III, 34% (n = 24; 7 Grade 3a, 16 Grade 3b, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred (6%), one case of osteomyelitis and one case of flap failure. The limb salvage was greater than 98%. CONCLUSIONS In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fas-ciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children. PMID:20501017

Recent Developments in Ground-Borne Noise and Vibration Control

NASA Astrophysics Data System (ADS)

Nelson, J. T.

1996-05-01

Vibration control provisions available to the transit designer include (among others) precision straightened rail, ballast mats, floating slabs and very soft direct fixation fasteners, in addition to rail grinding, wheel truing, and continuous welded rail. Recently, the Los Angeles Metro has developed specifications for a soft resilient direct fixation fastener to fit the same base dimensions as the standard direct fixation fastener. In San Francisco, low resonance frequency (8 Hz) floating slabs have been constructed to mitigate predicted ground vibration impacts at nearby residential structures. In Atlanta, low resonance frequency loading slabs have been constructed to maintain a low vibration environment in a medical building planned to be built over the subway structure. In Portland and Pasadena, ballast mats have been recommended to control light rail transit ground vibration impacts on housing located at typically 35 feet from the alignment. Each of these provisions are briefly described in view of recent applications at U.S. transit systems.

Micromorphological and ultramicroscopic aspects of buried remains: Time-dependent markers of decomposition and permanence in soil in experimental burial.

PubMed

Zangarini, Sara; Trombino, Luca; Cattaneo, Cristina

2016-06-01

A buried body not only determines an environmental response at the deposition site but it is also affected by the soil. The experiment was performed using eleven swine carcasses buried in an open site (Northern Italy). Changes occurring in bone tissue at different post-burial intervals were evaluated observing thin sections of bones through micromorphological and ultramicroscopic (SEM-EDS) techniques. These methods allowed the identification of: (a) magnesium phosphate (Mg3(PO4)2) crystallizations, probably linked to decomposition of bones and soft tissues; (b) significant sulphur levels which seem to be related to hydrogen sulphide (H2S) fixation in bone tissue; (c) metal oxide concentrations in the form of unusual violet-blue colorations, which probably are evidence of the soil's action and penetration in bones, also testified by (d) the presence of mineral grains enclosed in the osseous tissue. The results underline the possibility of identifying both time-dependent markers of decomposition and indicators of permanence in soil in buried bones. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Treatment of metacarpal fractures].

PubMed

Prokop, A; Jubel, A; Helling, H J; Kulus, S; Rehm, K E

2002-09-01

Conservative treatment of metacarpal fractures is recommended if there is no joint displacement, malrotation, displacement of over 30 degrees ad axim and shortening of over 5 mm. Surgery should be performed in open fractures and serial fractures of metacarpal bone. Early functional treatment should be carried out in stable, not displaced fractures. A cast can be used for a short period in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60 - 90 degrees. Twin-tape fixation allows functional treatment after soft-tissue swelling has disappeared. Closed reduction of displaced fractures of the fifth metacarpal bone (boxer's fracture) is not successful. Cases with displacement of over 30 degrees may be treated surgically by intramedullary stabilisation.

Floating-Harbor syndrome associated with middle ear abnormalities.

PubMed

Hendrickx, Jan-Jaap; Keymolen, Kathelijn; Desprechins, Brigitte; Casselman, Jan; Gordts, Frans

2010-01-01

Floating-Harbor syndrome is a rare syndrome of unknown etiology, which was first described in 1973. A triad of main features characterizes Floating-Harbor syndrome: short stature, characteristic face, and an expressive speech delay. We present a patient in whom the hearing thresholds improved insufficiently after placement of grommets. High-resolution CT scan of the temporal bone showed a prominent soft-tissue thickening suspected of causing fixation of the malleus, and fusion of the malleus head with the body of the incus. To our knowledge this is the first reported abnormal middle ear anatomy in a patient with Floating-Harbor syndrome. A conservative treatment with hearing aids was preferred as an initial treatment in favor of a surgical exploration.

Vascularized Pedicled Fibula Onlay Bone Graft Augmentation for Complicated Tibiotalocalcaneal Arthrodesis With Retrograde Intramedullary Nail Fixation: A Case Series.

PubMed

Roukis, Thomas S; Kang, Rachel B

2016-01-01

Tibiotalocalcaneal arthrodesis stabilized with retrograde intramedullary nail fixation is associated with a high incidence of complications. This is especially true when performed with a bulk structural allograft and poor soft tissue quality. In select high-risk limb salvage cases, we have augmented tibiotalocalcaneal arthrodesis procedures stabilized using retrograde intramedullary nail fixation with a vascularized pedicled fibular onlay bone graft. We present the data from 10 such procedures with a mean follow-up period of 10.9 ± 5.4 (range 6 to 20) months involving 10 patients (9 males and 1 female). The etiology was avascular osteonecrosis of the talus and/or distal tibia and a resultant large volume cavitary bone defect (8 ankles), severe equinocavovarus contracture (1 ankle), and failed total ankle replacement (1 ankle). A frozen femoral head bulk allograft was used twice, a whole frozen talus allograft once, and a freeze-dried calcaneal allograft once. The fibula was mobilized with intact musculoperiosteal perforating branches of the peroneal artery as a vascularized pedicle onlay bone graft fixated with a screw and washer construct. The mean fibular graft length was 10.2 ± 2.3 cm. The mean interval to radiographic fusion was 2.6 ± 0.6 months and to weightbearing was 3.1 ± 1.4 months. Two stable bulk allograft-host bone and fibular graft-host bone nonunions occurred after intramedullary nail hardware failure. Tibiotalocalcaneal arthrodesis augmented by vascularized pedicled fibular graft stabilized with retrograde compression intramedullary nail fixation offers a reliable option for complex salvage situations when few other options exist. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures.

PubMed

Tu, Kai-Kai; Zhou, Xian-Ting; Tao, Zhou-Shan; Chen, Wei-Kai; Huang, Zheng-Liang; Sun, Tao; Zhou, Qiang; Yang, Lei

2015-12-01

Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

A New Antigen Retrieval Technique for Human Brain Tissue

PubMed Central

Byne, William; Haroutunian, Vahram; García-Villanueva, Mercedes; Rábano, Alberto; García-Amado, María; Prensa, Lucía; Giménez-Amaya, José Manuel

2008-01-01

Immunohistochemical staining of tissues is a powerful tool used to delineate the presence or absence of an antigen. During the last 30 years, antigen visualization in human brain tissue has been significantly limited by the masking effect of fixatives. In the present study, we have used a new method for antigen retrieval in formalin-fixed human brain tissue and examined the effectiveness of this protocol to reveal masked antigens in tissues with both short and long formalin fixation times. This new method, which is based on the use of citraconic acid, has not been previously utilized in brain tissue although it has been employed in various other tissues such as tonsil, ovary, skin, lymph node, stomach, breast, colon, lung and thymus. Thus, we reported here a novel method to carry out immunohistochemical studies in free-floating human brain sections. Since fixation of brain tissue specimens in formaldehyde is a commonly method used in brain banks, this new antigen retrieval method could facilitate immunohistochemical studies of brains with prolonged formalin fixation times. PMID:18852880

Inactivation of Influenza A virus, Adenovirus, and Cytomegalovirus with PAXgene tissue fixative and formalin.

PubMed

Kap, Marcel; Arron, Georgina I; Loibner, M; Hausleitner, Anja; Siaulyte, Gintare; Zatloukal, Kurt; Murk, Jean-Luc; Riegman, Peter

2013-08-01

Formalin fixation is known to inactivate most viruses in a vaccine production context, but nothing is published about virus activity in tissues treated with alternative, non-crosslinking fixatives. We used a model assay based on cell culture to test formalin and PAXgene Tissue fixative for their virus-inactivating abilities. MDCK, A549, and MRC-5 cells were infected with Influenza A virus, Adenovirus, and Cytomegalovirus, respectively. When 75% of the cells showed a cytopathic effect (CPE), the cells were harvested and incubated for 15 min, or 1, 3, 6, or 24 hours, with PBS (positive control), 4% formalin, or PAXgene Tissue Fix. The cells were disrupted and the released virus was used to infect fresh MDCK, A549, and MRC-5 cells cultured on cover slips in 24-well plates. The viral cultures were monitored for CPE and by immunocytochemistry (ICC) to record viral replication and infectivity. Inactivation of Adenovirus by formalin occurred after 3 h, while Influenza A virus as well as Cytomegalovirus were inactivated by formalin after 15 min. All three virus strains were inactivated by PAXgene Tissue fixative after 15 min. We conclude that PAXgene Tissue fixative is at least as effective as formalin in inactivating infectivity of Influenza A virus, Adenovirus, and Cytomegalovirus.

Talimogene Laherparepvec and Radiation Therapy in Treating Patients With Newly Diagnosed Soft Tissue Sarcoma That Can Be Removed by Surgery

ClinicalTrials.gov

2018-05-23

FNCLCC Sarcoma Grade 2; FNCLCC Sarcoma Grade 3; Leiomyosarcoma; Liposarcoma; Stage I Soft Tissue Sarcoma AJCC v7; Stage IA Soft Tissue Sarcoma AJCC v7; Stage IB Soft Tissue Sarcoma AJCC v7; Stage II Soft Tissue Sarcoma AJCC v7; Stage IIA Soft Tissue Sarcoma AJCC v7; Stage IIB Soft Tissue Sarcoma AJCC v7; Undifferentiated Pleomorphic Sarcoma

Knee arthrodesis with lengthening: experience of using Ilizarov techniques to salvage large asymmetric defects following infected peri-articular fractures.

PubMed

Barwick, Thomas W; Montgomery, Richard J

2013-08-01

We present four patients with large bone defects due to infected internal fixation of knee condylar fractures. All were treated by debridement of bone and soft tissue and stabilisation with flap closure if required, followed by bone transport arthrodesis of the knee with simultaneous lengthening. Four patients (three male and one female), mean age 46.5 years (37-57 years), with posttraumatic osteomyelitis at the knee (three proximal tibia and one distal femur) were treated by debridement of infected tissue and removal of internal fixation. Substantial condylar bone defects resulted on the affected side of the knee joint (6-10 cm) with loss of the extensor mechanism in all tibial cases. Two patients required muscle flaps after debridement. All patients received intravenous antibiotics for at least 6 weeks. Bone transport with a circular frame was used to achieve an arthrodesis whilst simultaneously restoring a functional limb length. In three cases a 'peg in socket' docking technique was fashioned to assist stability and subsequent consolidation of the arthrodesis. Arthrodesis of the knee, free of recurrent infection, was successfully achieved in all cases. None has since required further surgery. Debridement to union took an average of 25 months (19-31 months). The median number of interventions undertaken was 9 (8-12). Two patients developed deep vein thrombosis (DVT), one complicated by PE, which delayed treatment. Two required surgical correction of pre-existent equinus contracture using frames. The median limb length discrepancy (LLD) at the end of treatment was 3 cm (3-4 cm). None has required subsequent amputation. Bone loss and infection both reduce the success rate of any arthrodesis. However, by optimising the host environment with eradication of infection by radical debridement, soft-tissue flaps when necessary and bone transport techniques to close the defect, one can achieve arthrodesis and salvage a useful limb. The residual LLD can result from not accounting for later impaction at peg and socket sites, which had the effect of increasing LLD beyond the desirable amount. We therefore recommend continuing the lengthening for an additional 1-2 cm to allow for this. Copyright © 2013 Elsevier Ltd. All rights reserved.

The management of open tibial fractures in children: a retrospective case series of eight years' experience of 61 cases at a paediatric specialist centre.

PubMed

Nandra, R S; Wu, F; Gaffey, A; Bache, C E

2017-04-01

Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between 2007 and 2015 presented with an open tibia fracture. Their mean age was nine years (2 to 16) and the median follow-up was ten months (interquartile range 5 to 18). Management involved IV antibiotics, early debridement and combined treatment of the skeletal and soft-tissue injuries in line with standards proposed by the British Orthopaedic Association. There were 36 diaphyseal fractures and 25 distal tibial fractures. Of the distal fractures, eight involved the physis. Motor vehicle collisions accounted for two thirds of the injuries and 38 patients (62%) arrived outside of normal working hours. The initial method of stabilisation comprised: casting in nine cases (15%); elastic nailing in 19 (31%); Kirschner (K)-wiring in 13 (21%); intramedullary nailing in one (2%); open reduction and plate fixation in four (7%); and external fixation in 15 (25%). Wound management comprised: primary wound closure in 24 (39%), delayed primary closure in 11 (18%), split skin graft (SSG) in eight (13%), local flap with SSG in 17 (28%) and a free flap in one. A total of 43 fractures (70%) were Gustilo-Anderson grade III. There were four superficial (6.6%) and three (4.9%) deep infections. Two deep infections occurred following open reduction and plate fixation and the third after K-wire fixation of a distal fracture. No patient who underwent primary wound closure developed an infection. All the fractures united, although nine patients required revision of a mono-lateral to circular frame for delayed union (two) or for altered alignment or length (seven). The mean time to union was two weeks longer in diaphyseal fractures than in distal fractures (13 weeks versus 10.8 weeks, p = 0.016). Children aged > 12 years had a significantly longer time to union than those aged < 12 years (16.3 weeks versus 11.4 weeks, p = 0.045). The length of stay in hospital for patients with a Gustilo-Anderson grade IIIB fracture was twice as long as for less severe injuries. Fractures in children heal better than those in adults. Based on our experience of deep infection we discourage the use of internal fixation with a plate for open tibial fractures in children. We advocate aggressive initial wound debridement in theatre with early definitive combined orthopaedic and plastic surgery in order to obtain skeletal stabilisation and soft-tissue cover. Cite this article: Bone Joint J 2017;99-B:544-53. ©2017 The British Editorial Society of Bone & Joint Surgery.

[Micro-computed tomography of the vasculature in parenchymal organs and lung alveoli].

PubMed

Langheinrich, A C; Bohle, R M; Breithecker, A; Lommel, D; Rau, W S

2004-09-01

Micro-CT has become a powerful technique in non-destructive 3D imaging and morphometric analysis. First results were limited to the investigation of osteoporosis in cancellous bone. But the availability of systems with almost microscopic resolution and sufficient soft tissue contrast has opened up entirely new applications for laboratory investigation of blood vessels and soft tissues. This article gives an overview of micro-CT technology and the potential of three-dimensional imaging of the vessel wall and soft-tissue architecture imaging in different organs using different contrast perfusion and staining techniques. Micro-CT provides quantitative information on human plaque morphology equivalent to histomorphometric analysis. Based on differences in grey-scale attenuations, micro-CT also correctly identifies atherosclerotic lesions that are histologically classified as fibrous plaques, calcified lesions, fibroatheroma, and lipid rich lesions. Micro-CT is a promising method to visualize the architecture of the renal vasculature and, importantly, to separate cortex and medulla for the visualization of glomeruli and their afferent and efferent arterioles. Micro-CT can determine the vascular surface in a defined placental volume. Combining of micro-CT data and total placental volume enables an estimation of the approximate surface of the placental vasculature. The diameter of opacified vessels in the investigated samples ranged from 2 mm (chorion plate artery) to 14 micro m (smallest vessel diameter, terminal loop). Recognizing that lung parenchyma can only be visualized if the alveoli are completely expanded and the contrast of the thin alveolar walls is enhanced, we tested two preparation methods: (1) fixation of lung tissue with formalin vapour and staining with silver nitrate, and (2) intravenous injection of a barium sulfate-gelatine-thymol mixture in vivo in the anesthetized animal. We evaluated the ability of this mixture to enter the pulmonary microcirculation and the technical feasibility of micro-CT to assess lung micro-architecture.

Sorafenib in Treating Patients With Soft Tissue Sarcomas (Extremity Sarcoma Closed to Entry as of 5/30/07)

ClinicalTrials.gov

2014-04-01

Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Metastatic Osteosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Osteosarcoma; Stage I Adult Soft Tissue Sarcoma; Stage II Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma

Outcome Analysis following Operative Skeletal Stabilization in Established Non Unions of Malleolar Fractures - A Series of 11 Cases.

PubMed

Balasubramanian, Navin; Babu, Ganesh; Prakasam, Sindhuja

2015-01-01

Established non-unions pose a real nightmare for even the most accomplished surgeon. The variations in anatomy due to extensive fibrous tissue growth, soft tissue contractures around the fracture site and bony alterations like smoothening and sclerosis of the fracture ends must each be addressed as a whole if good outcome is to be expected. Here we present a series of 11 patients who had bimalleolar fracture of the ankle following which they had native splinting. These patients presented to us with established non-union. There were 7 males and 4 females in the study. The average age was 44.63 years. Ten out of the 11 patients went on to union (90.1%) following internal fixation with or without immobilization in a plaster cast at an average of 13.8 weeks (range 12-17 weeks). The remaining patient did not progress to union and was advised revision fixation but she refused. She was put on an ankle foot orthoses and mobilized with satisfactory results. There was no infection in any of the patients. Two patients had delayed wound healing with delayed suture removal at 18 days. Weight bearing was started at the end of 16 weeks in all the patients. All patients were assessed using the Karlsson and Peterson functional score for the ankle. Six patients had excellent outcome, 3 had good outcome, 2 had fair with one patient having poor functional result. We conclude that open reduction internal fixation +/- bone grafting provides excellent union rates and good functional results in even the most established non unions of bimalleolar fractures of the ankle.

RCL2, a potential formalin substitute for tissue fixation in routine pathological specimens.

PubMed

Masir, Noraidah; Ghoddoosi, Mahdiieh; Mansor, Suhada; Abdul-Rahman, Faridah; Florence, Chandramaya S; Mohamed-Ismail, Nor Azlin; Tamby, Mohammad-Rafaee; Md-Latar, Nani Harlina

2012-04-01

To investigate RCL2 as a fixative for tissue fixation in routine histopathological examination and to assess tissue suitability for ancillary investigations.   Forty-nine samples from 36 fresh specimens were cut into three equal pieces and fixed in RCL2 diluted in 100% ethanol, RCL2 in 95% ethanol, or neutral buffered formalin as control. Suitability for microtomy, quality of histomorphology, histochemistry, immunohistochemistry, fluorescent and silver in-situ hybridization analysis and extracted genomic DNA were assessed. Microtomy was straightforward in most tissue blocks, but there was difficulty in cutting in approximately a quarter of samples, which required careful handling by an experienced technician. There were no significant differences in tissue morphology between RCL2- and formalin-fixed tissues (P=0.08). Generally, the quality of histochemical staining, immunohistochemistry and in-situ hybridization were comparable to that of formalin-fixed tissues. Inconsistent immunoreactivity was noted, however, with antibodies against pan-cytokeratin and progesterone receptor. Genomic DNA concentration was higher in RCL2-fixed tissues. Using RCL2 diluted in 95% ethanol did not affect fixation quality. RCL2 is a potential formalin substitute suitable as a fixative for use in routine histopathological examination; however, difficulty in microtomy and occasional discrepancies in immunohistochemical reactivity require further optimization of the methodology. © 2012 Blackwell Publishing Ltd.

Marked and variable inhibition by chemical fixation of cytochrome oxidase and succinate dehydrogenase in single motoneurons

NASA Technical Reports Server (NTRS)

Chalmers, G. R.; Edgerton, V. R.

1989-01-01

The effect of tissue fixation on succinate dehydrogenase and cytochrome oxidase activity in single motoneurons of the rat was demonstrated using a computer image processing system. Inhibition of enzyme activity by chemical fixation was variable, with some motoneurons being affected more than others. It was concluded that quantification of enzymatic activity in chemically fixed tissue provides an imprecise estimate of enzyme activities found in fresh-frozen tissues.

Observation, Radiation Therapy, Combination Chemotherapy, and/or Surgery in Treating Young Patients With Soft Tissue Sarcoma

ClinicalTrials.gov

2017-09-07

Adult Alveolar Soft-part Sarcoma; Adult Angiosarcoma; Adult Epithelioid Sarcoma; Adult Extraskeletal Chondrosarcoma; Adult Extraskeletal Osteosarcoma; Adult Fibrosarcoma; Adult Leiomyosarcoma; Adult Liposarcoma; Adult Malignant Fibrous Histiocytoma; Adult Malignant Hemangiopericytoma; Adult Malignant Mesenchymoma; Adult Neurofibrosarcoma; Adult Synovial Sarcoma; Childhood Alveolar Soft-part Sarcoma; Childhood Angiosarcoma; Childhood Epithelioid Sarcoma; Childhood Fibrosarcoma; Childhood Leiomyosarcoma; Childhood Liposarcoma; Childhood Malignant Mesenchymoma; Childhood Neurofibrosarcoma; Childhood Synovial Sarcoma; Dermatofibrosarcoma Protuberans; Metastatic Childhood Soft Tissue Sarcoma; Nonmetastatic Childhood Soft Tissue Sarcoma; Stage I Adult Soft Tissue Sarcoma; Stage II Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma

Elimination of Aesthetic Deformations of the Midface Area Our Experience.

PubMed

Sulamanidze, Marlen; Sulamanidze, George; Sulamanidze, Constantin

2018-06-01

The aesthetic manifestations of the aging process in the cheekbone, cheek and infraorbital areas are especially concerning for patients, so rejuvenating interventions in these areas are most in demand. To introduce the experience of our clinic for aesthetic manipulation using Aptos (anti-ptosis) thread lifting methods in the midface area. Among the surgical interventions that we used were Aptos thread lifting methods both in combination with lower blepharoplasty, and without it. At the same time, special attention was paid to the individual approach, trying to minimize invasiveness and, most importantly, trying to achieve the effect of moving subcutaneous soft tissues to a new, more advantageous position from an aesthetic point of view, with their fixation to dense structures. The results of application of the presented methods to lift the cheek-zygomatic and infraorbital regions using Aptos methods were studied. In the overwhelming majority of cases, the results satisfied both surgeons and patients. Aptos methods for lifting the midface soft tissues, which we used, are quite effective for rejuvenating the aging face. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An electromechanical based deformable model for soft tissue simulation.

PubMed

Zhong, Yongmin; Shirinzadeh, Bijan; Smith, Julian; Gu, Chengfan

2009-11-01

Soft tissue deformation is of great importance to surgery simulation. Although a significant amount of research efforts have been dedicated to simulating the behaviours of soft tissues, modelling of soft tissue deformation is still a challenging problem. This paper presents a new deformable model for simulation of soft tissue deformation from the electromechanical viewpoint of soft tissues. Soft tissue deformation is formulated as a reaction-diffusion process coupled with a mechanical load. The mechanical load applied to a soft tissue to cause a deformation is incorporated into the reaction-diffusion system, and consequently distributed among mass points of the soft tissue. Reaction-diffusion of mechanical load and non-rigid mechanics of motion are combined to govern the simulation dynamics of soft tissue deformation. An improved reaction-diffusion model is developed to describe the distribution of the mechanical load in soft tissues. A three-layer artificial cellular neural network is constructed to solve the reaction-diffusion model for real-time simulation of soft tissue deformation. A gradient based method is established to derive internal forces from the distribution of the mechanical load. Integration with a haptic device has also been achieved to simulate soft tissue deformation with haptic feedback. The proposed methodology does not only predict the typical behaviours of living tissues, but it also accepts both local and large-range deformations. It also accommodates isotropic, anisotropic and inhomogeneous deformations by simple modification of diffusion coefficients.

Landing on your own two feet: a case report of bilateral calcaneus and open pilon fractures.

PubMed

Tiedeken, Nathan C; Hampton, David; Shaffer, Gene

2014-01-01

High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Imaging of childhood torticollis due to atlanto-axial rotatory fixation.

PubMed

Maheshwaran, S; Sgouros, S; Jeyapalan, K; Chapman, S; Chandy, J; Flint, G

1995-12-01

Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and "cock robin" deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.

Resorbable fixation in facial plastic and head and neck reconstructive surgery: an initial report on polylactic acid implants.

PubMed

Moe, K S; Weisman, R A

2001-10-01

The purpose of this study was to evaluate and report our initial experience with a resorbable fixation system in facial cosmetic and head and neck reconstructive surgery. The specific goals were to determine in which settings the absorbable system could be used, to evaluate the outcome of its use, to detail complications that occurred, and to report our observations on advantages and disadvantages of the system compared with traditional methods of osteosynthesis and fixation. A retrospective review of the initial 30 consecutive patients at the University of California, San Diego Division of Head and Neck Surgery who received polylactic acid (PLA) implants. Academic tertiary referral/level I trauma center. Criteria for inclusion into the study were any patient over age 18 who underwent a procedure involving the use of a PLA implant between March 1999 and October 2000. In addition to the typical indications for metal plate or mesh implantation, PLA was used for "protected bone regeneration." Detailed records were kept of all patients in whom PLA implants were used, including the exact procedure and type of implant. All patients were operated by the authors. Operative reports, hospital charts, and office records were analyzed for any perioperative or postoperative complications. The attending surgeon noted advantages and disadvantages of the system. Patients have been followed from 2 to 18 months at the time of this report and are part of an ongoing long-term follow-up study. PLA implants were used in 35 procedures on 30 consecutive patients (multiple unilateral fracture repairs were counted as a single procedure). Uses included fixation of craniofacial fractures (zygomaticomaxillary, orbit floor, frontal bone [N = 9]; fixation of craniofacial osteotomy [N = 8]; protected bone regeneration [N = 3]; mandible, cranial bone donor site [N = 2]; bone grafting [N = 2]; craniectomy reconstruction [N = 2], and soft tissue suspension [endoscopic browlifting, N = 6, static facial suspension, N = 1]). There were 4 complications in this series: 2 partial flap losses, 1 in a patient who had had preoperative radiation and the other in a heavy smoker; 1 infected cranial bone flap in a patient who had had two prior surgeries and radiation; and 1 wound dehiscence over a plate that was improperly contoured. Advantages noted by the surgeons were ease of contouring the mesh or plates, including in situ reshaping, apparent decrease in operative time, low implant profile, minimal soft tissue reaction, and radiolucency of the system, allowing postoperative imaging without metallic artifact. We found the PLA system to be highly effective, and noted no absolute contraindications to its use compared with standard metal plating systems. The 11% incidence of complications in this series was acceptable and probably not the result of the PLA implant material, although further experience is needed to determine the role of PLA implants in radiated tissue. The primary advantages to PLA appear to be its ease of use, radiolucency, eventual resorption, and, possibly, improved precision of reduction. The use in protected bone regeneration may also be an advantage, but long-term follow-up of our population will be needed to determine this. Based on short-term outcome analysis of our initial experience with PLA implantation, it appears to be an efficacious and safe technology for applications in head and neck and facial plastic surgery.

A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients.

PubMed

White, T O; Bugler, K E; Appleton, P; Will, E; McQueen, M M; Court-Brown, C M

2016-09-01

The fundamental concept of open reduction and internal fixation (ORIF) of ankle fractures has not changed appreciably since the 1960s and, whilst widely used, is associated with complications including wound dehiscence and infection, prominent hardware and failure. Closed reduction and intramedullary fixation (CRIF) using a fibular nail, wires or screws is biomechanically stronger, requires minimal incisions, and has low-profile hardware. We hypothesised that fibular nailing in the elderly would have similar functional outcomes to standard fixation, with a reduced rate of wound and hardware problems. A total of 100 patients (25 men, 75 women) over the age of 65 years with unstable ankle fractures were randomised to undergo standard ORIF or fibular nailing (11 men and 39 women in the ORIF group, 14 men and 36 women in the fibular nail group). The mean age was 74 years (65 to 93) and all patients had at least one medical comorbidity. Complications, patient related outcome measures and cost-effectiveness were assessed over 12 months. Significantly fewer wound infections occurred in the fibular nail group (p = 0.002). At one year, there was no evidence of difference in mean functional scores (Olerud and Molander Scores 63; 30 to 85, versus 61; 10 to 35, p = 0.61) or scar satisfaction. The overall cost of treatment in the fibular nail group was £91 less than in the ORIF group despite the higher initial cost of the implant. We conclude that the fibular nail allows accurate reduction and secure fixation of ankle fractures, with a significantly lower rate of soft-tissue complications, and is more cost-effective than ORIF. Cite this article: Bone Joint J 2016;98-B:1248-52. ©2016 The British Editorial Society of Bone & Joint Surgery.

Perioperative management of external fixation in staged protocols: an international survey.

PubMed

Hodel, Sandro; Link, Björn-Christian; Babst, Reto; Mallee, W H; Posso, Philippe; Beeres, Frank J P

2018-05-01

Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities. A 26-question survey was sent to 170 members of the Traumaplatform. The survey included questions concerning demographics, level of training, type of training and perioperative protocols as: antibiotic prophylaxis, intraoperative management, disinfection and postoperative pin site care. All responses were statistically analysed, and intraoperative measures rated on a 5-point Likert scale. The responses of fifty orthopaedic trauma and general surgeons (response rate, 29.4%) were analysed. The level of experience was more than 5 years in 92% (n = 46) with up to 50 closed fractures of the extremities annually treated with external fixation in 80% (n = 40). Highest consensus could be identified in the following perioperative measures: preoperative antibiotic prophylaxis with a second-generation cephalosporin (86%, n = 43), changing gloves if manipulation of the external fixator is necessary during surgery (86%, n = 43; 4.12 points on the Likert scale), avoid overlapping of the pin sites with the definitive implant site (94%, n = 47; 4.12 points on the Likert scale) and soft tissue protection with a drill sleeve (83.6%, n = 41). Our survey could identify some general principles, which were rated as important by a majority of the respondents. Futures studies' focus should elucidate the role of perioperative antibiotics and different disinfection protocols on implant-associated infections after temporary external fixation in staged protocols. This study provides Level IV evidence according to Oxford centre for evidence-based medicine.

Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population.

PubMed

Joshi, Deepak; Gupta, Lalit Mohan; Tanwar, Milind; Lal, Ajay; Chaudhary, Deepak

2018-03-01

Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology. To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results. This study also intended to establish whether computed tomography measurements correlate with actual anthropometric measurements. Cross-sectional study; Level of evidence, 3. A total of 64 participants with 108 healthy shoulders were included in this study. Additionally, 100 skeletally mature bone specimens of the scapula were measured to assess glenoid diameter as well as coracoid width and length in 2 perpendicular planes with a humeral subtraction 3-dimensional en face glenoid view. Specimen and participant measurements proved that the congruent arc technique was able to fill up to 50% more glenoid bone loss than the classical technique in an Indian population (mean ± SD, 13.45 ± 6.97 vs 7.96 ± 4.89 mm, respectively), with computed tomography being the best and most accurate modality to study it. The mean difference in the bone block length restoration of the glenoid bony arc was 5.41 ± 2.08 mm. Radii of curvature were congruent in populations of the Indian subcontinent. The congruent arc technique can be performed in an Indian population but with caution and careful presurgical assessment of bone loss. However, adequate coracoid dimension to accommodate the implant for fixation without failure must be ensured, as anthropometry suggests the existence of a subset of the population in whom the graft may have compromised width for accommodating standard implants for fixation.

Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study

PubMed Central

Suri, Harpreet Singh; Gangrade, Kewal

2016-01-01

Introduction High energy intra-articular fractures involving the tibial plateau causes various problems related to management like wound dehiscence, severe comminution leading to malalignment and delayed complications like varus collapse, implant failure and arthritis of knee joint. Aim This study was done to determine functional, radiological outcome and the complications of Schatzker V and VI tibial plateau fractures treated with bipillar plating with dual plates with a regular follow-up of atleast 3 years. Materials and Methods Total 34 cases of tibial plateau fracture type V and VI treated with dual plating were studied from January 2011 to December 2013 in KIMS Hospital were followed for minimum of 3 years. The patients were operated through an anterolateral approach for lateral plate and a medial column plate was put through a minimally invasive medial approach or an open posteromedial approach. Results Total 34 patients were evaluated postoperatively thoroughly for functional outcome using The Knee Society Score and radiological outcomes by Modified Rasmussen Assessment criteria which showed 29 patients (85.29%) had excellent and 5 patients (14.71%) had good objective knee society score. 24 patients (70.59%) had excellent, 8 patients (23.53%) had good and 1patient (2.94%) were each of poor and fair functional knee society score. Eleven patients (32.35%) had excellent, 21patients (61.76%) had good and 2 patients (5.88%) had fair radiological outcome. Conclusion We conclude that open reduction and internal fixation of high-energy tibial plateau fractures with dual plates via 2 incisions gives excellent to good functional outcome with minimal soft tissue complications. Thus, a minimally invasive approach should be used which helps in preventing soft tissue problems and helps in early wound healing. Fixation done by bipillar plating is important for early mobilization of knee joint. Early mobilization leads to better range of movements and thereby better functional outcome. PMID:27437315

Diode laser soft-tissue surgery: advancements aimed at consistent cutting, improved clinical outcomes.

PubMed

Romanos, Georgios E

2013-01-01

Laser dentistry and soft-tissue surgery, in particular, have become widely adopted in recent years. Significant cost reductions for dental lasers and the increasing popularity of CADCAM, among other factors, have contributed to a substantial increase in the installed base of dental lasers, especially soft-tissue lasers. New development in soft-tissue surgery, based on the modern understanding of laser-tissue interactions and contact soft-tissue surgery mechanisms, will bring a higher quality and consistency level to laser soft-tissue surgery. Recently introduced diode-laser technology enables enhanced control of side effects that result from tissue overheating and may improve soft-tissue surgical outcomes.

Weigners fixative-an alternative to formalin fixation for histology with improved preservation of nucleic acids.

PubMed

Klopfleisch, R; von Deetzen, M; Weiss, A Th; Weigner, J; Weigner, F; Plendl, J; Gruber, A D

2013-01-01

Formalin fixation and paraffin embedding (FFPE) is the standard method for tissue storage in histopathology. However, FFPE has disadvantages in terms of user health, environment, and nucleic acid integrity. Weigners fixative has been suggested as an alternative for embalming cadavers in human and veterinary anatomy. The present study tested the applicability of Weigners for histology and immunohistochemistry and the preservation of nucleic acids. To this end, a set of organs was fixed for 2 days and up to 6 months in Weigners (WFPE) or formalin. WFPE tissues from the skin, brain, lymphatic tissues, liver, and muscle had good morphologic preservation, comparable to formalin fixation. The quality of kidney and lung samples was inferior to FFPE material due to less accentuated nuclear staining and retention of proteinaceous interstitial fluids. Azan, Turnbull blue, toluidin, and immunohistochemical stainings for CD79a, cytokeratin, vimentin, and von Willebrand factor led to comparable results with both fixates. Of note, immunohistochemical detection of CD3 was possible after 6 months in WFPE but not in FFPE tissues. mRNA, miRNA, and DNA from WFPE tissues had superior quality and allowed for amplification of miRNA, 400-bp-long mRNA, and 1000-bp-long DNA fragments after 6 months of fixation in WFPE. In summary, Weigners fixative is a nonhazardous alternative to formalin, which provides a good morphologic preservation of most organs, a similar sensitivity for protein detection, and a superior preservation of nucleic acids. Weigners may therefore be a promising alternative to cryopreservation and may be embraced by people affected by formalin allergies.

Histological Assessment of PAXgene Tissue Fixation and Stabilization Reagents

PubMed Central

Kap, Marcel; Smedts, Frank; Oosterhuis, Wolter; Winther, Rosa; Christensen, Nanna; Reischauer, Bilge; Viertler, Christian; Groelz, Daniel; Becker, Karl-Friedrich; Zatloukal, Kurt; Langer, Rupert; Slotta-Huspenina, Julia; Bodo, Koppany; de Jong, Bas; Oelmuller, Uwe; Riegman, Peter

2011-01-01

Within SPIDIA, an EC FP7 project aimed to improve pre analytic procedures, the PAXgene Tissue System (PAXgene), was designed to improve tissue quality for parallel molecular and morphological analysis. Within the SPIDIA project promising results were found in both genomic and proteomic experiments with PAXgene-fixed and paraffin embedded tissue derived biomolecules. But, for this technology to be accepted for use in both clinical and basic research, it is essential that its adequacy for preserving morphology and antigenicity is validated relative to formalin fixation. It is our aim to assess the suitability of PAXgene tissue fixation for (immuno)histological methods. Normal human tissue specimens (n = 70) were collected and divided into equal parts for fixation either with formalin or PAXgene. Sections of the obtained paraffin-embedded tissue were cut and stained. Morphological aspects of PAXgene-fixed tissue were described and also scored relative to formalin-fixed tissue. Performance of PAXgene-fixed tissue in immunohistochemical and in situ hybridization assays was also assessed relative to the corresponding formalin-fixed tissues. Morphology of PAXgene-fixed paraffin embedded tissue was well preserved and deemed adequate for diagnostics in most cases. Some antigens in PAXgene-fixed and paraffin embedded sections were detectable without the need for antigen retrieval, while others were detected using standard, formalin fixation based, immunohistochemistry protocols. Comparable results were obtained with in situ hybridization and histochemical stains. Basically all assessed histological techniques were found to be applicable to PAXgene-fixed and paraffin embedded tissue. In general results obtained with PAXgene-fixed tissue are comparable to those of formalin-fixed tissue. Compromises made in morphology can be called minor compared to the advantages in the molecular pathology possibilities. PMID:22110732

Cosmetic lower limb lengthening by Ilizarov apparatus: what are the risks?

PubMed

Novikov, Konstantin I; Subramanyam, Koushik N; Muradisinov, Serghei O; Novikova, Olga S; Kolesnikova, Elina S

2014-11-01

Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes. The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1 year after treatment (mean, 6 years; range, 1-14 years) and were reviewed for this report. The mean age of these patients was 25 years (range, 14-68 years) and their mean preoperative height was 159 cm (range, 130-174 cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9 cm (range, 2-13 cm), 7.3 cm (range, 3.5-13 cm) in males and 6.5 cm (range, 2-13 cm) in females. The mean lengthening, maturation, and external fixator indexes were 12 days/cm (range, 4.3-24 days/cm), 19 days/cm (range, 5.2-63 days/cm), and 31 days/cm (range, 12-78 days/cm), respectively. Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One hundred thirty of 131 patients subjectively felt satisfied and had improved self-esteem. Distraction osteogenesis using the Ilizarov external fixator is an option for carefully selected motivated patients with awareness of this technique. Soft tissue and bone-related complications including those that necessitate reinterventions should be expected during the course of treatment, although most can be managed without permanent sequelae or disability. Future studies with more robust methods will need to determine whether the risks and benefits of this procedure are well balanced. Preoperative counseling, considering the ethical questions this procedure can raise, is of paramount importance for the patient to weigh the risk versus anticipated benefits. Studies from other centers will be important as we move forward. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Biology of soft tissue wound healing and regeneration--consensus report of Group 1 of the 10th European Workshop on Periodontology.

PubMed

Hämmerle, Christoph H F; Giannobile, William V

2014-04-01

The scope of this consensus was to review the biological processes of soft tissue wound healing in the oral cavity and to histologically evaluate soft tissue healing in clinical and pre-clinical models. To review the current knowledge regarding the biological processes of soft tissue wound healing at teeth, implants and on the edentulous ridge. Furthermore, to review soft tissue wound healing at these sites, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Searches of the literature with respect to recessions at teeth and soft tissue deficiencies at implants, augmentation of the area of keratinized tissue and soft tissue volume were conducted. The available evidence was collected, categorized and summarized. Oral mucosal and skin wound healing follow a similar pattern of the four phases of haemostasis, inflammation, proliferation and maturation/matrix remodelling. The soft connective tissue determines the characteristics of the overlaying oral epithelium. Within 7-14 days, epithelial healing of surgical wounds at teeth is completed. Soft tissue healing following surgery at implants requires 6-8 weeks for maturation. The resulting tissue resembles scar tissue. Well-designed pre-clinical studies providing histological data have been reported describing soft tissue wound healing, when using barrier membranes, growth and differentiation factors and soft tissue substitutes. Few controlled clinical studies with low numbers of patients are available for some of the treatments reviewed at teeth. Whereas, histological new attachment has been demonstrated in pre-clinical studies resulting from some of the treatments reviewed, human histological data commonly report a lack of new attachment but rather long junctional epithelial attachment and connective tissue adhesion. Regarding soft tissue healing at implants human data are very scarce. Oral soft tissue healing at teeth, implants and the edentulous ridge follows the same phases as skin wound healing. Histological studies in humans have not reported new attachment formation at teeth for the indications studied. Human histological data of soft tissue wound healing at implants are limited. The use of barriers membranes, growth and differentiation factors and soft tissue substitutes for the treatment of localized gingival/mucosal recessions, insufficient amount of keratinized tissue and insufficient soft tissue volume is at a developing stage. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.

PubMed

Park, Chul-Hyun; Ahn, Ji-Yong; Kim, Yu-Mi; Lee, Woo-Chun

2013-06-01

The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

Effect of Fixatives and Tissue Processing on the Content and Integrity of Nucleic Acids

PubMed Central

Srinivasan, Mythily; Sedmak, Daniel; Jewell, Scott

2002-01-01

Clinical and molecular medicines are undergoing a revolution based on the accelerated advances in biotechnology such as DNA microarrays and proteomics. Answers to fundamental questions such as how does the DNA sequence differ between individuals and what makes one individual more prone for a certain disease are eagerly being sought in this postgenomic era. Several government and nonprofit organizations provide the researchers access to human tissues for molecular studies. The tissues procured by the different organizations may differ with respect to fixation and processing parameters that may affect significantly the molecular profile of the tissues. It is imperative that a prospective investigator be aware of the potential contributing factors before designing a project. The purpose of this review is to provide an overview of the methods of human tissue acquisition, fixation, and preservation. In addition, the parameters of procurement and fixation that affect the quality of the tissues at the molecular level are discussed. PMID:12466110

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature.

PubMed

Zhou, Yu; Zhou, Zhenyu; Liu, Lifeng; Cao, Xuecheng

2018-03-21

Skeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of irreducible facet dislocation is usually accompanied with potential catastrophic consequences including neurological deficit and severe disability. Therefore, a consistent and evidence-based treatment plan is imperative. The literature regarding the management of traumatic unilateral locked cervical facet dislocations was reviewed. Two patient cases (a 30-year-old Asian man and a 25-year-old Asian woman) who suffered irreducible cervical facet dislocations were presented. These two patients received surgical treatments including posterior reduction by poking facet joints, adjacent spinous process fixation by wire rope banding, anterior plate fixation, and intervertebral fusion after the failure of skull traction and closed reduction. At the postoperative 24-month follow-up, intervertebral fusion was achieved and our patients' neurological status improved based on the American Spinal Injury Association scale, compared with their preoperative status. Unilateral facet joint dislocations of subaxial cervical spine are difficult to reduce when complicated with posterior facet fractures or ligamentous injury. Magnetic resonance imaging can be beneficial for identifying ventral and dorsal compressive lesions, as well as ligamentous or capsule rupture. The combination of posterior reduction and anterior fixation with fusion has advantages in terms of clinical safety, ease of operation, and less iatrogenic damage.

Microwave energy fixation for electron microscopy.

PubMed Central

Login, G. R.; Dvorak, A. M.

1985-01-01

We have demonstrated that microwave energy (MW) can be used in conjunction with chemical cross-linking agents in order to rapidly fix cell suspensions and tissue blocks for electron microscopy in 7-9 seconds. The optimal MW fixation method involved immersing tissues up to 1 cu cm in dilute aldehyde fixation and immediately irradiating the specimens in a conventional microwave oven for 9 seconds to 50 C. Ultrastructural preservation of samples irradiated by MW energy was comparable to that of the control samples immersed in aldehyde fixative for 2 hours at 25 C. Stereologic analysis showed that tissue blocks fixed by the MW fixation method did not cause organelles such as liver mitochondria and salivary gland granules to shrink or to swell. Potential applications for this new fixation technology include the investigation of rapid intracellular processes (eg, vesicular transport) and preservation of proteins that are difficult to demonstrate with routine fixation methods (eg, antigens and enzymes). Images Figure 4 Figure 5 Figure 2 Figure 3 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 PMID:3927740

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

PubMed Central

Vasiliadis, Elias S; Grivas, Theodoros B; Psarakis, Spyridon A; Papavasileiou, Evangelos; Kaspiris, Angelos; Triantafyllopoulos, Georgios

2009-01-01

Background Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces. Materials and methods Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed. Results All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II. Conclusion Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to restore normal movement of talus against the mortise. Both Ilizarov and hinged external fixators are unable to restore ligamentous stability. External fixation is recommended only for fractures of the ankle joint caused by axial compression because it is biomechanically superior and has a lower complication rate. PMID:19754962

Studying Genes in Tissue Samples From Younger and Adolescent Patients With Soft Tissue Sarcomas

ClinicalTrials.gov

2016-05-13

Childhood Alveolar Soft-part Sarcoma; Childhood Angiosarcoma; Childhood Desmoplastic Small Round Cell Tumor; Childhood Epithelioid Sarcoma; Childhood Fibrosarcoma; Childhood Leiomyosarcoma; Childhood Liposarcoma; Childhood Malignant Mesenchymoma; Childhood Neurofibrosarcoma; Childhood Synovial Sarcoma; Chordoma; Desmoid Tumor; Metastatic Childhood Soft Tissue Sarcoma; Nonmetastatic Childhood Soft Tissue Sarcoma; Recurrent Childhood Soft Tissue Sarcoma

A Simplified Way for the Stabilization of Pediatric Mandibular Fracture With an Occlusal Splint.

PubMed

Demirkol, Mehmet; Demirkol, Nermin; Abdo, Omar Hasan; Aras, Mutan Hamdi

2016-06-01

The management of pediatric mandibular fractures is challenging for maxillofacial surgeons due to ongoing mandibular growth involving tooth buds. The treatment of such fractures has been a topic of much research. Generally accepted methods for the treatment of mandibular parasymphyseal or symphyseal fractures in children are conservative approaches involving the use of acrylic splints, lateral compression with an open-cap splint stabilized by circummandibular wiring, and maxillomandibular fixation with an arch bar and eyelet wiring. The aim of this technical note was to describe a straightforward approach to the treatment of pediatric mandibular fractures, in which an occlusal splint is secured to prevent trauma to the soft tissue, without the need for general anesthesia.

Soft tissue modelling with conical springs.

PubMed

Omar, Nadzeri; Zhong, Yongmin; Jazar, Reza N; Subic, Aleksandar; Smith, Julian; Shirinzadeh, Bijan

2015-01-01

This paper presents a new method for real-time modelling soft tissue deformation. It improves the traditional mass-spring model with conical springs to deal with nonlinear mechanical behaviours of soft tissues. A conical spring model is developed to predict soft tissue deformation with reference to deformation patterns. The model parameters are formulated according to tissue deformation patterns and the nonlinear behaviours of soft tissues are modelled with the stiffness variation of conical spring. Experimental results show that the proposed method can describe different tissue deformation patterns using one single equation and also exhibit the typical mechanical behaviours of soft tissues.

Early tension loss in an anterior cruciate ligament graft. A cadaver study of four tibial fixation devices.

PubMed

Grover, Dustin M; Howell, Stephen M; Hull, Maury L

2005-02-01

The tensile force applied to an anterior cruciate ligament graft determines the maximal anterior translation; however, it is unknown whether the tensile force is transferred to the intra-articular portion of the graft and whether the intra-articular tension and maximal anterior translation are maintained shortly after ligament reconstruction. Ten cadaveric knees were reconstructed with a double-looped tendon graft. The graft was looped through a femoral fixation transducer that measured the resultant force on the proximal end of the graft. A pneumatic cylinder applied a tensile force of 110 N to the graft exiting the tibial tunnel with the knee in full extension. The graft was fixed sequentially with four tibial fixation devices (a spiked metal washer, double staples, a bioabsorbable interference screw, and a WasherLoc). Three cyclic loading treatments designed to conservatively load the graft and its fixation were applied. The combined loss in intra-articular graft tension from friction, insertion of the tibial fixation device, and three cyclic loading treatments was 50% for the spiked washer (p = 0.0004), 100% for the double staples (p < 0.0001), 64% for the interference screw (p = 0.0001), and 56% for the WasherLoc (p < 0.0001). The tension loss caused an increase in the maximal anterior translation from that of the intact knee of 2.0 mm for the spiked washer (p = 0.005), 7.8 mm for the double staples (p < 0.0001), 2.7 mm for the interference screw (p = 0.001), and 2.1 mm for the WasherLoc (p < 0.0001). The tensile force applied to a soft-tissue anterior cruciate ligament graft is not transferred intra-articularly and is not maintained during graft fixation. The loss in tension is caused by friction in the tibial tunnel and wrapping the graft around the shank of the screw of the spiked washer, insertion of the tibial fixation device, and cyclical loading of the knee. The amount of tension loss is sufficient to increase the maximal anterior translation.

Minimally invasive reduction and fixation of displaced calcaneal fractures: surgical technique and radiographic analysis.

PubMed

Arastu, Mateen; Sheehan, Brendan; Buckley, Richard

2014-03-01

The optimal treatment of calcaneal fractures is controversial. A specific subgroup of healthy patients has good outcomes with open reduction and internal fixation using an extensile lateral approach. However, there are many patients who do not fit into this category. Consequently, they are either denied surgical intervention or put at significant risk of developing complications as a result of open surgical intervention. Minimally invasive reduction and fixation (MIRF) of calcaneal fractures can restore the height, width, length and shape of the hindfoot in addition to restoring the orientation of the posterior facet of the calcaneus (Böhler's angle). We present a series of 31 patients treated with minimally invasive reduction and fixation technique using threaded K wires and Steinmann pins as an alternative treatment method in patients who are not suitable for open reduction and internal fixation. The mean time to surgery from injury was six days (range one to ten days). The mean duration of surgery was 35 minutes (range 11-52 minutes). The mean followup was 14.9 months (range of seven to 30 months). The mean change in Böhler's angle and length of the calcaneus from intra-operative fixation to final followup were 18.7° and 4.7 mm, respectively. The complication rate was low and there was one case of a superficial wound infection and no cases of deep infection or peroneal impingement in this series. The MIRF technique with the use of threaded K wires has not been previously described in the literature. In our experience, the operative time is short and can be safely performed even in the presence of extensive soft tissue swelling in the immediate period following injury. The infection risk is low and calcaneal morphology was improved and maintained in terms of Böhler's angle. This technique is suitable to be considered in patients who have significant medical co-morbidities (smokers, diabetics, peripheral vascular disease) and in those patients who are not suitable for an extensile lateral approach and internal fixation.

Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome

PubMed Central

Raj, Manish; Kumar, Sunil; Singh, Pulkesh; Kumar, Dinesh; Singh, Jasveer; Deep, Akash

2016-01-01

Introduction Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. Aim To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. Materials and Methods In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Results Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian’s criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Conclusion Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA/B fractures without increasing the risk of infection. It gives better stability to fracture site and lessen the risk of implant failure. PMID:27042541

Soft Tissue Sarcoma—Health Professional Version

Cancer.gov

Soft tissue sarcomas are malignant tumors that arise in any of the mesodermal tissues of the extremities, trunk and retroperitoneum, or head and neck. Soft tissue sarcomas may be heterogeneous. Find evidence-based information on soft tissue sarcoma treatment and research.

Profiling of potential driver mutations in sarcomas by targeted next generation sequencing.

PubMed

Andersson, Carola; Fagman, Henrik; Hansson, Magnus; Enlund, Fredrik

2016-04-01

Comprehensive genetic profiling by massively parallel sequencing, commonly known as next generation sequencing (NGS), is becoming the foundation of personalized oncology. For sarcomas very few targeted treatments are currently in routine use. In clinical practice the preoperative diagnostic workup of soft tissue tumours largely relies on core needle biopsies. Although mostly sufficient for histopathological diagnosis, only very limited amounts of formalin fixated paraffin embedded tissue are often available for predictive mutation analysis. Targeted NGS may thus open up new possibilities for comprehensive characterization of scarce biopsies. We therefore set out to search for driver mutations by NGS in a cohort of 55 clinically and morphologically well characterized sarcomas using low input of DNA from formalin fixated paraffin embedded tissues. The aim was to investigate if there are any recurrent or targetable aberrations in cancer driver genes in addition to known chromosome translocations in different types of sarcomas. We employed a panel covering 207 mutation hotspots in 50 cancer-associated genes to analyse DNA from nine gastrointestinal stromal tumours, 14 synovial sarcomas, seven myxoid liposarcomas, 22 Ewing sarcomas and three Ewing-like small round cell tumours at a large sequencing depth to detect also mutations that are subclonal or occur at low allele frequencies. We found nine mutations in eight different potential driver genes, some of which are potentially actionable by currently existing targeted therapies. Even though no recurrent mutations in driver genes were found in the different sarcoma groups, we show that targeted NGS-based sequencing is clearly feasible in a diagnostic setting with very limited amounts of paraffin embedded tissue and may provide novel insights into mesenchymal cell signalling and potentially druggable targets. Interestingly, we also identify five non-synonymous sequence variants in 4 established cancer driver genes in DNA from normal tissue from sarcoma patients that may possibly predispose or contribute to neoplastic development. Copyright © 2016 Elsevier Inc. All rights reserved.

[Clinical effect modified Chevron osteotomy combined with lateral tissue loosening in treating mild-moderate hallux valgus through internal signal approach].

PubMed

Chen, Xue-Qiang; Wu, Qun-Feng; Dong, Wei-Qin; Yu, Li-Xin; Li, Xiong-Feng

2018-03-25

To explore clinical effect of modified Chevron osteotomy combined with lateral tissue loosening for the treatment of mild-moderate hallux valgus through internal signal approach. From July 2015 to June 2016, 26 patients with mild-moderate hallux valgus treated with modified Chevron osteotomy combined with lateral tissue loosening through internal signal approach, including 2 males and 24 females aged from 45 to 65 years old with an average of(54.6±4.8) years old;the courses of diseases ranged from 1 to 5 months with an average of (7.5±3.3) months. Hallux valgus angle(HVA), inter metatarsal angle(IMA) were measured at 12 months after operation, and AOFAS score was applied to evaluate clinical effect before and after operation. All incisions were healed at stage I. No incision occurred infection, metatarsal necrosis and recurrence of hallux valgus deformity. Two patients occurred skin numbness caused by musculocutaneous nerve injury. Twenty-six patients were followed up from 6 to 12 months with an average of(9.12±2.06) months. HVA, IMA were(30.01±3.71)°, (14.00±1.50)° before operation and(9.41±4.16)°, (7.00±0.60)° after operation, which had significant difference. There was statistical significance in AOFAS score before operation 54.77±9.59 and after operation 92.73±5.47, and 19 cases obtained excellent results and 7 moderate. Modified Chevron osteotomy combined with full thread headless pressure screw fixation and lateral tissue loosening for the treatment of mild-moderate hallux valgus has advantages of excellent exposure, simple operation, stable fixation, rapid recovery. Akin osteotomy with internal capsulorrhaphy were used with lateral loosening and could recover soft tissue balance between lateral and internal, and could receive satisfied clinical effects. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Necrotizing soft tissue infection

MedlinePlus

Necrotizing fasciitis; Fasciitis - necrotizing; Flesh-eating bacteria; Soft tissue gangrene; Gangrene - soft tissue ... Many different types of bacteria can cause this infection. A very severe and usually deadly form of necrotizing soft tissue infection is due to the ...

SU-E-T-409: Evaluation of Tissue Composition Effect On Dose Distribution in Radiotherapy with 6 MV Photon Beam of a Medical Linac

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghorbani, M; Tabatabaei, Z; Noghreiyan, A Vejdani

Purpose: The aim of this study is to evaluate soft tissue composition effect on dose distribution for various soft tissues and various depths in radiotherapy with 6 MV photon beam of a medical linac. Methods: A phantom and Siemens Primus linear accelerator were simulated using MCNPX Monte Carlo code. In a homogeneous cubic phantom, six types of soft tissue and three types of tissue-equivalent materials were defined separately. The soft tissues were muscle (skeletal), adipose tissue, blood (whole), breast tissue, soft tissue (9-component) and soft tissue (4-component). The tissue-equivalent materials included: water, A-150 tissue-equivalent plastic and perspex. Photon dose relativemore » to dose in 9-component soft tissue at various depths on the beam’s central axis was determined for the 6 MV photon beam. The relative dose was also calculated and compared for various MCNPX tallies including,F8, F6 and,F4. Results: The results of the relative photon dose in various materials relative to dose in 9-component soft tissue and using different tallies are reported in the form of tabulated data. Minor differences between dose distributions in various soft tissues and tissue-equivalent materials were observed. The results from F6 and F4 were practically the same but different with,F8 tally. Conclusion: Based on the calculations performed, the differences in dose distributions in various soft tissues and tissue-equivalent materials are minor but they could be corrected in radiotherapy calculations to upgrade the accuracy of the dosimetric calculations.« less

[Mini-subvastus approach for total knee replacement].

PubMed

Halder, Andreas; Beier, Alexander; Neumann, Wolfram

2009-03-01

Total knee replacement in minimally invasive technique without any trauma to the extensor apparatus and with soft-tissue-referenced bone resections. Only the subvastus approach preserves the integrity of the extensor apparatus and has therefore been modified to become a minimally invasive technique with a shorter skin incision and lateralization instead of eversion of the patella. Soft-tissue balancing is done through this direct anterior approach. Mild to moderate varus osteoarthritis of the knee up to 15 degrees of malalignment, mild and passively correctable valgus osteoarthritis of the knee up to 10 degrees of malalignment. Severe, contract varus osteoarthritis of the knee, severe and moderate, contract valgus osteoarthritis of the knee, severe obesity, exceptionally muscular patients, decreased skin perfusion. Central skin incision from the superior pole of the patella to the tibial tubercle. Exposure of the medial retinaculum and mobilization of the vastus medialis muscle subcutaneously. Incision of the medial retinaculum and blunt separation of the vastus medialis muscle from the intermuscular septum. Lateralization of the patella and flexion of the knee joint. Resection of the tibia perpendicular to the diaphysis. Adjustment of the anteroposterior (AP) resection block at the level of the anterior femoral cortex and of rotation by applying equal tension to the collateral ligaments. Balancing of soft-tissue tension in flexion gap by release, if necessary. After AP resection fixation of distal resection block in planned valgus angle. Balancing of soft-tissue tension in extension gap by release, if necessary. After distal femur resection facet resection, adaptation of posterior femoral condyles, and implantation of prosthesis. Check on stability and range of motion. Wound closure. Full weight bearing from the 1st postoperative day, CPM (continuous passive motion) with up to 90 degrees flexion with peridural anesthesia as tolerated, stair climbing starting on the 7th postoperative day. 100 patients were randomized to total knee replacement via a parapatellar or subvastus approach. Radiologically, there were no differences in operative precision or leg alignment. Patients treated minimally invasively suffered less pain and achieved a higher flexion of 110 degrees versus 95 degrees 6 weeks postoperatively. However, there were two cases of delayed wound healing in this group. The surgical technique is demanding and the operating time is longer. Long-term results are still missing.

Soft tissue wound healing at teeth, dental implants and the edentulous ridge when using barrier membranes, growth and differentiation factors and soft tissue substitutes.

PubMed

Vignoletti, Fabio; Nunez, Javier; Sanz, Mariano

2014-04-01

To review the biological processes of wound healing following periodontal and periimplant plastic surgery when different technologies are used in a) the coverage of root and implant dehiscences, b) the augmentation of keratinized tissue (KT) and c) the augmentation of soft tissue volume. An electronic search from The National Library of Medicine (MEDLINE-PubMed) was performed: English articles with research focus in oral soft tissue regeneration, providing histological outcomes, either from animal experimental studies or human biopsy material were included. Barrier membranes, enamel matrix derivatives, growth factors, allogeneic and xenogeneic soft tissue substitutes have been used in soft tissue regeneration demonstrating different degrees of regeneration. In root coverage, these technologies were able to improve new attachment, although none has shown complete regeneration. In KT augmentation, tissue-engineered allogenic products and xenogeneic collagen matrixes demonstrated integration within the host connective tissue and promotion of keratinization. In soft tissue augmentation and peri-implant plastic surgery there are no histological data currently available. Soft tissue substitutes, growth differentiation factors demonstrated promising histological results in terms of soft tissue regeneration and keratinization, whereas there is a need for further studies to prove their added value in soft tissue augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effect of fixatives and temperature on the quality of glycogen demonstration.

PubMed

Zakout, Yosef Mohamed Azzam; Salih, Magdi M; Ahmed, H G

2010-04-01

Glycogen is demonstrated in a number of lesions and is diagnostically significant, particularly in certain tumors. To stain glycogen accurately, it is essential to choose a suitable fixative, temperature and staining method. We used rabbit liver to assess these variables. Specimens were fixed in three fixatives at two temperatures: 10% formalin, neutral buffered formalin (NBF) and Bouin's solution at 37 and 4 degrees C. Seventy-two paraffin sections were prepared and stained with periodic acid-Schiff (PAS), hexamine (methenamine) silver and Best's carmine methods. Negative control sections using diastase digestion were used for all methods to confirm the presence of glycogen. For the PAS reaction, Bouin's fixative gave better results at both temperatures compared to the other fixatives. For hexamine (methenamine) silver, the quality of staining was improved for tissues fixed in both 10% formalin and NBF at 37 degrees C compared to Bouin's solution. Both 10% formalin and NBF at 4 degrees C gave better results than Bouin's solution. For Best's carmine, Bouin's solution gave the best results for tissues fixed at 4 degrees C. Fixation of tissues with NBF at 37 degrees C gave the best quality staining. We concluded that the quality of glycogen staining in paraffin sections is greatly affected by both the fixative and the temperature of fixation.

Soft tissue deformation modelling through neural dynamics-based reaction-diffusion mechanics.

PubMed

Zhang, Jinao; Zhong, Yongmin; Gu, Chengfan

2018-05-30

Soft tissue deformation modelling forms the basis of development of surgical simulation, surgical planning and robotic-assisted minimally invasive surgery. This paper presents a new methodology for modelling of soft tissue deformation based on reaction-diffusion mechanics via neural dynamics. The potential energy stored in soft tissues due to a mechanical load to deform tissues away from their rest state is treated as the equivalent transmembrane potential energy, and it is distributed in the tissue masses in the manner of reaction-diffusion propagation of nonlinear electrical waves. The reaction-diffusion propagation of mechanical potential energy and nonrigid mechanics of motion are combined to model soft tissue deformation and its dynamics, both of which are further formulated as the dynamics of cellular neural networks to achieve real-time computational performance. The proposed methodology is implemented with a haptic device for interactive soft tissue deformation with force feedback. Experimental results demonstrate that the proposed methodology exhibits nonlinear force-displacement relationship for nonlinear soft tissue deformation. Homogeneous, anisotropic and heterogeneous soft tissue material properties can be modelled through the inherent physical properties of mass points. Graphical abstract Soft tissue deformation modelling with haptic feedback via neural dynamics-based reaction-diffusion mechanics.

Soft Tissue Alterations in Esthetic Postextraction Sites: A 3-Dimensional Analysis.

PubMed

Chappuis, V; Engel, O; Shahim, K; Reyes, M; Katsaros, C; Buser, D

2015-09-01

Dimensional alterations of the facial soft and bone tissues following tooth extraction in the esthetic zone play an essential role to achieve successful outcomes in implant therapy. This prospective study is the first to investigate the interplay between the soft tissue dimensions and the underlying bone anatomy during an 8-wk healing period. The analysis is based on sequential 3-dimensional digital surface model superimpositions of the soft and bone tissues using digital impressions and cone beam computed tomography during an 8-wk healing period. Soft tissue thickness in thin and thick bone phenotypes at extraction was similar, averaging 0.7 mm and 0.8 mm, respectively. Interestingly, thin bone phenotypes revealed a 7-fold increase in soft tissue thickness after an 8-wk healing period, whereas in thick bone phenotypes, the soft tissue dimensions remained unchanged. The observed spontaneous soft tissue thickening in thin bone phenotypes resulted in a vertical soft tissue loss of only 1.6 mm, which concealed the underlying vertical bone resorption of 7.5 mm. Because of spontaneous soft tissue thickening, no significant differences were detected in the total tissue loss between thin and thick bone phenotypes at 2, 4, 6, and 8 wk. More than 51% of these dimensional alterations occurred within 2 wk of healing. Even though the observed spontaneous soft tissue thickening in thin bone phenotypes following tooth extraction conceals the pronounced underlying bone resorption pattern by masking the true bone deficiency, spontaneous soft tissue thickening offers advantages for subsequent bone regeneration and implant therapies in sites with high esthetic demand (Clinicaltrials.gov NCT02403700). © International & American Associations for Dental Research.

Expansion method in secondary total ear reconstruction for undesirable reconstructed ear.

PubMed

Liu, Tun; Hu, Jintian; Zhou, Xu; Zhang, Qingguo

2014-09-01

Ear reconstruction by autologous costal cartilage grafting is the most widely applied technique with fewer complications. However, undesirable ear reconstruction brings more problems to plastic surgeons. Some authors resort to free flap or osseointegration technique with prosthetic ear. In this article, we introduce a secondary total ear reconstruction with expanded skin flap method. From July 2010 to April 2012, 7 cases of undesirable ear reconstruction were repaired by tissue expansion method. Procedures including removal of previous cartilage framework, soft tissue expander insertion, and second stage of cartilage framework insertion were performed to each case regarding their local conditions. The follow-up time ranged from 6 months to 2.5 years. All of the cases recovered well with good 3-dimensional forms, symmetrical auriculocephalic angle, and stable fixation. All these evidence showed that this novel expansion method is safe, stable, and less traumatic for secondary total ear reconstruction. With sufficient expanded skin flap and refabricated cartilage framework, lifelike appearance of reconstructed ear could be acquired without causing additional injury.

Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.

PubMed

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2017-11-01

Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.

Combined maxillary and mandibular distraction osteogenesis in patients with hemifacial microsomia.

PubMed

Sant'Anna, Eduardo Franzotti; Lau, Geórgia W T; Marquezan, Mariana; de Souza Araújo, Mônica Tirre; Polley, John W; Figueroa, Alvaro A

2015-05-01

Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction. Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and an ipsilateral horizontal mandibular ramus osteotomy. A semiburied distraction device was placed over the ramus, and intermaxillary fixation was applied. Anteroposterior cephalometric and frontal photographic analyses were conducted before and after distraction. Statistics were used to analyze the preoperative and postoperative changes. Cephalometrically, the nasal floor and the occlusal and gonial plane angles decreased. The ratios of affected-unaffected ramus and gonial angle heights improved by 15% and 20%, respectively. The position of menton moved toward the midline. The photographic analysis showed a decrease of the nasal and commissure plane angles, and the chin moved to the unaffected side. The parallelism between the horizontal skeletal and soft tissue planes improved, with an increase in the affected side ramus height and correction of the chin point toward the midline. Simultaneous maxillary and mandibular distraction improved facial balance and symmetry. Patients in the permanent dentition with fixed orthodontic appliances and well-aligned dental arches responded well to this intervention. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Cone-Beam Computed Tomography Evaluation of Horizontal and Vertical Dimensional Changes in Buccal Peri-Implant Alveolar Bone and Soft Tissue: A 1-Year Prospective Clinical Study.

PubMed

Kaminaka, Akihiro; Nakano, Tamaki; Ono, Shinji; Kato, Tokinori; Yatani, Hirofumi

2015-10-01

This study evaluated changes in the horizontal and vertical dimensions of the buccal alveolar bone and soft tissue over a 1-year period following implant prosthesis. Thirty-three participants with no history of guided bone regeneration or soft tissue augmentation underwent dental implant placement with different types of connections. The dimensions of the buccal alveolar bone and soft tissue were evaluated immediately and at 1 year after prosthesis from reconstructions of cross-sectional cone-beam computed tomography images. The vertical and horizontal loss of buccal bone and soft tissue around implants with conical connections were lower than around those with external or internal connections. Statistically significant negative correlations were observed between initial horizontal bone thickness and changes in vertical bone and soft tissue height (p < .05), and between initial horizontal soft tissue thickness and the change in vertical soft tissue height (p < .05). Implants with a conical connection preserve peri-implant alveolar bone and soft tissue more effectively than other connection types. Furthermore, the initial buccal alveolar bone and soft tissue thickness around the implant platform may influence their vertical dimensional changes at 1 year after implant prosthesis. © 2014 Wiley Periodicals, Inc.

Blade-order-dependent radiocarbon variability in brown seaweed (Undaria pinnatifida) reflected a cold Oyashio water intrusion event in an embayment of the Sanriku coast, northeastern Japan

NASA Astrophysics Data System (ADS)

Satoh, N.; Fukuda, H.; Miyairi, Y.; Yokoyama, Y.; Nagata, T.

2015-12-01

Radiocarbon in dissolved inorganic carbon (DIC) in seawater varies greatly, both geographically and with depth. This "reservoir effect" is thought to be reflected in the radiocarbon content (Δ14C) of marine organisms, via DIC fixation by primary producers and subsequent trophic transfer. The Δ14C of marine organismal soft tissues might thus provide unique information about their habitats, diets, migration and other environmental histories. However, the effectiveness of this approach has yet to be extensively explored, with data on Δ14C variability in soft tissues of marine organisms being markedly limited. Here we examined whether Δ14C values of individual pinnate blades (leaf-like structures) of brown seaweed (Undaria pinnatifida) reflect the Δ14C of DIC in the water current prevailing at the time of blade formation. The study was conducted in Otsuchi Bay located in the Sanriku coastal region, northeastern Japan, where 14C-depleted cold Oyashio current and warm Tsugaru current (high Δ14C) converge, affecting the physiology and growth of marine organisms growing there. U. pinnatifida individuals cultured in the bay (length of saprophytes, 140-215 cm) were harvested in April 2014 and Δ14C of blades were determined by accelerator mass spectrometry. Younger blades formed after the Oyashio water intrusion had significantly lower Δ14C values compared to older blades formed before the event. The Δ14C values of younger and older blades were generally consistent with the Δ14C of DIC in Oyashio (-60.5 ‰) and Tsugaru (24.9 ‰) waters, respectively. Thus, despite possible turnover of organic carbon in seaweed soft tissues, blade-order-dependent Δ14C variability appeared to strongly reflect the Oyashio intrusion event (radiocarbon shift) in the bay.

RCL2, a New Fixative, Preserves Morphology and Nucleic Acid Integrity in Paraffin-Embedded Breast Carcinoma and Microdissected Breast Tumor Cells

PubMed Central

Delfour, Christophe; Roger, Pascal; Bret, Caroline; Berthe, Marie-Laurence; Rochaix, Philippe; Kalfa, Nicolas; Raynaud, Pierre; Bibeau, Frédéric; Maudelonde, Thierry; Boulle, Nathalie

2006-01-01

Methacarn and RCL2, a new noncrosslinking fixative, were compared to formalin-fixed or frozen tissue samples of the same invasive breast carcinoma and were evaluated for their effects on tissue morphology and immunohistochemistry as well as DNA and RNA integrity. The histomorphology of methacarn- or RCL2-fixed paraffin-embedded tumors was similar to that observed with the matched formalin-fixed tissues. Immunohistochemistry using various antibodies showed comparable results with either fixative, leading to accurate breast tumor diagnosis and determination of estrogen and progesterone receptors, and HER2 status. Methacarn and RCL2 fixation preserved DNA integrity as demonstrated by successful amplification and sequencing of large DNA amplicons. Similarly, high-quality RNA could be extracted from methacarn- or RCL2-fixed paraffin-embedded MCF-7 cells, whole breast tumor tissues, or microdissected breast tumor cells, as assessed by electropherogram profiles and real-time reverse transcriptase-polymerase chain reaction quantification of various genes. Moreover, tissue morphology and RNA integrity were preserved after 8 months of storage. Altogether, these results indicate that methacarn, as previously shown, and RCL2, a promising new fixative, have great potential for performing both morphological and molecular analyses on the same fixed tissue sample, even after laser-capture microdissection, and can open new doors for investigating small target lesions such as premalignant breast lesions. PMID:16645201

[Early operative treatment of pelvic fractures associated with urethral disruption].

PubMed

Jia, Jian; Guo, Lu-Zeng; Wu, Chang-Lin; Chen, Jia-Geng; Zhang, Tie-Liang; Pei, Fu-Xing

2007-02-15

To evaluate the early operative treatment and clinical results of pelvic fractures associated with urethra disruption. From January 1995 to January 2005, 25 patients suffered from pelvic fractures combined urethra disruption treated by operation were retrospectively analyzed. According to Tile's classification, 1 case was stable pelvic fracture, 17 rotational unstable fractures, and 7 rotational combined vertical unstable fractures. The complete urethra rupture were in 23 cases and incomplete in 2 cases. The operative methods included: (1) emergency open reduction and internal fixation of the pelvis combined primary urethra suturing in 2 cases, partial suturing after realignment in 4 cases, realignment in 2 cases, and urethrovaginal penetrating wound repairing in 1 case; (2) primary urethra realignment only and delayed (range, 7 to 21 days) pelvic internal fixation in 10 cases; (3) early cystostomy and delayed (range, 3 to 21 days) urethra realignment and pelvic internal fixation in 6 cases. The mean follow-up time of all patients was 34 months (range from 6 to 120 months). According to Majeed's evaluation, 17 cases of pelvic injury showed excellent results, 5 good, and 3 fare. After urinary catheter removed, the mean maximal urine flow rate of 19 (76%) patients was 18.6 ml/s and the mean scar length between both disrupted ends on the film of excretion urethrography was 0.51 cm. Five (20%) cases suffered in dysuria needed urethral dilatation or further surgery. One (4%) female could not control urination who need a second-look operation. The primary suprapubic soft tissue avulsion wound infection secondary to retropubic abscess was found in 1 case, posterior urethra-stenosis in 5 cases, sexual impotence in 3 cases, and incontinence in 1 case. The satisfactory reduction and effective fixation of the pelvic fractures is an anatomical basis for receiving "tension-free urethral anastomosis".

Pathogen Inactivating Properties and Increased Sensitivity in Molecular Diagnostics by PAXgene, a Novel Non-Crosslinking Tissue Fixative.

PubMed

Loibner, Martina; Buzina, Walter; Viertler, Christian; Groelz, Daniel; Hausleitner, Anja; Siaulyte, Gintare; Kufferath, Iris; Kölli, Bettina; Zatloukal, Kurt

2016-01-01

Requirements on tissue fixatives are getting more demanding as molecular analysis becomes increasingly relevant for routine diagnostics. Buffered formaldehyde in pathology laboratories for tissue fixation is known to cause chemical modifications of biomolecules which affect molecular testing. A novel non-crosslinking tissue preservation technology, PAXgene Tissue (PAXgene), was developed to preserve the integrity of nucleic acids in a comparable way to cryopreservation and also to preserve morphological features comparable to those of formalin fixed samples. Because of the excellent preservation of biomolecules by PAXgene we investigated its pathogen inactivation ability and biosafety in comparison to formalin by in-vitro testing of bacteria, human relevant fungi and human cytomegalovirus (CMV). Guidelines for testing disinfectants served as reference for inactivation assays. Furthermore, we tested the properties of PAXgene for detection of pathogens by PCR based assays. All microorganisms tested were similarly inactivated by PAXgene and formalin except Clostridium sporogenes, which remained viable in seven out of ten assays after PAXgene treatment and in three out of ten assays after formalin fixation. The findings suggest that similar biosafety measures can be applied for PAXgene and formalin fixed samples. Detection of pathogens in PCR-based diagnostics using two CMV assays resulted in a reduction of four to ten quantification cycles of PAXgene treated samples which is a remarkable increase of sensitivity. PAXgene fixation might be superior to formalin fixation when molecular diagnostics and highly sensitive detection of pathogens is required in parallel to morphology assessment.

Validation of a Radiography-Based Quantification Designed to Longitudinally Monitor Soft Tissue Calcification in Skeletal Muscle.

PubMed

Moore, Stephanie N; Hawley, Gregory D; Smith, Emily N; Mignemi, Nicholas A; Ihejirika, Rivka C; Yuasa, Masato; Cates, Justin M M; Liu, Xulei; Schoenecker, Jonathan G

2016-01-01

Soft tissue calcification, including both dystrophic calcification and heterotopic ossification, may occur following injury. These lesions have variable fates as they are either resorbed or persist. Persistent soft tissue calcification may result in chronic inflammation and/or loss of function of that soft tissue. The molecular mechanisms that result in the development and maturation of calcifications are uncertain. As a result, directed therapies that prevent or resorb soft tissue calcifications remain largely unsuccessful. Animal models of post-traumatic soft tissue calcification that allow for cost-effective, serial analysis of an individual animal over time are necessary to derive and test novel therapies. We have determined that a cardiotoxin-induced injury of the muscles in the posterior compartment of the lower extremity represents a useful model in which soft tissue calcification develops remote from adjacent bones, thereby allowing for serial analysis by plain radiography. The purpose of the study was to design and validate a method for quantifying soft tissue calcifications in mice longitudinally using plain radiographic techniques and an ordinal scoring system. Muscle injury was induced by injecting cardiotoxin into the posterior compartment of the lower extremity in mice susceptible to developing soft tissue calcification. Seven days following injury, radiographs were obtained under anesthesia. Multiple researchers applied methods designed to standardize post-image processing of digital radiographs (N = 4) and quantify soft tissue calcification (N = 6) in these images using an ordinal scoring system. Inter- and intra-observer agreement for both post-image processing and the scoring system used was assessed using weighted kappa statistics. Soft tissue calcification quantifications by the ordinal scale were compared to mineral volume measurements (threshold 450.7mgHA/cm3) determined by μCT. Finally, sample-size calculations necessary to discriminate between a 25%, 50%, 75%, and 100% difference in STiCSS score 7 days following burn/CTX induced muscle injury were determined. Precision analysis demonstrated substantial to good agreement for both post-image processing (κ = 0.73 to 0.90) and scoring (κ = 0.88 to 0.93), with low inter- and intra-observer variability. Additionally, there was a strong correlation in quantification of soft tissue calcification between the ordinal system and by mineral volume quantification by μCT (Spearman r = 0.83 to 0.89). The ordinal scoring system reliably quantified soft tissue calcification in a burn/CTX-induced soft tissue calcification model compared to non-injured controls (Mann-Whitney rank test: P = 0.0002, ***). Sample size calculations revealed that 6 mice per group would be required to detect a 50% difference in STiCSS score with a power of 0.8. Finally, the STiCSS was demonstrated to reliably quantify soft tissue calcification [dystrophic calcification and heterotopic ossification] by radiographic analysis, independent of the histopathological state of the mineralization. Radiographic analysis can discriminate muscle injury-induced soft tissue calcification from adjacent bone and follow its clinical course over time without requiring the sacrifice of the animal. While the STiCSS cannot identify the specific type of soft tissue calcification present, it is still a useful and valid method by which to quantify the degree of soft tissue calcification. This methodology allows for longitudinal measurements of soft tissue calcification in a single animal, which is relatively less expensive, less time-consuming, and exposes the animal to less radiation than in vivo μCT. Therefore, this high-throughput, longitudinal analytic method for quantifying soft tissue calcification is a viable alternative for the study of soft tissue calcification.

Validation of a Radiography-Based Quantification Designed to Longitudinally Monitor Soft Tissue Calcification in Skeletal Muscle

PubMed Central

Moore, Stephanie N.; Hawley, Gregory D.; Smith, Emily N.; Mignemi, Nicholas A.; Ihejirika, Rivka C.; Yuasa, Masato; Cates, Justin M. M.; Liu, Xulei; Schoenecker, Jonathan G.

2016-01-01

Introduction Soft tissue calcification, including both dystrophic calcification and heterotopic ossification, may occur following injury. These lesions have variable fates as they are either resorbed or persist. Persistent soft tissue calcification may result in chronic inflammation and/or loss of function of that soft tissue. The molecular mechanisms that result in the development and maturation of calcifications are uncertain. As a result, directed therapies that prevent or resorb soft tissue calcifications remain largely unsuccessful. Animal models of post-traumatic soft tissue calcification that allow for cost-effective, serial analysis of an individual animal over time are necessary to derive and test novel therapies. We have determined that a cardiotoxin-induced injury of the muscles in the posterior compartment of the lower extremity represents a useful model in which soft tissue calcification develops remote from adjacent bones, thereby allowing for serial analysis by plain radiography. The purpose of the study was to design and validate a method for quantifying soft tissue calcifications in mice longitudinally using plain radiographic techniques and an ordinal scoring system. Methods Muscle injury was induced by injecting cardiotoxin into the posterior compartment of the lower extremity in mice susceptible to developing soft tissue calcification. Seven days following injury, radiographs were obtained under anesthesia. Multiple researchers applied methods designed to standardize post-image processing of digital radiographs (N = 4) and quantify soft tissue calcification (N = 6) in these images using an ordinal scoring system. Inter- and intra-observer agreement for both post-image processing and the scoring system used was assessed using weighted kappa statistics. Soft tissue calcification quantifications by the ordinal scale were compared to mineral volume measurements (threshold 450.7mgHA/cm3) determined by μCT. Finally, sample-size calculations necessary to discriminate between a 25%, 50%, 75%, and 100% difference in STiCSS score 7 days following burn/CTX induced muscle injury were determined. Results Precision analysis demonstrated substantial to good agreement for both post-image processing (κ = 0.73 to 0.90) and scoring (κ = 0.88 to 0.93), with low inter- and intra-observer variability. Additionally, there was a strong correlation in quantification of soft tissue calcification between the ordinal system and by mineral volume quantification by μCT (Spearman r = 0.83 to 0.89). The ordinal scoring system reliably quantified soft tissue calcification in a burn/CTX-induced soft tissue calcification model compared to non-injured controls (Mann-Whitney rank test: P = 0.0002, ***). Sample size calculations revealed that 6 mice per group would be required to detect a 50% difference in STiCSS score with a power of 0.8. Finally, the STiCSS was demonstrated to reliably quantify soft tissue calcification [dystrophic calcification and heterotopic ossification] by radiographic analysis, independent of the histopathological state of the mineralization. Conclusions Radiographic analysis can discriminate muscle injury-induced soft tissue calcification from adjacent bone and follow its clinical course over time without requiring the sacrifice of the animal. While the STiCSS cannot identify the specific type of soft tissue calcification present, it is still a useful and valid method by which to quantify the degree of soft tissue calcification. This methodology allows for longitudinal measurements of soft tissue calcification in a single animal, which is relatively less expensive, less time-consuming, and exposes the animal to less radiation than in vivo μCT. Therefore, this high-throughput, longitudinal analytic method for quantifying soft tissue calcification is a viable alternative for the study of soft tissue calcification. PMID:27438007

Early prophylactic autogenous bone grafting in type III open tibial fractures.

PubMed

Kesemenli, Cumhur C; Kapukaya, Ahmet; Subaşi, Mehmet; Arslan, Huseyin; Necmioğlu, Serdar; Kayikçi, Cuma

2004-08-01

The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough débridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.

Exploring the potential of polyurethane-based soft foam as cell-free scaffold for soft tissue regeneration.

PubMed

Gerges, Irini; Tamplenizza, Margherita; Martello, Federico; Recordati, Camilla; Martelli, Cristina; Ottobrini, Luisa; Tamplenizza, Mariacaterina; Guelcher, Scott A; Tocchio, Alessandro; Lenardi, Cristina

2018-06-01

Reconstructive treatment after trauma and tumor resection would greatly benefit from an effective soft tissue regeneration. The use of cell-free scaffolds for adipose tissue regeneration in vivo is emerging as an attractive alternative to tissue-engineered constructs, since this approach avoids complications due to cell manipulation and lack of synchronous vascularization. In this study, we developed a biodegradable polyurethane-based scaffold for soft tissue regeneration, characterized by an exceptional combination between softness and resilience. Exploring the potential as a cell-free scaffold required profound understanding of the impact of its intrinsic physico-chemical properties on the biological performance in vivo. We investigated the effect of the scaffold's hydrophilic character, degradation kinetics, and internal morphology on (i) the local inflammatory response and activation of MGCs (foreign body response); (ii) its ability to promote rapid vascularisation, cell infiltration and migration through the scaffold over time; and (iii) the grade of maturation of the newly formed tissue into vascularized soft tissue in a murine model. The study revealed that soft tissue regeneration in vivo proceeded by gradual infiltration of undifferentiated mesenchymal cells though the periphery toward the center of the scaffold, where the rapid formation of a functional and well-formed vascular network supported cell viability overtime. Exploring the potential of polyurethane-based soft foam as cell-free scaffold for soft tissue regeneration. In this work, we address the unmet need for synthetic functional soft tissue substitutes that provide adequate biological and mechanical support to soft tissue. We developed a series of flexible cross-linked polyurethane copolymer scaffolds with remarkable fatigue-resistance and tunable physico-chemical properties for soft tissue regeneration in vivo. Accordingly, we could extend the potential of this class of biomaterials, which was so far confined for bone and osteochondral tissue regeneration, to other types of connective tissue. Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Combination Chemotherapy in Treating Patients With Previously Untreated Rhabdomyosarcoma

ClinicalTrials.gov

2013-06-13

Adult Malignant Mesenchymoma; Adult Rhabdomyosarcoma; Alveolar Childhood Rhabdomyosarcoma; Childhood Malignant Mesenchymoma; Embryonal Childhood Rhabdomyosarcoma; Embryonal-botryoid Childhood Rhabdomyosarcoma; Nonmetastatic Childhood Soft Tissue Sarcoma; Previously Untreated Childhood Rhabdomyosarcoma; Stage I Adult Soft Tissue Sarcoma; Stage II Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma

Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia.

PubMed

Gupta, Anil; Anjum, Rashid; Singh, Navdeep; Hackla, Shafiq

2015-04-01

Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient's pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. The use of dual plating for fixation of the lower tibia and fibula fractures is often associated with soft tissue complications, exposed implant, and increased risk of infection. We conclude that in fractures of the distal tibia and fibula it is better to use a rush nail for the fibula with a concurrent MIPPO for the tibia for the reasons cited above. Moreover, with the use of rush nail the cost of implant is also reduced, which is a very important factor in developing countries.

Validation and utilization of a TFE3 break-apart FISH assay for Xp11.2 translocation renal cell carcinoma and alveolar soft part sarcoma.

PubMed

Pradhan, Dinesh; Roy, Somak; Quiroga-Garza, Gabriela; Cieply, Kathleen; Mahaffey, Alyssa L; Bastacky, Sheldon; Dhir, Rajiv; Parwani, Anil V

2015-09-29

Xp11.2 or TFE3 translocation renal cell carcinomas (RCC) and alveolar soft part sarcoma (ASPS) are characterized by chromosome translocations involving the Xp11.2 breakpoint resulting in transcription factor TFE3 gene fusions. The most common translocations documented in TFE3 RCCs are t(X;1) (p11.2;q21) and t(X;17) (p11.2;q25) which leads to fusion of TFE3 gene on Xp11.2 with PRCC or ASPL respectively. TFE3 immunohistochemistry (IHC) has been inconsistent over time due to background staining problems in part related to fixation issues. Karyotyping to detect TFE3 gene rearrangement requires typically unavailable fresh tissue. Reverse transcriptase-polymerase chain reaction (RT-PCR) is generally very challenging due to degradation of RNA in archival material. The study objective was to develop and validate a TFE3 break-apart fluorescence in situ hybridization (FISH) assay to confirm Xp11 translocation RCCs and ASPS. Representative sections of formalin-fixed paraffin-embedded tissue blocks were selected in 40 possible cases. Approximately 60 tumor cells were analyzed in the targeted region. The validation of TFE3 FISH was done with 11 negative and two positive cases. Cut off for a positive result was validated as >7.15 % positive nuclei with any pattern of break-apart signals. FISH evaluation was done blinded of the immunohistochemical or karyotype data. Three out of forty cases were positive for the TFE3 break-apart signals by FISH. The negative cases were reported as clear cell RCC with papillary features (10), clear cell RCC with sarcomatoid areas (2), Papillary RCC with clear cell areas (9), Chromophobe RCC (2), RCC, unclassified type (3) and renal medullary carcinoma (1). 3 of the negative cases were consultation cases for renal tumor with unknown histology. Seven negative cases were soft tissue tumor suspicious for ASPS. Our study validates the utility of TFE3 break-apart FISH on formalin-fixed paraffin-embedded tissue sections for diagnosis and confirmation of Xp11.2 translocation RCCs and ASPS.

Dimensional soft tissue changes following soft tissue grafting in conjunction with implant placement or around present dental implants: a systematic review.

PubMed

Poskevicius, Lukas; Sidlauskas, Antanas; Galindo-Moreno, Pablo; Juodzbalys, Gintaras

2017-01-01

To systematically review changes in mucosal soft tissue thickness and keratinised mucosa width after soft tissue grafting around dental implants. An electronic literature search was conducted of the MEDLINE database published between 2009 and 2014. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in soft tissue thickness or keratinised mucosa width after soft tissue grafting at implant placement or around a present implant at 6-month follow-up or longer were included. The search resulted in fourteen articles meeting the inclusion criteria: Six of them reported connective tissue grafting around present dental implants, compared to eight at the time of implant placement. Better long-term soft tissue thickness outcomes were reported for soft tissue augmentation around dental implants (0.8-1.4 mm), compared with augmentation at implant placement (-0.25-1.43 mm). Both techniques were effective in increasing keratinised tissue width: at implant placement (2.5 mm) or around present dental implants (2.33-2.57 mm). The present systematic review discovered that connective tissue grafts enhanced keratinised mucosa width and soft tissue thickness for an observation period of up to 48 months. However, some shrinkage may occur, resulting in decreases in soft tissue, mostly for the first three months. Further investigations using accurate evaluation methods need to be done to evaluate the appropriate time for grafting. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Soft-tissue tension total knee arthroplasty.

PubMed

Asano, Hiroshi; Hoshino, Akiho; Wilton, Tim J

2004-08-01

It is far from clear how best to define the proper strength of soft-tissue tensioning in total knee arthroplasty (TKA). We attached a torque driver to the Monogram balancer/tensor device and measured soft-tissue tension in full extension and 90 degrees flexion during TKA. In our surgical procedure, when we felt proper soft-tissue tension was being applied, the mean distraction force was noted to be 126N in extension and 121N in flexion. There was no significant correlation between soft-tissue tension and the postoperative flexion angle finally achieved. To the best of our knowledge, this is the first study to assess the actual distraction forces in relation to soft-tissue tension in TKA. Further study may reveal the most appropriate forces to achieve proper soft-tissue tension in the wide variety of circumstances presenting at knee arthroplasty.

Survivorship of the native hip joint after percutaneous repair of acetabular fractures in the elderly.

PubMed

Gary, Joshua L; Lefaivre, Kelly A; Gerold, Frank; Hay, Michael T; Reinert, Charles M; Starr, Adam J

2011-10-01

Our purpose was to examine survivorship of the native hip joint in patients ages 60 and over who underwent percutaneous reduction and fixation of acetabular fractures. A retrospective review at a University Level I Trauma Center was performed. Our institutional trauma database was reviewed. Patients aged 60 or older treated with percutaneous reduction and fixation of acetabular fractures between 1994 and 2007 were selected. 79 consecutive patients with 80 fractures were identified. Rate of conversion to total hip arthroplasty were used to construct a Kaplan-Meier curve showing survivorship of the native hip joint after treatment. 75 fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5-11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no conversions to arthroplasty beyond 4.7 years postoperatively. There were no statistically significant associations between conversion to arthroplasty and age, sex, closed vs. limited open reduction, and simple vs. complex fracture pattern. Percutaneous fixation is a viable treatment option for patients age 60 or greater with acetabular fractures. Rates of conversion to total hip arthroplasty are comparable to open treatment methods and if conversion is required, soft tissues are preserved for future surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

Higher trophic level affects nutrient, silicon, metal(loid), and radionuclide mobilization from freshwater sediments

NASA Astrophysics Data System (ADS)

Schaller, Jörg; Planer-Friedrich, Britta

2017-04-01

Organic sediments in aquatic ecosystems are well known sinks for nutrients, silicon, and metal(loid)s. Organic matter-decomposing organisms like invertebrate shredders, grazers, bioturbators, and filter feeder are key-species for the carbon and energy turnover within the decomposer community. We could show that invertebrate shredders and grazer affect element fixation or remobilization by changing binding properties of organic sediments and the attached biofilm. Bioturbators affect element fixation or remobilization by changing redox conditions within the uppermost sediment layer. Last but not least filter feeders, like the zebra mussel Dreissena polymorpha, an invasive organism in North American and European freshwater ecosystems significantly contributed to element mobilization of silicon, iron, phosphorus, arsenic, and copper and to immobilization of uranium (p<0.001), probably driven by redox conditions, microbial activity within the gut system, or active control of element homeostasis. Except of the filter feeder D. polymorpha, the invertebrates are able to minimize the accumulation of non-nutrient elements due to specific strategies, which is an important strategy for species living in systems tending to element accumulation. However, D. polymorpha revealed a significant uptake and accumulation of arsenic, copper, iron, and especially uranium both into the soft body tissues and the seashell. This accumulation by D. polymorpha is in line with previous observations of metal(loid) accumulation from biomonitoring studies. In summary, higher trophic level strongly contributes to element fixation or remobilization in aquatic systems.

Current concepts review: Fractures of the patella

PubMed Central

Gwinner, Clemens; Märdian, Sven; Schwabe, Philipp; Schaser, Klaus-D.; Krapohl, Björn Dirk; Jung, Tobias M.

2016-01-01

Fractures of the patella account for about 1% of all skeletal injuries and can lead to profound impairment due to its crucial function in the extensor mechanism of the knee. Diagnosis is based on the injury mechanism, physical examination and radiological findings. While the clinical diagnosis is often distinct, there are numerous treatment options available. The type of treatment as well as the optimum timing of surgical intervention depends on the underlying fracture type, the associated soft tissue damage, patient factors (i.e. age, bone quality, activity level and compliance) and the stability of the extensor mechanism. Regardless of the treatment method an early rehabilitation is recommended in order to avoid contractures of the knee joint capsule and cartilage degeneration. For non-displaced and dislocated non-comminuted transverse patellar fractures (2-part) modified anterior tension band wiring is the treatment of choice and can be combined – due to its biomechanical superiority – with cannulated screw fixation. In severe comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates for anatomic restoration of the retropatellar surface and extension mechanism results in best outcome. Additional circular cerclage wiring using either typical metal cerclage wires or resorbable PDS/non-resorbable FiberWires increases fixation stability and decreases risk for re-dislocation. Distal avulsion fractures should be fixed with small fragment screws and should be protected by a transtibial McLaughlin cerclage. Partial or complete patellectomy should be regarded only as a very rare salvage operation due to its severe functional impairment. PMID:26816667

Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults.

PubMed

Gursu, Sarper; Bahar, Hakan; Camurcu, Yalkin; Yildirim, Timur; Buyuk, Fettah; Ozcan, Cagri; Sahin, Vedat

2015-01-01

Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. Level IV, case series. © The Author(s) 2014.

Soft Tissue Sarcoma—Patient Version

Cancer.gov

Soft tissue sarcoma is a cancer that starts in soft tissues like muscle, tendons, fat, lymph vessels, blood vessels, and nerves. These cancers can develop anywhere in the body but are found mostly in the arms, legs, chest, and abdomen. Start here to find information on soft tissue sarcoma treatment and research.

Combination Chemotherapy and Radiation Therapy in Treating Patients With Newly Diagnosed Rhabdomyosarcoma

ClinicalTrials.gov

2017-06-27

Adult Malignant Mesenchymoma; Adult Rhabdomyosarcoma; Childhood Alveolar Rhabdomyosarcoma; Childhood Botryoid-Type Embryonal Rhabdomyosarcoma; Childhood Embryonal Rhabdomyosarcoma; Childhood Malignant Mesenchymoma; Non-Metastatic Childhood Soft Tissue Sarcoma; Stage I Adult Soft Tissue Sarcoma; Stage II Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Untreated Childhood Rhabdomyosarcoma

UK Fixation of Distal Tibia Fractures (UK FixDT): protocol for a randomised controlled trial of ‘locking’ plate fixation versus intramedullary nail fixation in the treatment of adult patients with a displaced fracture of the distal tibia

PubMed Central

Achten, Juul; Parsons, Nicholas R; McGuinness, Katie R; Petrou, Stavros; Lamb, Sarah E; Costa, Matthew L

2015-01-01

Introduction The treatment of displaced, extra-articular fractures of the distal tibia remains controversial. These injuries are difficult to manage due to limited soft tissue cover, poor vascularity of the area and proximity to the ankle joint. Surgical treatment options are expanding and include locked intramedullary nails, plate and screw fixation and external fixator systems. The nail and plate options are most commonly used in the UK, but controversy exists over which treatment is most clinically and cost-effective. In this multicentre randomised controlled trial we aim to assess ratings of disability 6 months postinjury in patients who have sustained a distal tibia fracture treated with either an intramedullary nail or plate and locking screw fixation. Methods and analysis Adult patients presenting at trial centres with an acute fracture of the distal tibia will be considered for inclusion. A total of 320 patients will provide 90% power to detect a difference of 8 points in Disability Rating Index (DRI) score at 6 months at the 5% level. The randomisation sequence is stratified by trial centre and age, and administered via web-based service with 1:1 treatment allocation. Baseline demographic and pre-injury functional data and radiographs will be collected using the DRI, Olerud and Molander, and EuroQol EQ-5D questionnaire. Clinical assessment, early complications and radiographs will be recorded at 6–8 weeks. Functional outcome, health-related quality of life and resource use will be collected at 3, 6 and 12 months postoperatively. The main analysis will investigate differences in DRI 6 months postsurgery, between the two treatment groups, on an intention-to-treat basis. Tests will be two-sided and considered to provide evidence for a significant difference if p values are <0.05. Ethics and dissemination NRES Committee West-Midlands, 6/11/2012 (ref:12/WM/0340). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences. Trial registration number ISRCTN99771224. PMID:26384729

Soft-Tissue Grafting Techniques Associated With Immediate Implant Placement.

PubMed

Bishara, Mark; Kurtzman, Gregori M; Khan, Waji; Choukroun, Joseph; Miron, Richard J

2018-02-01

Immediate implant placement often presents challenges in terms of predictably obtaining soft-tissue coverage over the implant site. While delayed implant placement offers the ability for soft tissues to grow and invade the extraction socket making their attachment around implants more predictable, immediate implant placement poses a significant risk of bacterial invasion towards the implant surface as a result of insignificant soft-tissue volume. Soft-tissue grafting techniques have often been proposed for use during immediate implant placement to augment soft-tissue deficiencies, including the use of either palatal connective tissue grafts (CTGs) or collagen-derived scaffolds. However, both of these approaches have significant drawbacks in that CTGs are harvested with high patient morbidity and collagen scaffolds remain avascular and acelluar posing a risk of infection/implant contamination. More recently, platelet-rich fibrin (PRF) has been proposed as an economical and biological means to speed soft-tissue wound healing. In combination with immediate implant placement, PRF offers an easily procurable low-cost regenerative modality that offers an efficient way to improve soft-tissue attachment around implants. Furthermore, the supra-physiological concentration of defense-fighting leukocytes in PRF, combined with a dense fibrin meshwork, is known to prevent early bacterial contamination of implant surfaces, and the biological concentrations of autologous growth factors in PRF is known to increase tissue regeneration. This article discusses soft-tissue grafting techniques associated with immediate implant placement, presents several cases demonstrating the use of PRF in routine immediate implant placement, and further discusses the biological and economic advantages of PRF for the management of soft-tissue grafting during immediate implant placement.

Next-gen tissue: preservation of molecular and morphological fidelity in prostate tissue.

PubMed

Gillard, Marc; Tom, Westin R; Antic, Tatjana; Paner, Gladell P; Lingen, Mark W; VanderWeele, David J

2015-01-01

Personalization of cancer therapy requires molecular evaluation of tumor tissue. Traditional tissue preservation involves formalin fixation, which degrades the quality of nucleic acids. Strategies to bank frozen prostate tissue can interfere with diagnostic studies. PAXgene is an alternative fixative that preserves protein and nucleic acid quality. Portions of prostates obtained from autopsy specimens were fixed in either 10% buffered formalin or PAXgene, and processed and embedded in paraffin. Additional sections were immediately embedded in OCT and frozen. DNA and RNA were extracted from the formalin-fixed, PAXgene-fixed, or frozen tissue. Quantitative PCR was used to compare the quality of DNA and RNA obtained from all three tissue types. In addition, 5 μm sections were cut from specimens devoid of cancer and from prostate cancer specimens obtained at prostatectomy and fixed in PAXgene. They were either stained with hematoxylin and eosin or interrogated with antibodies for p63, PSA and p504. Comparable tissue morphology was observed in both the formalin and PAXgene-fixed specimens. Similarly, immunohistochemical expression of the P63, PSA and P504 proteins was comparable between formalin and PAXgene fixation techniques. DNA from the PAXgene-fixed tissue was of similar quality to that from frozen tissue. RNA was also amplified with up to 8-fold greater efficiency in the PAXgene fixed tissue compared to the formalin-fixed tissue. Prostate specimens fixed with PAXgene have preserved histologic morphology, stain appropriately, and have preserved quality of nucleic acids. PAXgene fixation facilitates the use of prostatectomy tissue for molecular biology techniques such as next-generation sequencing.

Nondestructive cryomicro-CT imaging enables structural and molecular analysis of human lung tissue.

PubMed

Vasilescu, Dragoş M; Phillion, André B; Tanabe, Naoya; Kinose, Daisuke; Paige, David F; Kantrowitz, Jacob J; Liu, Gang; Liu, Hanqiao; Fishbane, Nick; Verleden, Stijn E; Vanaudenaerde, Bart M; Lenburg, Marc; Stevenson, Christopher S; Spira, Avrum; Cooper, Joel D; Hackett, Tillie-Louise; Hogg, James C

2017-01-01

Micro-computed tomography (CT) enables three-dimensional (3D) imaging of complex soft tissue structures, but current protocols used to achieve this goal preclude cellular and molecular phenotyping of the tissue. Here we describe a radiolucent cryostage that permits micro-CT imaging of unfixed frozen human lung samples at an isotropic voxel size of (11 µm) 3 under conditions where the sample is maintained frozen at -30°C during imaging. The cryostage was tested for thermal stability to maintain samples frozen up to 8 h. This report describes the methods used to choose the materials required for cryostage construction and demonstrates that whole genome mRNA integrity and expression are not compromised by exposure to micro-CT radiation and that the tissue can be used for immunohistochemistry. The new cryostage provides a novel method enabling integration of 3D tissue structure with cellular and molecular analysis to facilitate the identification of molecular determinants of disease. The described micro-CT cryostage provides a novel way to study the three-dimensional lung structure preserved without the effects of fixatives while enabling subsequent studies of the cellular matrix composition and gene expression. This approach will, for the first time, enable researchers to study structural changes of lung tissues that occur with disease and correlate them with changes in gene or protein signatures. Copyright © 2017 the American Physiological Society.

Melorheostosis with recurrent soft-tissue components: a histologically confirmed case.

PubMed

Hasegawa, Shoichi; Kanda, Shotaro; Imada, Hiroki; Yamaguchi, Takehiko; Akiyama, Toru

2017-03-01

Melorheostosis is a very rare disorder characterized by irregular cortical thickening seen on radiographs. In this paper, we present a case of melorheostosis with microscopically confirmed soft-tissue components. The patient was a 51-year-old man who complained of severe pain in the lateral aspect of his right knee. The excision of an ossified soft-tissue lesion relieved intractable pain that had lasted 20 years. Microscopically, the cortex of the affected fibula was composed of thick compact bone and the soft-tissue component consisted of dense compact bone without endochondral ossification. The presence of soft-tissue osseous nodules around the joints is one of the specific conditions for melorheostosis and should be differentiated from synovial chondromatosis. The ossified soft-tissue lesion in our patient is to our knowledge the first reported case of the histologically confirmed soft-tissue component of melorheostosis, which differs from that of synovial chondromatosis.

Fiber-reinforced scaffolds in soft tissue engineering

PubMed Central

Wang, Wei; Fan, Yubo; Wang, Xiumei; Watari, Fumio

2017-01-01

Abstract Soft tissue engineering has been developed as a new strategy for repairing damaged or diseased soft tissues and organs to overcome the limitations of current therapies. Since most of soft tissues in the human body are usually supported by collagen fibers to form a three-dimensional microstructure, fiber-reinforced scaffolds have the advantage to mimic the structure, mechanical and biological environment of natural soft tissues, which benefits for their regeneration and remodeling. This article reviews and discusses the latest research advances on design and manufacture of novel fiber-reinforced scaffolds for soft tissue repair and how fiber addition affects their structural characteristics, mechanical strength and biological activities in vitro and in vivo. In general, the concept of fiber-reinforced scaffolds with adjustable microstructures, mechanical properties and degradation rates can provide an effective platform and promising method for developing satisfactory biomechanically functional implantations for soft tissue engineering or regenerative medicine. PMID:28798872

Soft tissue modelling through autowaves for surgery simulation.

PubMed

Zhong, Yongmin; Shirinzadeh, Bijan; Alici, Gursel; Smith, Julian

2006-09-01

Modelling of soft tissue deformation is of great importance to virtual reality based surgery simulation. This paper presents a new methodology for simulation of soft tissue deformation by drawing an analogy between autowaves and soft tissue deformation. The potential energy stored in a soft tissue as a result of a deformation caused by an external force is propagated among mass points of the soft tissue by non-linear autowaves. The novelty of the methodology is that (i) autowave techniques are established to describe the potential energy distribution of a deformation for extrapolating internal forces, and (ii) non-linear materials are modelled with non-linear autowaves other than geometric non-linearity. Integration with a haptic device has been achieved to simulate soft tissue deformation with force feedback. The proposed methodology not only deals with large-range deformations, but also accommodates isotropic, anisotropic and inhomogeneous materials by simply changing diffusion coefficients.

Concomitant Correction of a Soft-Tissue Fenestration with Keratinised Tissue Augmentation By Using A Rotated Double-Pedicle Flap During Second-Stage Implant Surgery- A Case Report

PubMed Central

Reddy, Aileni Amarender; Kumar, P. Anoop; Sailaja, Sistla; Chakravarthy, Yshs

2015-01-01

Soft tissue deficiencies and defects around dental implants have been observed frequently. Soft-tissue defects after implant procedures originate from the process of modelling of periimplant mucosa and often cause aesthetic disharmony, food debris accumulation and soft tissue shrinkage. Periimplant mucogingival surgery focuses on creating an optimum band of keratinized tissue resulting in soft tissue architecture similar to the gingiva around natural teeth. A 23-year-old male reported to the Department of Periodontology with a complaint of gum soreness, foul smell and food accumulation at a site where a 3.75 x 11.5mm implant was placed previously. On clinical examination, fenestration of tissue above the cover screw was observed and there appeared to be a keratinized tissue of 1mm surrounding the implant. The case was managed by use of a rotated double-pedicle flap during second-stage implant surgery to correct the soft-tissue fenestration defect and to obtain a keratinized periimplant soft tissue. A periosteal bed was prepared by giving a horizontal incision at the mucogingival junction to a depth of 4 mm. Two split-thickness keratinized pedicles were dissected from the mesial and distal interproximal tissues near the implant. After rotation, both the pedicles were sutured to each other mid-buccally and the pedicles were rigidly immobilized with sutures. At 1 month, there was a 3mm band of stable and firm keratinized tissue over the underlying tissues. The procedure resulted in an aesthetic improvement due to enhanced soft tissue architecture and optimum integration between the peri-implant soft tissue and the final prosthesis. PMID:26816998

Prevalence of Soft Tissue Calcifications in CBCT Images of Mandibular Region.

PubMed

Khojastepour, Leila; Haghnegahdar, Abdolaziz; Sayar, Hamed

2017-06-01

Most of the soft tissue calcifications within the head and neck region might not be accompanied by clinical symptoms but may indicate some pathological conditions. The aim of this research was to determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) images of mandibular region. In this cross sectional study the CBCT images of 602 patients including 294 men and 308 women with mean age 41.38±15.18 years were evaluated regarding the presence, anatomical location; type (single or multiple) and size of soft tissue calcification in mandibular region. All CBCT images were acquired by NewTom VGi scanner. Odds ratio and chi-square tests were used for data analysis and p < 0.05 was considered to be statistically significant. 156 out of 602 patients had at least one soft tissue calcification in their mandibular region (25.9%. of studied population with mean age 51.7±18.03 years). Men showed significantly higher rate of soft tissue calcification than women (30.3% vs. 21.8%). Soft tissue calcification was predominantly seen at posterior region of the mandible (88%) and most of them were single (60.7%). The prevalence of soft tissue calcification increased with age. Most of the detected soft tissue calcifications were smaller than 3mm (90%). Soft tissue calcifications in mandibular area were a relatively common finding especially in posterior region and more likely to happen in men and in older age group.

[Study of susceptibility weighted imaging on MR and pathologic findings to distinguish benign or malignant soft tissue tumor].

PubMed

Liu, J; Chen, Y; Bao, X M; Ling, X L; Ding, J P; Zhang, Z K

2017-05-23

Objective: To explore the diagnostic performance of susceptibility weighted imaging (SWI)in distinguishing benign or malignant soft tissue tumor, and to study pathological observation. Methods: Sixty-eight patients with soft tissue tumor, who received no previous treatment or invasive examination, received routine preoperative MRI examination and SWI scanning. The graduation and distribution of intratumoral susceptibility signal intensity(ITSS) and proportion of tumor volume were observed.The pathological results were also included for comparative analysis. Results: Fourty of 68 patients were benign and 28 were malignant. 72.5% (29/40) patients with benign soft tissue tumors were ITSS grade 1 and ITSS grade 3 (hemangioma). 89.3%(25/28) patients with malignant soft tissue tumors were ITSS grade 2 and ITSS grade 3. The difference was statistically significant ( P <0.01). The distribution of ITSS in patients with benign soft tissue tumors was dominated by peripheral distribution and diffuse distribution (hemangioma), accounting for 90.0% (36/40). The distribution of ITSS in patients with malignant soft tissue tumors mainly distributed in the central region, accounting for 78.6% (22 /28). The difference was statistically significant ( P <0.01). The proportion of tumor volume occupied by ITSS in benign soft tissue tumors was <1/3 and> 2/3 (hemangioma), accounting for 90.0% (36/40). The volume of malignant soft tissue tumors were predominantly <1/3 , accounting for 82.1% (23/28). The difference was statistically significant ( P <0.01). Conclusion: SWI is sensitive in displaying the vein and blood metabolites in soft tissue lesions, which is helpful for the differential diagnosis of benign and malignant tumors in soft tissue.

The efficacy of the modified classification system of soft tissue injury in extension injury of the lower cervical spine.

PubMed

Song, Kyung-Jin; Kim, Gyu-Hyung; Lee, Kwang-Bok

2008-07-01

To classify comprehensively the severity of soft tissue injury for extension injuries of the lower cervical spine by magnetic resonance imaging (MRI). To investigate severity of extension injuries using a modified classification system for soft tissue injury by MRI, and to determine the possibility of predicting cord injury by determining the severity of soft tissue injury. It is difficult to diagnose extension injuries by plain radiography and computed tomography. MRI is considered to be the best method of diagnosing soft tissue injuries. The authors examined whether an MRI based diagnostic standard could be devised for extension injuries of the cervical spine. MRI was performed before surgery in 81 patients that had experienced a distractive-extension injury during the past 5 years. Severities of soft tissue injury were subdivided into 5 stages. The retropharyngeal space and the retrotracheal space were measured, and their correlations with the severity of soft tissue injury were examined, as was the relation between canal stenosis and cord injury. Cord injury developed in injuries greater than Grade III (according to our devised system) accompanied by posterior longitudinal ligament rupture (P < 0.01). As the severity of soft tissue injury increased, the cord signal change increased (P < 0.01), the retropharyngeal space and the retrotracheal space increased, and swelling severity in each stage were statistically significant (P < 0.01). In canal stenosis patients, soft tissue damage and cord injury were not found to be associated (P = 0.45). In cases of distractive-extension injury, levels of soft tissue injury were determined accurately by MRI. Moreover, the severity of soft tissue injury was found to be closely associated with the development of cord injury.

A study of cephalometric soft tissue profile among adolescents from the three West African countries of Nigeria, Ghana and Senegal.

PubMed

Fadeju, A D; Otuyemi, O D; Ngom, P I; Newman-Nartey, M

2013-03-01

Since the introduction of cephalometry, numerous studies have established normal values for Caucasian populations. In Africa, most investigations have established norms and ethnic variations associated with the skeletal pattern. To date, there has been no study comparing soft tissue patterns among adolescents in the West African sub-region. The objective of this investigation was to determine and compare soft tissue patterns among 12- to 16-year-old Nigerian, Ghanaian and Senegalese adolescents, establish any gender dimorphism and compare them with published Caucasian norms. Lateral cephalometric radiographs of adolescents with a normal incisor relationship aged between 12 and 16 years from Nigeria, Ghana, and Senegal were taken under standardized conditions and traced to determine soft tissue patterns. Data obtained were subjected to statistical analysis. The total sample consisted of 165 females and 135 males with a mean age of 13·96 (1·58) years. A number of soft tissue parameters showed significant differences (P<0·05). These included comparison between males and females, and Nigerian, Ghanaian and Senegalese, including lip separation, upper lip length, upper lip exposure, Li-esthetic line, lower lip-NP, nasal tip angle, N-Pr-Pg, Pg-Ls, B-N pogonion and pogonion-mandibular angle. Differences also existed between these West African soft tissue values and published Caucasian norms, including nasolabial angle, mentolabial angle, nasal depth, nose tip, total soft tissue facial convexity and nasal depth angle. The comparative analysis of soft tissue patterns among 12- to 16-year-old adolescents from Nigeria, Ghana and Senegal demonstrated statistically significant differences in soft tissue value between these West African adolescents and published Caucasian soft tissue norms. This study provides useful data in relation to soft tissue parameters for subjects originating from the West African sub-region.

Effect of pre-fixation delay and freezing on mink testicular endpoints for environmental research.

PubMed

Spörndly-Nees, Ellinor; Ekstedt, Elisabeth; Magnusson, Ulf; Fakhrzadeh, Azadeh; Luengo Hendriks, Cris L; Holm, Lena

2015-01-01

There is growing interest in using wild animals to monitor the real-life cocktail effect of environmental chemicals on male reproduction. However, practical difficulties, such as long distances to the laboratory, generally prolong the time between euthanisation and specimen handling. For instance, tissue fixation is often performed on frozen material or on material where deterioration has started, which may affect tissue morphology. This study examined the effect of pre-fixation delay and freezing on mink testicular endpoints in order to determine robust endpoints in suboptimally handled specimens. Sexually mature farmed mink (n=30) selected at culling were divided into six groups and subjected to different time intervals between euthanisation and fixation or freezing: 0 hours (fixed immediately post mortem), 6 hours, 18 hours, 30 hours, 42 hours, or frozen 6 hours post mortem and thawed overnight. Unaffected endpoints when pre-fixation storage was extended to 30 hours included: area and diameter of the seminiferous tubules, length and weight of the testes, and acrosomes marked with Gata-4. Epithelial height, Sertoli cells marked with Gata-4 and cell morphology were affected endpoints after 6 hours of storage. Freezing the tissue prior to fixation severely altered cell morphology and reduced testicular weight, tubular diameter and area. Morphological changes seen after 6 hours included shredded germ cells and excess cytoplasm in seminiferous tubular lumen, chromatin rearrangements and increased germ cell death. Extended delay before fixation and freezing affected many endpoints in the mink testicular tissue. Some of these endpoints may mimic chemically induced effects, which is important to consider when evaluating specimens from wild animals for environmental toxicity.

Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer

PubMed Central

Cuéllar, Vanessa G.; Ghiassi, Alidad; Sharpe, Frances

2016-01-01

Introduction: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Methods: Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Results: Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. Conclusions: This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm. PMID:27757363

Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer.

PubMed

Stevanovic, Milan V; Cuéllar, Vanessa G; Ghiassi, Alidad; Sharpe, Frances

2016-09-01

In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm.

Improved results of LINE-1 methylation analysis in formalin-fixed, paraffin-embedded tissues with the application of a heating step during the DNA extraction process.

PubMed

Wen, Xianyu; Jeong, Seorin; Kim, Younghoon; Bae, Jeong Mo; Cho, Nam Yun; Kim, Jung Ho; Kang, Gyeong Hoon

2017-01-01

Formalin-fixed, paraffin-embedded (FFPE) tissues are important resources for profiling DNA methylation changes and for studying a variety of diseases. However, formalin fixation introduces inter-strand crosslinking, which might cause incomplete bisulfite conversion of unmethylated cytosines, which might lead to falsely elevated measurements of methylation levels in pyrosequencing assays. Long interspersed nucleotide element-1 (LINE-1) is a major constituent of repetitive transposable DNA elements, and its methylation is referred to correlates with global DNA methylation. To identify whether formalin fixation might impact the measured values of methylation in LINE-1 repetitive elements and whether prolonged heat-induced denaturation of DNA might reduce the artificial increases in measured values caused by formalin fixation, we analyzed paired fresh-frozen (FF) and FFPE xenograft tissue samples for their methylation levels in LINE-1 using a pyrosequencing assay. To further confirm the effect of a heating step in the measurement of LINE-1 or single gene methylation levels, we analyzed FFPE tissue samples of gastric cancer and colorectal cancer for their methylation status in LINE-1 and eight single genes, respectively. Formalin fixation led to an increase in the measured values of LINE-1 methylation regardless of the duration of fixation. Prolonged heating of the DNA at 95 °C for 30 min before bisulfite conversion was found (1) to decrease the discrepancy in the measured values between the paired FF and FFPE tissue samples, (2) to decrease the standard deviation of the measured value of LINE-1 methylation levels in FFPE tissue samples of gastric cancer, and (3) to improve the performance in the measurement of single gene methylation levels in FFPE tissue samples of colorectal cancer. Formalin fixation leads to artificial increases in the measured values of LINE-1 methylation, and the application of prolonged heating of DNA samples decreases the discrepancy in the measured values of LINE-1 methylation between paired FF and FFPE tissue samples. The application of prolonged heating of DNA samples improves bisulfite conversion-based measurement of LINE-1 or single gene methylation levels in FFPE tissue samples.

Effect of tissue composition on dose distribution in brachytherapy with various photon emitting sources

PubMed Central

Ghorbani, Mahdi; Salahshour, Fateme; Haghparast, Abbas; Knaup, Courtney

2014-01-01

Purpose The aim of this study is to compare the dose in various soft tissues in brachytherapy with photon emitting sources. Material and methods 103Pd, 125I, 169Yb, 192Ir brachytherapy sources were simulated with MCNPX Monte Carlo code, and their dose rate constant and radial dose function were compared with the published data. A spherical phantom with 50 cm radius was simulated and the dose at various radial distances in adipose tissue, breast tissue, 4-component soft tissue, brain (grey/white matter), muscle (skeletal), lung tissue, blood (whole), 9-component soft tissue, and water were calculated. The absolute dose and relative dose difference with respect to 9-component soft tissue was obtained for various materials, sources, and distances. Results There was good agreement between the dosimetric parameters of the sources and the published data. Adipose tissue, breast tissue, 4-component soft tissue, and water showed the greatest difference in dose relative to the dose to the 9-component soft tissue. The other soft tissues showed lower dose differences. The dose difference was also higher for 103Pd source than for 125I, 169Yb, and 192Ir sources. Furthermore, greater distances from the source had higher relative dose differences and the effect can be justified due to the change in photon spectrum (softening or hardening) as photons traverse the phantom material. Conclusions The ignorance of soft tissue characteristics (density, composition, etc.) by treatment planning systems incorporates a significant error in dose delivery to the patient in brachytherapy with photon sources. The error depends on the type of soft tissue, brachytherapy source, as well as the distance from the source. PMID:24790623

Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study.

PubMed

Saengsin, Jirawat; Vaseenon, Tanawat; Pattamapaspong, Nuttaya; Kritsaneephaiboon, Apipop

2017-08-01

A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P<0.05). Images from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Infected nonunion of tibia

PubMed Central

Chaudhary, Milind Madhav

2017-01-01

Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union. PMID:28566776

Melorheostosis of the axial skeleton with associated fibrolipomatous lesions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garver, P.; Resnick, D.; Haghighi, P.

1982-11-01

Two patients with melorheostotic-like lesions of the axial skeleton are described. In each case adjacent soft tissue masses containing both fatty and fibrous tissues were evident. The presence of such soft tissue tumors as well as other soft tissue abnormalities in melorheostosis emphasizes that the diesease should not be regarded as one confined to bone. The precise pathogenesis of the osseous and soft tissue abnormalities in melorheostosis remains obscure.

Mechanical verification of soft-tissue attachment on bioactive glasses and titanium implants.

PubMed

Zhao, Desheng; Moritz, Niko; Vedel, Erik; Hupa, Leena; Aro, Hannu T

2008-07-01

Soft-tissue attachment is a desired feature of many clinical biomaterials. The aim of the current study was to design a suitable experimental method for tensile testing of implant incorporation with soft-tissues. Conical implants were made of three compositions of bioactive glass (SiO(2)-P(2)O(5)-B(2)O(3)-Na(2)O-K(2)O-CaO-MgO) or titanium fiber mesh (porosity 84.7%). The implants were surgically inserted into the dorsal subcutaneous soft-tissue or back muscles in the rat. Soft-tissue attachment was evaluated by pull-out testing using a custom-made jig 8 weeks after implantation. Titanium fiber mesh implants had developed a relatively high pull-out force in subcutaneous tissue (12.33+/-5.29 N, mean+/-SD) and also measurable attachment with muscle tissue (2.46+/-1.33 N). The bioactive glass implants failed to show mechanically relevant soft-tissue bonding. The experimental set-up of mechanical testing seems to be feasible for verification studies of soft-tissue attachment. The inexpensive small animal model is beneficial for large-scale in vivo screening of new biomaterials.

Gemcitabine Hydrochloride With or Without Pazopanib Hydrochloride in Treating Patients With Refractory Soft Tissue Sarcoma

ClinicalTrials.gov

2017-11-01

Adult Alveolar Soft Part Sarcoma; Adult Angiosarcoma; Adult Desmoplastic Small Round Cell Tumor; Adult Epithelioid Hemangioendothelioma; Adult Epithelioid Sarcoma; Adult Extraskeletal Myxoid Chondrosarcoma; Adult Extraskeletal Osteosarcoma; Adult Fibrosarcoma; Adult Leiomyosarcoma; Adult Liposarcoma; Adult Malignant Mesenchymoma; Adult Malignant Peripheral Nerve Sheath Tumor; Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Adult Undifferentiated Pleomorphic Sarcoma; Malignant Adult Hemangiopericytoma; Recurrent Adult Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma

Depsipeptide (Romidepsin) in Treating Patients With Metastatic or Unresectable Soft Tissue Sarcoma

ClinicalTrials.gov

2017-05-18

Adult Alveolar Soft-part Sarcoma; Adult Angiosarcoma; Adult Epithelioid Sarcoma; Adult Extraskeletal Chondrosarcoma; Adult Extraskeletal Osteosarcoma; Adult Fibrosarcoma; Adult Leiomyosarcoma; Adult Liposarcoma; Adult Malignant Fibrous Histiocytoma; Adult Malignant Hemangiopericytoma; Adult Malignant Mesenchymoma; Adult Neurofibrosarcoma; Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Gastrointestinal Stromal Tumor; Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Adult Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma

[Total hip replacement with isoelastic prosthesis in animals (author's transl)].

PubMed

Muhr, O; Stockhusen, H; Müller, O

1976-10-08

Uncemented fixation and low-fraction materials are the basis of this experiment. Plastics with an elasticity similar to the bone ("isoelasticity") show very propitious material qualities. The direct cementless incorporation of test bodies must be checked. In 63 sheep isoelastic total hip joints were implanted. After 2 till 51 weeks the animals were sacrificed and 44 specimen of hips and organs were explored macroscopically, radiologically, spherimetrically and histologically. The result was: 1. Plastic hip prosthesis are incorporated in the bone, but the boundary layer is built by a collagenous fiber tissue. 2. Loosening brings resoption of the bone and expansion of the structural changed soft tissue. 3. The transformation of the femoral cortex to osteoporosis is considered possibly as the consequence of an insufficient biological transfer of the weight. 4. Fractures of the femoral prosthesis-stem could not be observed. 5. The radiology allows at the pelvis prosthesis a concret statement concerning stability, on the femoral part a probable one. 6. The abrasion is minimal, the tissue reaction to abrasion products is unessential. 7. Small abrasion particles are carried of by the lymph tract and stored in the first regional gland. A more distant spreading is not demonstrable.

Tissue Fixation and Processing for the Histological Identification of Lipids.

PubMed

Carriel, Víctor; Campos, Fernando; Aneiros-Fernández, José; Kiernan, John A

2017-01-01

Lipids are a heterogeneous group of substances characterized by their solubility in organic solvents and insolubility in water. Lipids can be found as normal components of different tissues and organs, and they can be affected by several pathological conditions. The histochemical identification of lipids plays an important role in histopathological diagnosis and research, but successful staining depends on adequate fixation and processing of the tissue. Here we describe methods to fix and process tissue samples for the histochemical identification of lipids in frozen or paraffin-embedded tissues.

Glycogen in the Nervous System. I; Methods for Light and Electron Microscopy

NASA Technical Reports Server (NTRS)

Estable, Rosita F. De; Estable-Puig, J. F.; Miquel, J.

1964-01-01

'l'he relative value of different methods for combined light and electron microscopical studies of glycogen in the nervous tissue was investigated. Picroalcoholic fixatives preserve glycogen in a considerable amount but give an inadequate morphological image of glycogen distribution and are unsuitable for ultrastructural studies. Fixation by perfusion, with Dalton's chromeosmic fluid seems adequate for ultrastructural cytochemistry of glycogen. Furthermore it permits routine paraffin embedding of brain slices adjacent to those used for electron microscopy. Dimedone blocking is a necessary step for a selective staining of glycogen with PAS after osmic fixation. Enzymatic removal of glycogen in osmic fixed nervous tissue can be done In paraffin-embedded tissue. It can also be performed in glycolmethacrylate-embedded tissue without removal of the embedding medium. Paraphenylenediamine stains glycogen following periodic acid oxidation.

An alternative means of retaining ocular structure and improving immunoreactivity for light microscopy studies

PubMed Central

Sun, Ning; Shibata, Brad; Hess, John F.

2015-01-01

Purpose Several properties of ocular tissue make fixation for light microscopy problematic. Because the eye is spherical, immersion fixation necessarily results in a temporal gradient of fixation, with surfaces fixing more rapidly and thoroughly than interior structures. The problem is compounded by the fact that the layers of the eye wall are compositionally quite different, resulting in different degrees of fixation-induced shrinkage and distortion. Collectively, these result in non-uniform preservation, as well as buckling and/or retinal detachment. This gradient problem is most acute for the lens, where the density of proteins can delay fixation of the central lens for days, and where the fixation gradient parallels the age gradient of lens cells, which complicates data interpretation. Our goal was to identify a simple method for minimizing some of the problems arising from immersion fixation, which avoided covalent modification of antigens, retained high quality structure, and maintained tissue in a state that is amenable to common cytochemical techniques. Methods A simple and inexpensive derivative of the freeze-substitution approach was developed and compared to fixation by immersion in formalin. Preservation of structure, immunoreactivity, GFP and tdTomato fluorescence, lectin reactivity, outer segment auto fluorescence, Click-iT chemistry, compatibility with in situ hybdrdization, and the ability to rehydrate eyes after fixation by freeze substitution for subsequent cryo sectioning were assessed. Results An inexpensive and simple variant of the freeze substitution approach provides excellent structural preservation for light microscopy, and essentially eliminates ocular buckling, retinal detachment, and outer segment auto-fluorescence, without covalent modification of tissue antigens. The approach shows a notable improvement in preservation of immunoreactivity. TdTomato intrinsic fluorescence is also preserved, as is compatibility with in situ hybridization, lectin labeling, and the Click-iT chemistry approach to labeling the thymidine analog EdU. On the negative side, this approach dramatically reduced intrinsic GFP fluorescence. Conclusions A simple, cost-effective derivative of the freeze substitution process is described that is of particular value in the study of rodent or other small eyes, where fixation gradients, globe buckling, retinal detachment, differential shrinkage, autofluorescence, and tissue immunoreactivity have been problematic. PMID:25991907

Prevalence of Soft Tissue Calcifications in CBCT Images of Mandibular Region

PubMed Central

Khojastepour, Leila; Haghnegahdar, Abdolaziz; Sayar, Hamed

2017-01-01

Statement of the Problem: Most of the soft tissue calcifications within the head and neck region might not be accompanied by clinical symptoms but may indicate some pathological conditions. Purpose: The aim of this research was to determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) images of mandibular region. Materials and Method: In this cross sectional study the CBCT images of 602 patients including 294 men and 308 women with mean age 41.38±15.18 years were evaluated regarding the presence, anatomical location; type (single or multiple) and size of soft tissue calcification in mandibular region. All CBCT images were acquired by NewTom VGi scanner. Odds ratio and chi-square tests were used for data analysis and p< 0.05 was considered to be statistically significant. Results: 156 out of 602 patients had at least one soft tissue calcification in their mandibular region (25.9%. of studied population with mean age 51.7±18.03 years). Men showed significantly higher rate of soft tissue calcification than women (30.3% vs. 21.8%). Soft tissue calcification was predominantly seen at posterior region of the mandible (88%) and most of them were single (60.7%). The prevalence of soft tissue calcification increased with age. Most of the detected soft tissue calcifications were smaller than 3mm (90%). Conclusion: Soft tissue calcifications in mandibular area were a relatively common finding especially in posterior region and more likely to happen in men and in older age group. PMID:28620632

Soft tissue changes from maxillary distraction osteogenesis versus orthognathic surgery in patients with cleft lip and palate--a randomized controlled clinical trial.

PubMed

Chua, Hannah Daile P; Cheung, Lim Kwong

2012-07-01

The objective of this randomized controlled clinical trial was to compare the soft tissue changes after maxillary advancement using conventional orthognathic surgery (CO) and distraction osteogenesis (DO) in patients with cleft lip and palate (CLP). The study group of 39 CLP patients with maxillary hypoplasia underwent either CO or DO with 4 to 10 mm of maxillary advancement. Lateral cephalographs were taken preoperatively and postoperatively at regular intervals. A series of skeletal, dental, and soft tissue landmarks was used to evaluate the changes in the soft tissue and the correlation of hard and soft tissue changes and ratios. Significant differences were found between the CO and DO patients at A point in both maxillary advancement and downgrafting in the early follow-up period. On soft tissue landmarks of pronasale, subnasale, and labial superius, significant differences were found between the 2 groups at 6 months postoperatively only with maxillary advancement. There was better correlation of hard and soft tissue changes with maxillary advancement. The nasal projection was significantly different between the 2 groups at the early and intermediate period. There was much more consistent hard to soft tissue ratios in maxillary advancement with DO than with CO. Both CO and DO can induce significant soft tissue changes of the upper lip and nose, particularly with maxillary advancement. DO generates more consistent hard to soft tissue ratios. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Cabozantinib-S-Malate in Treating Younger Patients With Recurrent, Refractory, or Newly Diagnosed Sarcomas, Wilms Tumor, or Other Rare Tumors

ClinicalTrials.gov

2018-06-25

Adrenal Cortex Carcinoma; Adult Alveolar Soft Part Sarcoma; Adult Clear Cell Sarcoma of Soft Parts; Adult Hepatocellular Carcinoma; Adult Rhabdomyosarcoma; Adult Soft Tissue Sarcoma; Childhood Alveolar Soft Part Sarcoma; Childhood Central Nervous System Neoplasm; Childhood Clear Cell Sarcoma of Soft Parts; Childhood Hepatocellular Carcinoma; Childhood Rhabdomyosarcoma; Childhood Soft Tissue Sarcoma; Childhood Solid Neoplasm; Ewing Sarcoma; Hepatoblastoma; Hepatocellular Carcinoma; Recurrent Adrenal Cortex Carcinoma; Recurrent Adult Hepatocellular Carcinoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Alveolar Soft Part Sarcoma; Recurrent Childhood Central Nervous System Neoplasm; Recurrent Childhood Hepatocellular Carcinoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma; Recurrent Hepatoblastoma; Recurrent Malignant Solid Neoplasm; Recurrent Osteosarcoma; Recurrent Renal Cell Carcinoma; Recurrent Rhabdomyosarcoma; Refractory Osteosarcoma; Renal Cell Carcinoma; Thyroid Gland Medullary Carcinoma; Wilms Tumor

Fixation of Hydroxyapatite-Coated Revision Implants Is Improved by the Surgical Technique of Cracking the Sclerotic Bone Rim

PubMed Central

Elmengaard, Brian; Bechtold, Joan E.; Chen, Xinqian; Søballe, Kjeld

2013-01-01

Revision joint replacement has poorer outcomes that have been associated with poorer mechanical fixation. We investigate a new bone-sparing surgical technique that locally cracks the sclerotic bone rim formed during aseptic loosening. We inserted 16 hydroxyapatite-coated implants bilaterally in the distal femur of eight dogs, using a controlled weight-bearing experimental model that replicates important features of a typical revision setting. At 8 weeks, a control revision procedure and a crack revision procedure were performed on contralateral implants. The crack procedure used a splined tool to perform a systematic local perforation of the sclerotic bone rim of the revision cavity. After 4 weeks, the hydroxyapatite-coated implants were evaluated for mechanical fixation by a push-out test and for tissue distribution by histomorphometry. The cracking revision procedure resulted in significantly improved mechanical fixation, significantly more bone ongrowth and bone volume in the gap, and reduced fibrous tissue compared to the control revision procedure. The study demonstrates that the sclerotic bone rim prevents bone ingrowth and promotes fixation by fibrous tissue. The effect of the cracking technique may be due to improved access to the vascular compartment of the bone. The cracking technique is a simple surgical method that potentially can improve the fixation of revision implants in sclerotic regions important for obtaining the fixation critical for overall implant stability. PMID:19148940

Quantitative morphology in canine cutaneous soft tissue sarcomas.

PubMed

Simeonov, R; Ananiev, J; Gulubova, M

2015-12-01

Stained cytological specimens from 24 dogs with spontaneous soft tissue sarcomas [fibrosarcoma (n = 8), liposarcoma (n = 8) and haemangiopericytoma (n = 8)], and 24 dogs with reactive connective tissue lesions [granulation tissue (n = 12) and dermal fibrosis (n = 12)] were analysed by computer-assisted nuclear morphometry. The studied morphometric parameters were: mean nuclear area (MNA; µm(2)), mean nuclear perimeter (MNP; µm), mean nuclear diameter (MND mean; µm), minimum nuclear diameter (Dmin; µm) and maximum nuclear diameter (Dmax; µm). The study aimed to evaluate (1) possibility for quantitative differentiation of soft tissue sarcomas from reactive connective tissue lesions and (2) by using cytomorphometry, to differentiate the various histopathological soft tissue sarcomas subtypes in dogs. The mean values of all nuclear cytomorphometric parameters (except for Dmax) were statistically significantly higher in reactive connective tissue processes than in soft tissue sarcomas. At the same time, however, there were no considerable differences among the different sarcoma subtypes. The results demonstrated that the quantitative differentiation of reactive connective tissue processes from soft tissue sarcomas in dogs is possible, but the same was not true for the different canine soft tissue sarcoma subtypes. Further investigations on this topic are necessary for thorough explication of the role of quantitative morphology in the diagnostics of mesenchymal neoplasms and tumour-like fibrous lesions in dogs. © 2014 John Wiley & Sons Ltd.

[Fitting of the reconstructed craniofacial hard and soft tissues based on 2-D digital radiographs].

PubMed

Feng, Yao-Pu; Qiao, Min; Zhou, Hong; Zhang, Yan-Ning; Si, Xin-Qin

2017-02-01

In this study, we reconstructed the craniofacial hard and soft tissues based on the data from digital cephalometric radiographs and laser scanning. The effective fitting of the craniofacial hard and soft tissues was performed in order to increase the level of orthognathic diagnosis and treatment, and promote the communication between doctors and patients. A small lead point was put on the face of a volunteer and frontal and lateral digital cephalometric radiographs were taken. 3-D reconstruction system of the craniofacial hard tissue based on 2-D digital radiograph was used to get the craniofacial hard tissue model by means of hard tissue deformation modeling. 3-D model of facial soft tissue was obtained by using laser scanning data. By matching the lead point coordinate, the hard tissue and soft tissue were fitted. The 3-D model of the craniofacial hard and soft tissues was rebuilt reflecting the real craniofacial tissue structure, and effective fitting of the craniofacial hard and soft tissues was realized. The effective reconstruction and fitting of the 3-D craniofacial structures have been realized, which lays a foundation for further orthognathic simulation and facial appearance prediction. The fitting result is reliable, and could be used in clinical practice.

The Diagnostic and Prognostic Value of Hematological and Chemical Abnormalities in Soft Tissue Sarcoma: A Comparative Study in Patients with Benign and Malignant Soft Tissue Tumors.

PubMed

Ariizumi, Takashi; Kawashima, Hiroyuki; Ogose, Akira; Sasaki, Taro; Hotta, Tetsuo; Hatano, Hiroshi; Morita, Tetsuro; Endo, Naoto

2018-01-01

The value of routine blood tests in malignant soft tissue tumors remains uncertain. To determine if these tests can be used for screening, the routine pretreatment blood test findings were retrospectively investigated in 359 patients with benign and malignant soft tissue tumors. Additionally, the prognostic potential of pretreatment blood abnormalities was evaluated in patients with soft tissue sarcomas. We compared clinical factors and blood tests findings between patients with benign and malignant soft tissue tumors using univariate and multivariate analysis. Subsequently, patients with malignant tumors were divided into two groups based on blood test reference values, and the prognostic significance of each parameter was evaluated. In the univariate analysis, age, tumor size, and tumor depth were significant clinical diagnostic factors. Significant increases in the granulocyte count, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and γ-glutamyl transpeptidase (γ-GTP) levels were found in patients with malignant soft tissue tumors. Multiple logistic regression showed that tumor size and ESR were independent factors that predicted malignant soft tissue tumors. The Kaplan-Meier survival analysis revealed that granulocyte counts, γ-GTP levels, and CRP levels correlated significantly with overall survival. Thus, pretreatment routine blood tests are useful diagnostic and prognostic markers for diagnosing soft tissue sarcoma. © 2018 by the Association of Clinical Scientists, Inc.

Radiation Therapy With or Without Combination Chemotherapy or Pazopanib Hydrochloride Before Surgery in Treating Patients With Newly Diagnosed Non-rhabdomyosarcoma Soft Tissue Sarcomas That Can Be Removed by Surgery

ClinicalTrials.gov

2018-06-20

Adult Fibrosarcoma; Alveolar Soft Part Sarcoma; Angiomatoid Fibrous Histiocytoma; Atypical Fibroxanthoma; Clear Cell Sarcoma of Soft Tissue; Epithelioid Malignant Peripheral Nerve Sheath Tumor; Epithelioid Sarcoma; Extraskeletal Myxoid Chondrosarcoma; Extraskeletal Osteosarcoma; Fibrohistiocytic Neoplasm; Glomus Tumor of the Skin; Inflammatory Myofibroblastic Tumor; Intimal Sarcoma; Leiomyosarcoma; Liposarcoma; Low Grade Fibromyxoid Sarcoma; Low Grade Myofibroblastic Sarcoma; Malignant Cutaneous Granular Cell Tumor; Malignant Peripheral Nerve Sheath Tumor; Malignant Triton Tumor; Mesenchymal Chondrosarcoma; Myxofibrosarcoma; Myxoid Chondrosarcoma; Myxoinflammatory Fibroblastic Sarcoma; Nerve Sheath Neoplasm; PEComa; Pericytic Neoplasm; Plexiform Fibrohistiocytic Tumor; Sclerosing Epithelioid Fibrosarcoma; Stage IB Soft Tissue Sarcoma AJCC v7; Stage IIB Soft Tissue Sarcoma AJCC v7; Stage III Soft Tissue Sarcoma AJCC v7; Stage IV Soft Tissue Sarcoma AJCC v7; Synovial Sarcoma; Undifferentiated (Embryonal) Sarcoma; Undifferentiated High Grade Pleomorphic Sarcoma of Bone

National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module VIII. Soft Tissue Injuries.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This instructor's lesson plan guide on soft tissue injuries is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Six units of study are presented: (1) anatomy and physiology of the skin; (2) patient assessment for soft-tissue injuries; (3) pathophysiology and management of soft tissue injuries;…

EF5 to Evaluate Tumor Hypoxia in Patients With High-Grade Soft Tissue Sarcoma or Mouth Cancer

ClinicalTrials.gov

2013-01-15

Stage I Adult Soft Tissue Sarcoma; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage II Adult Soft Tissue Sarcoma; Stage II Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Adult Soft Tissue Sarcoma; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity

Modern Soft Tissue Pathology | Center for Cancer Research

Cancer.gov

This book comprehensively covers modern soft tissue pathology and includes both tumors and non-neoplastic entities. Soft tissues make up a large bulk of the human body, and they are susceptible to a wide range of diseases. Many soft-tissue tumors are biologically very aggressive, and the chance of them metastasizing to vital organs is quite high. In recent years, the outlook

Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection.

PubMed

Sultan, Assem A; Piuzzi, Nicolas; Khlopas, Anton; Chughtai, Morad; Sodhi, Nipun; Mont, Michael A

2017-12-01

Despite the well-established success of total knee arthroplasty (TKA), iatrogenic ligamentous and soft tissue injuries are infrequent, but potential complications that can have devastating impact on clinical outcomes. These injuries are often related to technical errors and excessive soft tissue manipulation, particularly during bony resections. Recently, robotic-arm assisted TKA was introduced and demonstrated promising results with potential technical advantages over manual surgery in implant positioning and mechanical accuracy. Furthermore, soft tissue protection is an additional potential advantage offered by these systems that can reduce inadvertent human technical errors encountered during standard manual resections. Therefore, due to the relative paucity of literature, we attempted to answer the following questions: 1) does robotic-arm assisted TKA offer a technical advantage that allows enhanced soft tissue protection? 2) What is the available evidence about soft tissue protection? Recently introduced models of robotic-arm assisted TKA systems with advanced technology showed promising clinical outcomes and soft tissue protection in the short- and mid-term follow-up with results comparable or superior to manual TKA. In this review, we attempted to explore this dimension of robotics in TKA and investigate the soft tissue related complications currently reported in the literature.

Further Studies on the Lyo and Desmo Components of Several Hydrolytic Enzymes and Their Histochemical Significance

PubMed Central

Hannibal, Mark J.; Nachlas, Marvin M.

1959-01-01

This report describes additional studies of the lyo and desmo components of esterase, alkaline phosphatase, acid phosphatase, leucine aminopeptidase, and β-glucuronidase. The techniques used have already been reported (7). Enzyme diffusion occurs to different degrees in different fixatives, and varies somewhat with each enzyme. Loss of enzymatic activity during fixation occurs as a result of both inactivation due to the chemical reaction of the fixative with the enzymic protein, and diffusion of the lyo component into the fixative. The amount of diffusion into formalin can be reduced by the addition of salts, sucrose, or methocel. The pH of the aqueous medium significantly influences the removal of the lyo fraction from the tissue section. A striking similarity can be noted in the proportions of each fraction of enzyme present in the kidney of the rat, dog, and man. The procedure of fixation and paraffin embedding of tissue blocks does not wholly prevent the diffusion of the lyo component from the tissue sections when they are subsequently immersed in the aqueous incubation medium. PMID:13654449

Antigen Masking During Fixation and Embedding, Dissected

PubMed Central

Scalia, Carla Rossana; Boi, Giovanna; Bolognesi, Maddalena Maria; Riva, Lorella; Manzoni, Marco; DeSmedt, Linde; Bosisio, Francesca Maria; Ronchi, Susanna; Leone, Biagio Eugenio; Cattoretti, Giorgio

2016-01-01

Antigen masking in routinely processed tissue is a poorly understood process caused by multiple factors. We sought to dissect the effect on antigenicity of each step of processing by using frozen sections as proxies of the whole tissue. An equivalent extent of antigen masking occurs across variable fixation times at room temperature. Most antigens benefit from longer fixation times (>24 hr) for optimal detection after antigen retrieval (AR; for example, Ki-67, bcl-2, ER). The transfer to a graded alcohol series results in an enhanced staining effect, reproduced by treating the sections with detergents, possibly because of a better access of the polymeric immunohistochemical detection system to tissue structures. A second round of masking occurs upon entering the clearing agent, mostly at the paraffin embedding step. This may depend on the non-freezable water removal. AR fully reverses the masking due both to the fixation time and the paraffin embedding. AR itself destroys some epitopes which do not survive routine processing. Processed frozen sections are a tool to investigate fixation and processing requirements for antigens in routine specimens. PMID:27798289

Imaging the Drosophila retina: zwitterionic buffers PIPES and HEPES induce morphological artifacts in tissue fixation.

PubMed

Nie, Jing; Mahato, Simpla; Zelhof, Andrew C

2015-02-03

Tissue fixation is crucial for preserving the morphology of biological structures and cytological details to prevent postmortem degradation and autolysis. Improper fixation conditions could lead to artifacts and thus incorrect conclusions in immunofluorescence or histology experiments. To resolve reported structural anomalies with respect to Drosophila photoreceptor cell organization we developed and utilized a combination of live imaging and fixed samples to investigate the exact biogenesis and to identify the underlying source for the reported discrepancies in structure. We found that piperazine-N,N'-bis(ethanesulfonic acid) (PIPES) and 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES), two zwitterionic buffers commonly used in tissue fixation, can cause severe lumen and cell morphological defects in Drosophila pupal and adult retina; the inter-rhabdomeral lumen becomes dilated and the photoreceptor cells are significantly reduced in size. Correspondingly, the localization pattern of Eyes shut (EYS), a luminal protein, is severely altered. In contrast, tissues fixed in the phosphate buffered saline (PBS) buffer results in lumen and cell morphologies that are consistent with live imaging. We suggest that PIPES and HEPES buffers should be utilized with caution for fixation when examining the interplay between cells and their extracellular environment, especially in Drosophila pupal and adult retina research.

Effect of bone-soft tissue friction on ultrasound axial shear strain elastography

NASA Astrophysics Data System (ADS)

Tang, Songyuan; Chaudhry, Anuj; Kim, Namhee; Reddy, J. N.; Righetti, Raffaella

2017-08-01

Bone-soft tissue friction is an important factor affecting several musculoskeletal disorders, frictional syndromes and the ability of a bone fracture to heal. However, this parameter is difficult to determine using non-invasive imaging modalities, especially in clinical settings. Ultrasound axial shear strain elastography is a non-invasive imaging modality that has been used in the recent past to estimate the bonding between different tissue layers. As most elastography methods, axial shear strain elastography is primarily used in soft tissues. More recently, this technique has been proposed to assess the bone-soft tissue interface. In this paper, we investigate the effect of a variation in bone-soft tissue friction coefficient in the resulting axial shear strain elastograms. Finite element poroelastic models of bone specimens exhibiting different bone-soft tissue friction coefficients were created and mechanically analyzed. These models were then imported to an ultrasound elastography simulation module to assess the presence of axial shear strain patterns. In vitro experiments were performed to corroborate selected simulation results. The results of this study show that the normalized axial shear strain estimated at the bone-soft tissue interface is statistically correlated to the bone-soft tissue coefficient of friction. This information may prove useful to better interpret ultrasound elastography results obtained in bone-related applications and, possibly, monitor bone healing.

Effect of bone-soft tissue friction on ultrasound axial shear strain elastography.

PubMed

Tang, Songyuan; Chaudhry, Anuj; Kim, Namhee; Reddy, J N; Righetti, Raffaella

2017-07-12

Bone-soft tissue friction is an important factor affecting several musculoskeletal disorders, frictional syndromes and the ability of a bone fracture to heal. However, this parameter is difficult to determine using non-invasive imaging modalities, especially in clinical settings. Ultrasound axial shear strain elastography is a non-invasive imaging modality that has been used in the recent past to estimate the bonding between different tissue layers. As most elastography methods, axial shear strain elastography is primarily used in soft tissues. More recently, this technique has been proposed to assess the bone-soft tissue interface. In this paper, we investigate the effect of a variation in bone-soft tissue friction coefficient in the resulting axial shear strain elastograms. Finite element poroelastic models of bone specimens exhibiting different bone-soft tissue friction coefficients were created and mechanically analyzed. These models were then imported to an ultrasound elastography simulation module to assess the presence of axial shear strain patterns. In vitro experiments were performed to corroborate selected simulation results. The results of this study show that the normalized axial shear strain estimated at the bone-soft tissue interface is statistically correlated to the bone-soft tissue coefficient of friction. This information may prove useful to better interpret ultrasound elastography results obtained in bone-related applications and, possibly, monitor bone healing.

Local deformation for soft tissue simulation

PubMed Central

Omar, Nadzeri; Zhong, Yongmin; Smith, Julian; Gu, Chengfan

2016-01-01

ABSTRACT This paper presents a new methodology to localize the deformation range to improve the computational efficiency for soft tissue simulation. This methodology identifies the local deformation range from the stress distribution in soft tissues due to an external force. A stress estimation method is used based on elastic theory to estimate the stress in soft tissues according to a depth from the contact surface. The proposed methodology can be used with both mass-spring and finite element modeling approaches for soft tissue deformation. Experimental results show that the proposed methodology can improve the computational efficiency while maintaining the modeling realism. PMID:27286482

Comparison of fixation and processing methods for hairless guinea pig skin following sulfur mustard exposure. (Reannouncement with new availability information)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bryant, M.A.; Braue Jr, E.H.

1992-12-31

Ten anesthetized hairless guinea pigs Crl:IAF(HA)BR were exposed to 10 pi of neat sulfur mustard (HD) in a vapor cup on their skin for 7 min. At 24 h postexposure, the guinea pigs were euthanatized and skin sections taken for histologic evaluation. The skin was fixed using either 10% neutral buffered formalin (NBF), McDowell Trump fixative (4CF-IG), Zenker`s formol-saline (Helly`s fluid), or Zenker`s fluid. Fixed skin sections were cut in half: one half was embedded in paraffin and the other half in plastic (glycol methacrylate). Paraffin-embedded tissue was stained with hematoxylin and eosin; plastic-embedded tissue was stained with Lee`s methylenemore » blue basic fuchsin. Skin was also frozen unfixed, sectioned by cryostat, and stained with pinacyanole. HD-exposed skin was evaluated histologically for the presence of epidermal and follicular necrosis, microblister formation, epidermitis, and intracellular edema to determine the optimal fixation and embedding method for lesion preservation. The percentage of histologic sections with lesions varied little between fixatives and was similar for both paraffin and plastic embedding material. Plastic-embedded sections were thinner, allowing better histologic evaluation, but were more difficult to stain. Plastic embedding material did not infiltrate tissue fixed in Zenker`s fluid or Zenker`s formol-saline. Frozen tissue sections were prepared in the least processing time and lesion preservation was comparable to fixed tissue. It was concluded that standard histologic processing using formalin fixation and paraffin embedding is adequate for routine histopathological evaluation of HD skin lesions in the hairless guinea pig.... Sulfur mustard, Vesicating agents, Pathology, Hairless guinea pig model, Fixation.« less

Contribution of trochanteric soft tissues to fall force estimates, the factor of risk, and prediction of hip fracture risk.

PubMed

Bouxsein, Mary L; Szulc, Pawel; Munoz, Fracoise; Thrall, Erica; Sornay-Rendu, Elizabeth; Delmas, Pierre D

2007-06-01

We compared trochanteric soft tissue thickness, femoral aBMD, and the ratio of fall force to femoral strength (i.e., factor of risk) in 21 postmenopausal women with incident hip fracture and 42 age-matched controls. Reduced trochanteric soft tissue thickness, low femoral aBMD, and increased ratio of fall force to femoral strength (i.e., factor of risk) were associated with increased risk of hip fracture. The contribution of trochanteric soft tissue thickness to hip fracture risk is incompletely understood. A biomechanical approach to assessing hip fracture risk that compares forces applied to the hip during a sideways fall to femoral strength may by improved by incorporating the force-attenuating effects of trochanteric soft tissues. We determined the relationship between femoral areal BMD (aBMD) and femoral failure load in 49 human cadaveric specimens, 53-99 yr of age. We compared femoral aBMD, trochanteric soft tissue thickness, and the ratio of fall forces to bone strength (i.e., the factor of risk for hip fracture, phi), before and after accounting for the force-attenuating properties of trochanteric soft tissue in 21 postmenopausal women with incident hip fracture and 42 age-matched controls. Femoral aBMD correlated strongly with femoral failure load (r2 = 0.73-0.83). Age, height, and weight did not differ; however, women with hip fracture had lower total femur aBMD (OR = 2.06; 95% CI, 1.19-3.56) and trochanteric soft tissue thickness (OR = 1.82; 95% CI, 1.01, 3.31). Incorporation of trochanteric soft tissue thickness measurements reduced the estimates of fall forces by approximately 50%. After accounting for force-attenuating properties of trochanteric soft tissue, the ratio of fall forces to femoral strength was 50% higher in cases than controls (0.92 +/- 0.44 versus 0.65 +/- 0.50, respectively; p = 0.04). It is possible to compute a biomechanically based estimate of hip fracture risk by combining estimates of femoral strength based on an empirical relationship between femoral aBMD and bone strength in cadaveric femora, along with estimates of loads applied to the hip during a sideways fall that account for thickness of trochanteric soft tissues. Our findings suggest that trochanteric soft tissue thickness may influence hip fracture risk by attenuating forces applied to the femur during a sideways fall and provide rationale for developing improved measurements of trochanteric soft tissue and for studying a larger cohort to determine whether trochanteric soft tissue thickness contributes to hip fracture risk independently of aBMD.

Checklist and Scoring System for the Assessment of Soft Tissue Preservation in CT Examinations of Human Mummies: Application to the Tyrolean Iceman.

PubMed

Panzer, Stephanie; Pernter, Patrizia; Piombino-Mascali, Dario; Jankauskas, Rimantas; Zesch, Stephanie; Rosendahl, Wilfried; Hotz, Gerhard; Zink, Albert R

2017-12-01

Purpose  Soft tissues make a skeleton into a mummy and they allow for a diagnosis beyond osteology. Following the approach of structured reporting in clinical radiology, a recently developed checklist was used to evaluate the soft tissue preservation status of the Tyrolean Iceman using computed tomography (CT). The purpose of this study was to apply the "Checklist and Scoring System for the Assessment of Soft Tissue Preservation in CT Examinations of Human Mummies" to the Tyrolean Iceman, and to compare the Iceman's soft tissue preservation score to the scores calculated for other mummies. Materials and Methods  A whole-body (CT) (SOMATOM Definition Flash, Siemens, Forchheim, Germany) consisting of five scans, performed in January 2013 in the Department of Radiodiagnostics, Central Hospital, Bolzano, was used (slice thickness 0.6 mm; kilovolt ranging from 80 to 140). For standardized evaluation the "CT Checklist and Scoring System for the Assessment of Soft Tissue Preservation in Human Mummies" was used. Results  All checkpoints under category "A. Soft Tissues of Head and Musculoskeletal System" and more than half in category "B. Organs and Organ Systems" were observed. The scoring system accounted for a total score of 153 (out of 200). The comparison of the scores between the Iceman and three mummy collections from Vilnius, Lithuania, and Palermo, Sicily, as well as one Egyptian mummy resulted in overall higher soft tissue preservation scores for the Iceman. Conclusion  Application of the checklist allowed for standardized assessment and documentation of the Iceman's soft tissue preservation status. The scoring system allowed for a quantitative comparison between the Iceman and other mummies. The Iceman showed remarkable soft tissue preservation. Key Points   · The approach of structured reporting can be transferred to paleoradiology.. · The checklist allowed for standardized soft tissue assessment and documentation.. · The scoring system facilitated a quantitative comparison among mummies.. · Based on CT, the Tyrolean Iceman demonstrated remarkable soft tissue preservation.. Citation Format · Panzer S, Pernter P, Piombino-Mascali D et al. Checklist and Scoring System for the Assessment of Soft Tissue Preservation in CT Examinations of Human Mummies: Application to the Tyrolean Iceman. Fortschr Röntgenstr 2017; 189: 1152 - 1160. © Georg Thieme Verlag KG Stuttgart · New York.

Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.

PubMed

Neogi, Devdatta Suhas; Trikha, Vivek; Mishra, Kaushal Kant; Bandekar, Shivanand M; Yadav, Chandra Shekhar

2015-01-01

Bicondylar tibial plateau fractures are complex injuries and treatment is challenging. Ideal method is still controversial with risk of unsatisfactory results if not treated properly. Many different techniques of internal and external fixation are used. This study compares the clinical results in single locked plating versus dual plating (DP) using two incision approaches. Our hypothesis was that DP leads to less collapse and change in alignment at final followup compared with single plating. 61 cases of Type C tibial plateau fractures operated between January 2007 and June 2011 were included in this prospective study. All cases were operated either by single lateral locked plate by anterolateral approach or double plating through double incision. All cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 10.0 to analyze the data. Twenty nine patients in a single lateral locked plate and 32 patients in a double plating group were followed for minimum 2 years. All fractures healed, however there was a significant incidence of malalignment in the single lateral plating group. Though there was a significant increase in soft tissue issues with the double plating group; however, there was only 3.12% incidence of deep infection. There was no significant difference in Hospital for special surgery score at 2 years followup. Double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate.

Management of Nail Bed Injuries Associated with Fingertip Injuries.

PubMed

George, Alexander; Alexander, Reena; Manju, C

2017-01-01

Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips' injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [ n = 10 (4.5%)] and general anaesthesia [ n = 14 (6.3%)] were used. In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours.

Iatrogenic Bone and Soft Tissue Trauma in Robotic-Arm Assisted Total Knee Arthroplasty Compared With Conventional Jig-Based Total Knee Arthroplasty: A Prospective Cohort Study and Validation of a New Classification System.

PubMed

Kayani, Babar; Konan, Sujith; Pietrzak, Jurek R T; Haddad, Fares S

2018-03-27

The objective of this study was to compare macroscopic bone and soft tissue injury between robotic-arm assisted total knee arthroplasty (RA-TKA) and conventional jig-based total knee arthroplasty (CJ-TKA) and create a validated classification system for reporting iatrogenic bone and periarticular soft tissue injury after TKA. This study included 30 consecutive CJ-TKAs followed by 30 consecutive RA-TKAs performed by a single surgeon. Intraoperative photographs of the femur, tibia, and periarticular soft tissues were taken before implantation of prostheses. Using these outcomes, the macroscopic soft tissue injury (MASTI) classification system was developed to grade iatrogenic bone and soft tissue injuries. Interobserver and Intraobserver validity of the proposed classification system was assessed. Patients undergoing RA-TKA had reduced medial soft tissue injury in both passively correctible (P < .05) and noncorrectible varus deformities (P < .05); more pristine femoral (P < .05) and tibial (P < .05) bone resection cuts; and improved MASTI scores compared to CJ-TKA (P < .05). There was high interobserver (intraclass correlation coefficient 0.92 [95% confidence interval: 0.88-0.96], P < .05) and intraobserver agreement (intraclass correlation coefficient 0.94 [95% confidence interval: 0.92-0.97], P < .05) of the proposed MASTI classification system. There is reduced bone and periarticular soft tissue injury in patients undergoing RA-TKA compared to CJ-TKA. The proposed MASTI classification system is a reproducible grading scheme for describing iatrogenic bone and soft tissue injury in TKA. RA-TKA is associated with reduced bone and soft tissue injury compared with conventional jig-based TKA. The proposed MASTI classification may facilitate further research correlating macroscopic soft tissue injury during TKA to long-term clinical and functional outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Long-term stability of peri-implant tissues after bone or soft tissue augmentation. Effect of zirconia or titanium abutments on peri-implant soft tissues. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

PubMed

Sicilia, Alberto; Quirynen, Marc; Fontolliet, Alain; Francisco, Helena; Friedman, Anton; Linkevicius, Tomas; Lutz, Rainer; Meijer, Henny J; Rompen, Eric; Rotundo, Roberto; Schwarz, Frank; Simion, Massimo; Teughels, Wim; Wennerberg, Ann; Zuhr, Otto

2015-09-01

Several surgical techniques and prosthetic devices have been developed in the last decades, aiming to improve aesthetic, hygienic and functional outcomes that may affect the peri-implant tissues, such as procedures of bone and soft tissue augmentation and the use of custom-made abutments of titanium and zirconium. Three systematic reviews, based on randomized clinical trials and prospective studies covering the above reported topics were analysed, and the detected evidence was exposed to interactive experts' discussion during the group's and general assembly's meetings of the 4th EAO Consensus Conference. The results are reported using the following abbreviations: S-T: short-term evidence, M-T: medium-term evidence; L-T: long-term evidence; LE: limited evidence. Soft tissue augmentation procedures may be indicated for the increase of soft tissue thickness and keratinized tissue, the reduction of interproximal peri-implant bone loss, and the coverage of shallow peri-implant soft tissue recessions (S-T, LE), L-T is lacking. Guided bone regeneration approaches (GBR) showed efficacy when used for ridge reconstruction after the complete healing of the soft tissues (S-T & L-T), and the stability of the augmented bone may play a role in the maintenance of the soft tissue position and dimensions (LE). No significant differences were observed between titanium and zirconia abutments when evaluating probing pocket depth, bleeding on probing, marginal bone levels and mucosal recessions. Zirconia abutments were associated with more biological complications but demonstrated superiority in terms of achieving natural soft tissue colour (S-T). © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Malunited fracture of the body and condyle of the mandible : A Case Report.

PubMed

Yeluri, Ramakrishna; Baliga, Sudhindra; Munshi, Autar Krishen

2010-07-01

Mandibular fractures are the most common facial fractures seen in hospitalized children and their incidence increases with age. Treatment options include soft diet, intermaxillary fixation with eyelet wires, arch bars, circummandibular wiring, or stents. Alternative options include open reduction and internal fixation through either an intraoral or extraoral approach. Many factors complicate the management of pediatric mixed-dentition mandibular fractures: tooth eruption, short roots, developing tooth buds and growth issues. One major factor is the inherent instability of the occlusion in the mixed deciduous-permanent tooth phase. This case report documents a child in mixed dentition period with a complication arising due to direct fixation of the fractured mandible.

One-Step Preservation of Phosphoproteins and Tissue Morphology at Room Temperature for Diagnostic and Research Specimens

PubMed Central

Mueller, Claudius; Edmiston, Kirsten H.; Carpenter, Calvin; Gaffney, Eoin; Ryan, Ciara; Ward, Ronan; White, Susan; Memeo, Lorenzo; Colarossi, Cristina; Petricoin, Emanuel F.; Liotta, Lance A.; Espina, Virginia

2011-01-01

Background There is an urgent need to measure phosphorylated cell signaling proteins in cancer tissue for the individualization of molecular targeted kinase inhibitor therapy. However, phosphoproteins fluctuate rapidly following tissue procurement. Snap-freezing preserves phosphoproteins, but is unavailable in most clinics and compromises diagnostic morphology. Formalin fixation preserves tissue histomorphology, but penetrates tissue slowly, and is unsuitable for stabilizing phosphoproteins. We originated and evaluated a novel one-step biomarker and histology preservative (BHP) chemistry that stabilizes signaling protein phosphorylation and retains formalin-like tissue histomorphology with equivalent immunohistochemistry in a single paraffin block. Results Total protein yield extracted from BHP-fixed, routine paraffin-embedded mouse liver was 100% compared to snap-frozen tissue. The abundance of 14 phosphorylated proteins was found to be stable over extended fixation times in BHP fixed paraffin embedded human colon mucosa. Compared to matched snap-frozen tissue, 8 phosphoproteins were equally preserved in mouse liver, while AMPKβ1 Ser108 was slightly elevated after BHP fixation. More than 25 tissues from mouse, cat and human specimens were evaluated for preservation of histomorphology. Selected tissues were evaluated in a multi-site, independent pathology review. Tissue fixed with BHP showed equivalent preservation of cytoplasmic and membrane cytomorphology, with significantly better nuclear chromatin preservation by BHP compared to formalin. Immunohistochemical staining of 13 non-phosphorylated proteins, including estrogen receptor alpha, progesterone receptor, Ki-67 and Her2, was equal to or stronger in BHP compared to formalin. BHP demonstrated significantly improved immunohistochemical detection of phosphorylated proteins ERK Thr202/Tyr204, GSK3-α/β Ser21/Ser9, p38-MAPK Thr180/Tyr182, eIF4G Ser1108 and Acetyl-CoA Carboxylase Ser79. Conclusion In a single paraffin block BHP preserved the phosphorylation state of several signaling proteins at a level comparable to snap-freezing, while maintaining the full diagnostic immunohistochemical and histomorphologic detail of formalin fixation. This new tissue fixative has the potential to greatly facilitate personalized medicine, biobanking, and phospho-proteomic research. PMID:21858221

Maxillofacial trauma of pediatric patients in Malaysia: a retrospective study from 1999 to 2001 in three hospitals.

PubMed

Rahman, Roslan Abdul; Ramli, Roszalina; Rahman, Normastura Abdul; Hussaini, Haizal Mohd; Idrus, Sharifah Munirah Ai; Hamid, Abdul Latif Abdul

2007-06-01

Maxillofacial trauma in children is not common worldwide. Domestic injuries are frequently seen in younger children while older children are mostly involved in motor vehicle accidents (MVA). The objective of this study was to analyze the pattern of maxillofacial injuries in pediatric patients referred to three government main hospitals in different areas of West Malaysia. Patients' records of three selected hospitals in Malaysia (National University of Malaysia Hospital, Kajang Hospital and Seremban Hospital) from January 1999 to December 2001 were reviewed. Data associated with demographics, etiology of injury in relation to age group, type of injuries whether soft tissues of hard tissue in relation to age group and treatment modalities were collected. A total of 521 pediatric patients' records were reviewed. Malays made up the majority of patients with maxillofacial injuries in the three hospitals. Males outnumbered females in all the three hospitals. Injuries commonly occur in the 11-16 years old. MVA was the most common etiology followed by fall and assault. Soft tissue injuries were the most common type of injuries in all the hospitals. In relation to fractures, mandible was the most common bone to fracture with condyle being the most common site. Orbital fracture was the most common fracture in the midfacial area. Most of the fractures were managed conservatively especially in the younger age groups. Open reduction with or without internal fixation was more frequently carried out in the 11-16 years old group. Children exhibit different pattern of clinical features depending on the etiology and stage of their bone maturation. A dedicated team, who is competent in trauma and aware of the unique anatomy, physical and psychological characteristics of children, should manage pediatric patient with trauma.

Doxorubicin With Upfront Dexrazoxane Plus Olaratumab for the Treatment of Advanced or Metastatic Soft Tissue Sarcoma

ClinicalTrials.gov

2018-02-08

Sarcoma, Soft Tissue; Soft Tissue Sarcoma; Undifferentiated Pleomorphic Sarcoma; Leiomyosarcoma; Liposarcoma; Synovial Sarcoma; Myxofibrosarcoma; Angiosarcoma; Fibrosarcoma; Malignant Peripheral Nerve Sheath Tumor; Epithelioid Sarcoma

The operation of the century: total hip replacement.

PubMed

Learmonth, Ian D; Young, Claire; Rorabeck, Cecil

2007-10-27

In the 1960s, total hip replacement revolutionised management of elderly patients crippled with arthritis, with very good long-term results. Today, young patients present for hip-replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities. Advances in bioengineering technology have driven development of hip prostheses. Both cemented and uncemented hips can provide durable fixation. Better materials and design have allowed use of large-bore bearings, which provide an increased range of motion with enhanced stability and very low wear. Minimally invasive surgery limits soft-tissue damage and facilitates accelerated discharge and rehabilitation. Short-term objectives must not compromise long-term performance. Computer-assisted surgery will contribute to reproducible and accurate placement of implants. Universal economic constraints in healthcare services dictate that further developments in total hip replacement will be governed by their cost-effectiveness.

High-level expression of podoplanin in benign and malignant soft tissue tumors: immunohistochemical and quantitative real-time RT-PCR analysis.

PubMed

Xu, Yongjun; Ogose, Akira; Kawashima, Hiroyuki; Hotta, Tetsuo; Ariizumi, Takashi; Li, Guidong; Umezu, Hajime; Endo, Naoto

2011-03-01

Podoplanin is a 38 kDa mucin-type transmembrane glycoprotein that was first identified in rat glomerular epithelial cells (podocytes). It is expressed in normal lymphatic endothelium, but is absent from vascular endothelial cells. D2-40 is a commercially available mouse monoclonal antibody which binds to an epitope on human podoplanin. D2-40 immunoreactivity is therefore highly sensitive and specific for lymphatic endothelium. Recent investigations have shown widespread applications of immunohistochemical staining with D2-40 in evaluating podoplanin expression as an immunohistochemical marker for diagnosis and prognosis in various tumors. To determine whether the podoplanin (D2-40) antibody may be useful for the diagnosis of soft tissue tumors, 125 cases, including 4 kinds of benign tumors, 15 kinds of malignant tumors and 3 kinds of tumor-like lesions were immunostained using the D2-40 antibody. Total RNA was extracted from frozen tumor tissue obtained from 41 corresponding soft tissue tumor patients and 12 kinds of soft tissue tumor cell lines. Quantitative real-time PCR reactions were performed. Immunohistochemical and quantitative real-time RT-PCR analyses demonstrated the expression of the podoplanin protein and mRNA in the majority of benign and malignant soft tissue tumors and tumor-like lesions examined, with the exception of alveolar soft part sarcoma, embryonal and alveolar rhabdomyosarcoma, extraskeletal Ewing's sarcoma/peripheral primitive neuro-ectodermal tumor and lipoma, which were completely negative for podoplanin. Since it is widely and highly expressed in nearly all kinds of soft tissue tumors, especially in spindle cell sarcoma, myxoid type soft tissue tumors and soft tissue tumors of the nervous system, podoplanin is considered to have little value in the differential diagnosis of soft tissue tumors.

A Novel Esthetic Approach using Connective Tissue Graft for Soft Tissue Defect Following Surgical Excision of Gingival Fibrolipoma

PubMed Central

Parthasarathy, Harinath; Kumar, Praveenkrishna; Gajendran, Priyalochana; Appukuttan, Devapriya

2014-01-01

The aim of the present case report is to evaluate the adjunctive use of a connective tissue graft to overcome soft tissue defects following excision of a gingival fibrolipoma in the aesthetic region. Connective tissue graft has been well documented for treating defects of esthetic concern. However, the literature does not contain many reports on the esthetic clinical outcome following the use of connective tissue graft secondary to excision of soft tissue tumours. A 28-year-old male patient reported with a complaint of a recurrent growth in relation to his lower front tooth region. The lesion which was provisionally diagnosed as fibroma was treated with a complete surgical excision, following which a modified coronally advanced flap and connective tissue graft was adopted to overcome the soft tissue defect. The excised growth was diagnosed histologically as fibrolipoma. One year follow up showed no recurrence of the lesion and good esthetics.The adjunctive use of the connective tissue graft and modified coronally advanced flap predictably yields optimal soft tissue fill and excellent esthetics. Hence, routine use of this procedure may be recommended for surgical excision of soft tissue growths in esthetically sensitive areas. PMID:25584336

Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health.

PubMed

Giannobile, William V; Jung, Ronald E; Schwarz, Frank

2018-03-01

The goal of Working Group 1 at the 2nd Consensus Meeting of the Osteology Foundation was to comprehensively assess the effects of soft tissue augmentation procedures on peri-implant health or disease. A systematic review and meta-analysis on the effects of soft tissue augmentation procedures included a total of 10 studies (mucosal thickness: n = 6; keratinized tissue: n = 4). Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions and a plenary session approval. Soft tissue grafting to increase the width of keratinized tissue around implants was associated with greater reductions in gingival and plaque indices when compared to non-augmented sites. Statistically significant differences were noted for final marginal bone levels in favor of an apically positioned flap plus autogenous graft vs. all standard-of-care control treatments investigated. Soft tissue grafting (i.e., autogenous connective tissue) to increase the mucosal thickness around implants in the aesthetic zone was associated with significantly less marginal bone loss over time, but no significant changes in bleeding on probing, probing depths, or plaque scores when compared to sites without grafting. The limited evidence available supports the use of soft tissue augmentation procedures to promote peri-implant health. © 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.

Cixutumumab and Doxorubicin Hydrochloride in Treating Patients With Unresectable, Locally Advanced, or Metastatic Soft Tissue Sarcoma

ClinicalTrials.gov

2016-05-16

Adult Angiosarcoma; Adult Desmoplastic Small Round Cell Tumor; Adult Epithelioid Sarcoma; Adult Extraskeletal Myxoid Chondrosarcoma; Adult Extraskeletal Osteosarcoma; Adult Fibrosarcoma; Adult Leiomyosarcoma; Adult Liposarcoma; Adult Malignant Mesenchymoma; Adult Malignant Peripheral Nerve Sheath Tumor; Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Adult Undifferentiated High Grade Pleomorphic Sarcoma of Bone; Childhood Angiosarcoma; Childhood Desmoplastic Small Round Cell Tumor; Childhood Epithelioid Sarcoma; Childhood Fibrosarcoma; Childhood Leiomyosarcoma; Childhood Liposarcoma; Childhood Malignant Mesenchymoma; Childhood Malignant Peripheral Nerve Sheath Tumor; Childhood Pleomorphic Rhabdomyosarcoma; Childhood Rhabdomyosarcoma With Mixed Embryonal and Alveolar Features; Childhood Synovial Sarcoma; Dermatofibrosarcoma Protuberans; Malignant Adult Hemangiopericytoma; Malignant Childhood Hemangiopericytoma; Metastatic Childhood Soft Tissue Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage IV Adult Soft Tissue Sarcoma; Untreated Childhood Rhabdomyosarcoma

Inner power, physical strength and existential well-being in daily life: relatives' experiences of receiving soft tissue massage in palliative home care.

PubMed

Cronfalk, Berit Seiger; Strang, Peter; Ternestedt, Britt-Marie

2009-08-01

This article explores relatives' experiences of receiving soft tissue massage as a support supplement while caring for a dying family member at home. In palliative home care, relatives play an important role as carers to seriously ill and dying family members. To improve their quality of life, different support strategies are of importance. Complementary methods, such as soft tissue massage have become an appreciated supplement for these patients. However, only few studies focus on relatives experiences of receiving soft tissue massage as a supplemental support. Qualitative design Nineteen relatives received soft tissue massage (hand or foot) nine times (25 minutes) in their homes. Open-ended semi-structured tape-recorded interviews were conducted once per relative after the nine times of massage, using qualitative content analysis. Soft tissue massage gave the relatives' feelings of 'being cared for', 'body vitality' and 'peace of mind'. For a while, they put worries of daily life aside as they just experienced 'being'. During massage, it became apparent that body and mind is constituted of an indestructible completeness. The overarching theme was 'inner power, physical strength and existential well-being in their daily lives'. All relatives experienced soft tissue massage positively, although they were under considerable stress. Soft tissue massage could be an option to comfort and support relatives in palliative home care. In palliative nursing care, soft tissue massage could present a worthy supplement in supporting caring relatives.

Soft tissue thin-plate spline analysis of pre-pubertal Korean and European-Americans with untreated Angle's Class III malocclusions.

PubMed

Singh, G D; McNamara, J A; Lozanoff, S

1999-01-01

The purpose of this study was to assess soft tissue facial matrices in subjects of diverse ethnic origins with underlying dentoskeletal malocclusions. Pre-treatment lateral cephalographs of 71 Korean and 70 European-American children aged between 5 and 11 years with Angle's Class III malocclusions were traced, and 12 homologous, soft tissue landmarks digitized. Comparing mean Korean and European-American Class III soft tissue profiles, Procrustes analysis established statistical difference (P < 0.001) between the configurations, and this difference was also true at all seven age groups tested (P < 0.001). Comparing the overall European-American and Korean transformation, thin-plate spline analysis indicated that both affine and non-affine transformations contribute towards the total spline (deformation) of the averaged Class III soft tissue configurations. For non-affine transformations, partial warp (PW) 8 had the highest magnitude, indicating large-scale deformations visualized as labio-mental protrusion, predominantly. In addition, PW9, PW4, and PW5 also had high magnitudes, demonstrating labio-mental vertical compression and antero-posterior compression of the lower labio-mental soft tissues. Thus, Korean children with Class III malocclusions demonstrate antero-posterior and vertical deformations of the labio-mental soft tissue complex with respect to their European-American counterparts. Morphological heterogeneity of the soft tissue integument in subjects of diverse ethnic origin may obscure the underlying skeletal morphology, but the soft tissue integument appears to have minimal ontogenetic association with Class III malocclusions.

Biomedical analysis of formalin-fixed, paraffin-embedded tissue samples: The Holy Grail for molecular diagnostics.

PubMed

Donczo, Boglarka; Guttman, Andras

2018-06-05

More than a century ago in 1893, a revolutionary idea about fixing biological tissue specimens was introduced by Ferdinand Blum, a German physician. Since then, a plethora of fixation methods have been investigated and used. Formalin fixation with paraffin embedment became the most widely used types of fixation and preservation method, due to its proper architectural conservation of tissue structures and cellular shape. The huge collection of formalin-fixed, paraffin-embedded (FFPE) sample archives worldwide holds a large amount of unearthed information about diseases that could be the Holy Grail in contemporary biomarker research utilizing analytical omics based molecular diagnostics. The aim of this review is to critically evaluate the omics options for FFPE tissue sample analysis in the molecular diagnostics field. Copyright © 2018. Published by Elsevier B.V.

Improved Rubin-Bodner Model for the Prediction of Soft Tissue Deformations

PubMed Central

Zhang, Guangming; Xia, James J.; Liebschner, Michael; Zhang, Xiaoyan; Kim, Daeseung; Zhou, Xiaobo

2016-01-01

In craniomaxillofacial (CMF) surgery, a reliable way of simulating the soft tissue deformation resulted from skeletal reconstruction is vitally important for preventing the risks of facial distortion postoperatively. However, it is difficult to simulate the soft tissue behaviors affected by different types of CMF surgery. This study presents an integrated bio-mechanical and statistical learning model to improve accuracy and reliability of predictions on soft facial tissue behavior. The Rubin-Bodner (RB) model is initially used to describe the biomechanical behavior of the soft facial tissue. Subsequently, a finite element model (FEM) computers the stress of each node in soft facial tissue mesh data resulted from bone displacement. Next, the Generalized Regression Neural Network (GRNN) method is implemented to obtain the relationship between the facial soft tissue deformation and the stress distribution corresponding to different CMF surgical types and to improve evaluation of elastic parameters included in the RB model. Therefore, the soft facial tissue deformation can be predicted by biomechanical properties and statistical model. Leave-one-out cross-validation is used on eleven patients. As a result, the average prediction error of our model (0.7035mm) is lower than those resulting from other approaches. It also demonstrates that the more accurate bio-mechanical information the model has, the better prediction performance it could achieve. PMID:27717593

Alveolar soft part sarcoma causing perianal abscess.

PubMed

Sullivan, Niall; McCulloch, Tom; Leverton, David

2011-07-01

A 34-year-old woman presented with a perianal abscess that communicated with the vagina. There was a background of a one-year history of a conservatively treated, traumatic, paravaginal haematoma. Histology of the fistula tract showed alveolar soft part sarcoma and subsequent imaging identified a large soft tissue mass in the pelvis with lung metastases. Alveolar soft part sarcoma is a rare soft tissue sarcoma of unknown cellular origin affecting predominantly young women, often in deep soft tissues and lower extremities.

Late revision or correction of facial trauma-related soft-tissue deformities.

PubMed

Rieck, Kevin L; Fillmore, W Jonathan; Ettinger, Kyle S

2013-11-01

Surgical approaches used in accessing the facial skeleton for fracture repair are often the same as or similar to those used for cosmetic enhancement of the face. Rarely does facial trauma result in injuries that do not in some way affect the facial soft-tissue envelope either directly or as sequelae of the surgical repair. Knowledge of both skeletal and facial soft-tissue anatomy is paramount to successful clinical outcomes. Facial soft-tissue deformities can arise that require specific evaluation and management for correction. This article focuses on revision and correction of these soft-tissue-related injuries secondary to facial trauma. Copyright © 2013. Published by Elsevier Inc.

General Information about Childhood Soft Tissue Sarcoma

MedlinePlus

... Soft Tissue Sarcoma Treatment (PDQ®)–Patient Version General Information About Childhood Soft Tissue Sarcoma Go to Health ... the PDQ Pediatric Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

General Information about Adult Soft Tissue Sarcoma

MedlinePlus

... Soft Tissue Sarcoma Treatment (PDQ®)–Patient Version General Information About Adult Soft Tissue Sarcoma Go to Health ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

Safe corridors for K-wiring in phalangeal fractures.

PubMed

Rex, C; Vignesh, R; Javed, M; Balaji, Subba Chandra; Premanand, C; Zakki, Syed Ashfaque

2015-01-01

Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.

Correction of complex foot deformities using the Ilizarov external fixator.

PubMed

Kocaoğlu, Mehmet; Eralp, Levent; Atalar, Ata Can; Bilen, F Erkal

2002-01-01

There are many drawbacks to using conventional approaches to the treatment of complex foot deformities, like the increased risk of neurovascular injury, soft-tissue injury, and the shortening of the foot. An alternative approach that can eliminate these problems is the Ilizarov method. In the current study, a total of 23 deformed feet in 22 patients were treated using the Ilizarov method. The etiologic factors were burn contracture, poliomyelitis, neglected and relapsed clubfoot, trauma, gun shot injury, meningitis, and leg-length discrepancy (LLD). The average age of the patients was 18.2 (5-50) years. The mean duration of fixator application was 5.1 (2-14) months. We performed corrections without an osteotomy in nine feet and with an osteotomy in 14 feet. Additional bony corrective procedures included three tibial and one femoral osteotomies for lengthening and deformity correction, and one tibiotalar arthrodesis in five separate extremities. At the time of fixator removal, a plantigrade foot was achieved in 21 of the 23 feet by pressure mat analysis. Compared to preoperative status, gait was subjectively improved in all patients. Follow-up time from surgery averaged 25 months (13-38). Pin-tract problems were observed in all cases. Other complications were toe contractures in two feet, metatarsophalangeal subluxation from flexor tendon contractures in one foot, incomplete osteotomy in one foot, residual deformity in two feet, and recurrence of deformity in one foot. Our results indicate that the Ilizarov method is an effective alternative means of correcting complex foot deformities, especially in feet that previously have undergone surgery.

[Reconstruction of facial soft tissue defects with pedicled expanded flaps].

PubMed

Yangqun, Li; Yong, Tang; Wen, Chen; Zhe, Yang; Muxin, Zhao; Lisi, Xu; Chunmei, Hu; Yuanyuan, Liu; Ning, Ma; Jun, Feng; Weixin, Wang

2014-09-01

To investigate the application of pedicled expanded flaps for the reconstruction of facial soft tissue defects. The expanded skin flaps, pedicled with orbicularis oculi muscle, submental artery, the branch of facial artery, superficial temporal artery, interior upper arm artery, had similar texture and color as facial soft tissue. The pedicled expanded flaps have repaired the facial soft tissue defects. Between Jan. 2003 to Dec. 2013, 157 cases with facial soft tissue defects were reconstructed by pedicled expanded flaps. Epidermal necrosis happened at the distal end of 8 expanded flaps, pedicled with interior upper arm artery(4 cases), orbicularis oculi muscle(3 cases) and submental artery(1 case), which healed spontaneously after dressing. All the other flaps survived completely with similar color and inconspicuous scar. 112 cases were followed up for 8 months to 8 years. Satisfactory results were achieved in 75 cases. 37 cases with hypertrophic scar at incisions need secondary operation. Island pedicled expanded flap with similar texture and color as facial soft tissue is suitable for facial soft tissue defects. The facial extra-incision and large dog-ear deformity could be avoided.

Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters.

PubMed

Morii, Takeshi; Kishino, Tomonori; Shimamori, Naoko; Motohashi, Mitsue; Ohnishi, Hiroaki; Honya, Keita; Aoyagi, Takayuki; Tajima, Takashi; Ichimura, Shoichi

2018-01-01

Preoperative discrimination between benign and malignant soft tissue tumors is critical for the prevention of excess application of magnetic resonance imaging and biopsy as well as unplanned resection. Although ultrasound, including power Doppler imaging, is an easy, noninvasive, and cost-effective modality for screening soft tissue tumors, few studies have investigated reliable discrimination between benign and malignant soft tissue tumors. To establish a modality for discrimination between benign and malignant soft tissue tumors using ultrasound, we extracted the significant risk factors for malignancy based on ultrasound information from 40 malignant and 56 benign pathologically diagnosed soft tissue tumors and established a scoring system based on these risk factors. The maximum size, tumor margin, and vascularity evaluated using ultrasound were extracted as significant risk factors. Using the odds ratio from a multivariate regression model, a scoring system was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.85), confirming the accuracy of the scoring system. Ultrasound is a useful modality for establishing the differential diagnosis between benign and malignant soft tissue tumors.

Childhood Soft Tissue Sarcoma Treatment (PDQ®)—Health Professional Version

Cancer.gov

Pediatric soft tissue sarcomas are a heterogenous group of malignant tumors that originate from primitive mesenchymal tissue and account for 7% of all childhood tumors. Get detailed information about clinical presentation, diagnosis, prognosis, and treatment of newly diagnosed and recurrent soft tissue sarcoma in this summary for clinicians.

Fusion of the septic knee with external hybrid fixator.

PubMed

Kutscha-Lissberg, F; Hebler, U; Esenwein, S A; Muhr, G; Wick, M

2006-10-01

Arthrodesis is a well-recognized salvage procedure in patients with septic destruction of knee joints. It offers the opportunity for restoring weight bearing capability and significant pain relief as well as eradication of infection, but at the expense of joint motion. However, arthrodesis in order to joint sepsis may be difficult to achieve because of poor bone stock, persistent infection and soft tissue compromise. From 2000 to June 2004, in 70 consecutive patients arthrodesis of the knee was indicated. Nineteen patients were considered to have external hybrid fixator (EHF) and were therefore included to the prospective study protocol. Forty-three stabilisations of destructed knee joints were done by a modular titanium rod. In these cases bony fusion was very unlikely to be achieved because of devastating defects due to infected total knee arthroplasties. Eight patients were treated by compression nailing. In these situations EHF was not indicated. In three patients minor complication occurred. In two out of 17 patients fusion failed because of primary underestimated bony defects (11.8%). The use of EHF for arthrodeses after septic destruction of knee joints can be recommended according to our results. However, EHF will not be successful or applicable in each case. Therefore, physicians and institutions that offer this special method should have not only experiences with EHF but also with arthrodeses and alternative procedures.

Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

PubMed Central

Hannigan, Geoffrey D.; Pulos, Nicholas; Grice, Elizabeth A.; Mehta, Samir

2015-01-01

Significance: Open fractures are fractures in which the bone has violated the skin and soft tissue. Because of their severity, open fractures are associated with complications that can result in increased lengths of hospital stays, multiple operative interventions, and even amputation. One of the factors thought to influence the extent of these complications is exposure and contamination of the open fracture with environmental microorganisms, potentially those that are pathogenic in nature. Recent Advances: Current open fracture care aims to prevent infection by wound classification, prophylactic antibiotic administration, debridement and irrigation, and stable fracture fixation. Critical Issues: Despite these established treatment paradigms, infections and infection-related complications remain a significant clinical burden. To address this, improvements need to be made in our ability to detect bacterial infections, effectively remove wound contamination, eradicate infections, and treat and prevent biofilm formation associated with fracture fixation hardware. Future Directions: Current research is addressing these critical issues. While culture methods are of limited value, culture-independent molecular techniques are being developed to provide informative detection of bacterial contamination and infection. Other advanced contamination- and infection-detecting techniques are also being investigated. New hardware-coating methods are being developed to minimize the risk of biofilm formation in wounds, and immune stimulation techniques are being developed to prevent open fracture infections. PMID:25566415

Surgical timing of treating injured extremities: an evolving concept of urgency.

PubMed

Crist, Brett D; Ferguson, Tania; Murtha, Yvonne M; Lee, Mark A

2013-01-01

The management of some orthopaedic extremity injuries has changed over the past decade because of changing resource availability and the risks of complications. It is helpful to review the current literature regarding orthopaedic extremity emergencies and urgencies. The effects of the techniques of damage control orthopaedic techniques and the concept of the orthopaedic trauma room have also affected the management of these injuries. The available literature indicates that the remaining true orthopaedic extremity emergencies include compartment syndrome and vascular injuries associated with fractures and dislocations. Orthopaedic urgencies include open fracture management, femoral neck fractures in young patients treated with open reduction and internal fixation, and talus fractures that are open or those with impending skin compromise. Deciding when the definitive management of orthopaedic extremity injuries will occur has evolved as the concept of damage control orthopaedics has become more commonly accepted. Patient survival rates have improved with current resuscitative protocols. Definitive fixation of extremity injuries should be delayed until the patient's physiologic and extremity soft-tissue status allows for appropriate definitive management while minimizing the risks of complications. In patients with semiurgent orthopaedic injuries, the use of an orthopaedic trauma room has led to more efficient care of patients, fewer complications, and better time management for surgeons who perform on-call service for patients with traumatic orthopaedic injuries.

Alisertib in Treating Patients With Advanced or Metastatic Sarcoma

ClinicalTrials.gov

2017-11-29

Myxofibrosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Leiomyosarcoma; Recurrent Liposarcoma; Recurrent Malignant Peripheral Nerve Sheath Tumor; Recurrent Undifferentiated Pleomorphic Sarcoma; Stage III Soft Tissue Sarcoma AJCC v7; Stage IV Soft Tissue Sarcoma AJCC v7

Large Osteoarthritic Cyst Presenting as Soft Tissue Tumour – A Case Report

PubMed Central

Kosuge, DD; Park, DH; Cannon, SR; Briggs, TW; Pollock, RC; Skinner, JA

2007-01-01

Large osteoarthritic cysts can sometimes be difficult to distinguish from primary osseous and soft tissue tumours. We present such a case involving a cyst arising from the hip joint and eroding the acetabulum which presented as a soft tissue malignancy referred to a tertiary bone and soft tissue tumour centre. We discuss the diagnostic problems it may pose, and present a literature review of the subject. PMID:17535605

[Soft tissue melanoma: a clinical case].

PubMed

Frikh, Rachid; Oumakhir, Siham; Chahdi, Hafsa; Oukabli, Mohammed; Albouzidi, Abderrahmane; Baba, Noureddine; Hjira, Naoufal; Boui, Mohammed

2017-01-01

Soft tissue melanoma was first described by Enzinger in 1965 under the name of clear cell sarcoma. In 1983, Chung and Enzinger renamed it soft tissue melanoma due to its immunohistochemical similarities with melanoma. We here report the case of a 22-year old young man with this rare type of melanoma, presenting with molluscoid lesion on his ankle without any clinical sign of malignancy. Histology examination confirmed the diagnosis of soft tissue melanoma.

Soft-Tissue Injuries Associated With High-Energy Extremity Trauma: Principles of Management.

PubMed

Norris; Kellam

1997-01-01

The management of high-energy extremity trauma has evolved over the past several decades, and appropriate treatment of associated soft-tissue injuries has proved to be an important factor in achieving a satisfactory outcome. Early evaluation of the severely injured extremity is crucial. Severe closed injuries require serial observation of the soft tissues and early skeletal stabilization. Open injuries require early aggressive debridement of the soft tissues followed by skeletal stabilization. Temporary wound dressings should remain in place until definitive soft-tissue coverage has been obtained. Definitive soft-tissue closure will be expedited by serial debridements performed every 48 to 72 hours in a sterile environment. Skeletal union is facilitated by early bone grafting and/or modification of the stabilizing device. Aggressive rehabilitation, includ-ing early social reintegration, are crucial for a good functional outcome. Adherence to protocols is especially beneficial in the management of salvageable severely injured extremities.

Dynamic soft tissue deformation estimation based on energy analysis

NASA Astrophysics Data System (ADS)

Gao, Dedong; Lei, Yong; Yao, Bin

2016-10-01

The needle placement accuracy of millimeters is required in many needle-based surgeries. The tissue deformation, especially that occurring on the surface of organ tissue, affects the needle-targeting accuracy of both manual and robotic needle insertions. It is necessary to understand the mechanism of tissue deformation during needle insertion into soft tissue. In this paper, soft tissue surface deformation is investigated on the basis of continuum mechanics, where a geometry model is presented to quantitatively approximate the volume of tissue deformation. The energy-based method is presented to the dynamic process of needle insertion into soft tissue based on continuum mechanics, and the volume of the cone is exploited to quantitatively approximate the deformation on the surface of soft tissue. The external work is converted into potential, kinetic, dissipated, and strain energies during the dynamic rigid needle-tissue interactive process. The needle insertion experimental setup, consisting of a linear actuator, force sensor, needle, tissue container, and a light, is constructed while an image-based method for measuring the depth and radius of the soft tissue surface deformations is introduced to obtain the experimental data. The relationship between the changed volume of tissue deformation and the insertion parameters is created based on the law of conservation of energy, with the volume of tissue deformation having been obtained using image-based measurements. The experiments are performed on phantom specimens, and an energy-based analytical fitted model is presented to estimate the volume of tissue deformation. The experimental results show that the energy-based analytical fitted model can predict the volume of soft tissue deformation, and the root mean squared errors of the fitting model and experimental data are 0.61 and 0.25 at the velocities 2.50 mm/s and 5.00 mm/s. The estimating parameters of the soft tissue surface deformations are proven to be useful for compensating the needle-targeting error in the rigid needle insertion procedure, especially for percutaneous needle insertion into organs.

Effect of antipronation foot orthosis geometry on compression of heel and arch soft tissues.

PubMed

Sweeney, Declan; Nester, Christopher; Preece, Stephen; Mickle, Karen

2015-01-01

This study aimed to understand how systematic changes in arch height and two designs of heel wedging affect soft tissues under the foot. Soft tissue thickness under the heel and navicular was measured using ultrasound. Heel pad thickness was measured when subjects were standing on a flat surface and standing on an orthosis with 4 and 8 degree extrinsic wedges and 4 mm and 8 mm intrinsic wedges (n = 27). Arch soft tissue thickness was measured when subjects were standing and when standing on an orthosis with -6 mm, standard, and +6 mm increments in arch height (n = 25). Extrinsic and intrinsic heel wedges significantly increased soft tissue thickness under the heel compared with no orthosis. The 4 and 8 degree extrinsic wedges increased tissue thickness by 28% and 27.6%, respectively, while the 4 mm and 8 mm intrinsic wedges increased thickness by 23% and 14.6%, respectively. Orthotic arch height significantly affected arch soft tissue thickness. Compared with the no orthosis condition, the -6 mm, standard, and +6 mm arch heights decreased arch tissue thickness by 9%, 10%, and 11.8%, respectively. This study demonstrates that change in orthotic geometry creates different plantar soft tissue responses that we expect to affect transmission of force to underlying foot bones.

Cell-based regenerative approaches to the treatment of oral soft tissue defects.

PubMed

Bates, Damien; Kampa, Peggy

2013-01-01

Oral soft tissue plays an important role in the structure and function of the oral cavity by protecting against exogenous substances, pathogens, and mechanical stresses. Repair of oral soft tissue defects that arise as a result of disease, trauma, or congenital abnormalities is often accomplished via transplantation or transfer of autologous mucosal tissue. However, this method of treatment can be complicated by the relatively small amount of autologous mucosal tissue that is available, as well as by the morbidity that may be associated with the donor site and patient reluctance to have oral (eg, palatal) surgery. To circumvent these problems, clinicians have turned to the fields of tissue engineering and regenerative medicine to develop acellular and cellular strategies for regenerating oral soft tissue. This review focuses on the efficacy and safety of cell-based investigational approaches to the regeneration of oral soft tissue.

Quality Control of RNA Preservation and Extraction from Paraffin-Embedded Tissue: Implications for RT-PCR and Microarray Analysis

PubMed Central

Pichler, Martin; Zatloukal, Kurt

2013-01-01

Analysis of RNA isolated from fixed and paraffin-embedded tissues is widely used in biomedical research and molecular pathological diagnostics. We have performed a comprehensive and systematic investigation of the impact of factors in the pre-analytical workflow, such as different fixatives, fixation time, RNA extraction method and storage of tissues in paraffin blocks, on several downstream reactions including complementary DNA (cDNA) synthesis, quantitative reverse transcription polymerase chain reaction (qRT-PCR) and microarray hybridization. We compared the effects of routine formalin fixation with the non-crosslinking, alcohol-based Tissue Tek Xpress Molecular Fixative (TTXMF, Sakura Finetek), and cryopreservation as gold standard for molecular analyses. Formalin fixation introduced major changes into microarray gene expression data and led to marked gene-to-gene variations in delta-ct values of qRT-PCR. We found that qRT-PCR efficiency and gene-to-gene variations were mainly attributed to differences in the efficiency of cDNA synthesis as the most sensitive step. These differences could not be reliably detected by quality assessment of total RNA isolated from formalin-fixed tissues by electrophoresis or spectrophotometry. Although RNA from TTXMF fixed samples was as fragmented as RNA from formalin fixed samples, much higher cDNA yield and lower ct-values were obtained in qRT-PCR underlining the negative impact of crosslinking by formalin. In order to better estimate the impact of pre-analytical procedures such as fixation on the reliability of downstream analysis, we applied a qRT-PCR-based assay using amplicons of different length and an assay measuring the efficiency of cDNA generation. Together these two assays allowed better quality assessment of RNA extracted from fixed and paraffin-embedded tissues and should be used to supplement quality scores derived from automated electrophoresis. A better standardization of the pre-analytical workflow, application of additional quality controls and detailed sample information would markedly improve the comparability and reliability of molecular studies based on formalin-fixed and paraffin-embedded tissue samples. PMID:23936242

Finite element dynamic analysis of soft tissues using state-space model.

PubMed

Iorga, Lucian N; Shan, Baoxiang; Pelegri, Assimina A

2009-04-01

A finite element (FE) model is employed to investigate the dynamic response of soft tissues under external excitations, particularly corresponding to the case of harmonic motion imaging. A solid 3D mixed 'u-p' element S8P0 is implemented to capture the near-incompressibility inherent in soft tissues. Two important aspects in structural modelling of these tissues are studied; these are the influence of viscous damping on the dynamic response and, following FE-modelling, a developed state-space formulation that valuates the efficiency of several order reduction methods. It is illustrated that the order of the mathematical model can be significantly reduced, while preserving the accuracy of the observed system dynamics. Thus, the reduced-order state-space representation of soft tissues for general dynamic analysis significantly reduces the computational cost and provides a unitary framework for the 'forward' simulation and 'inverse' estimation of soft tissues. Moreover, the results suggest that damping in soft-tissue is significant, effectively cancelling the contribution of all but the first few vibration modes.

Soft-tissue reactions following irradiation of primary brain and pituitary tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baglan, R.J.; Marks, J.E.

1981-04-01

One hundred and ninety-nine patients who received radiation therapy for a primary brain or pituitary tumor were studied for radiation-induced soft-tissue reactions of the cranium, scalp, ears and jaw. The frequency of these reactions was studied as a function of: the radiation dose 5 mm below the skin surface, dose distribution, field size and fraction size. Forty percent of patients had complete and permanent epilation, while 21% had some other soft-tissue complication, including: scalp swelling-6%, external otitis-6%, otitis media-5%, ear swelling-4%, etc. The frequency of soft-tissue reactions correlates directly with the radiation dose at 5 mm below the skin surface.more » Patients treated with small portals (<70 cm/sup 2/) had few soft-tissue reactions. The dose to superficial tissues, and hence the frequency of soft-tissue reactions can be reduced by: (1) using high-energy megavoltage beams; (2) using equal loading of beams; and (3) possibly avoiding the use of electron beams.« less

The use of acellular dermal matrix membrane for vertical soft tissue augmentation during submerged implant placement: a case series.

PubMed

Puisys, Algirdas; Vindasiute, Egle; Linkevciene, Laura; Linkevicius, Tomas

2015-04-01

To evaluate the efficiency of acellular dermal matrix membrane to augment vertical peri-implant soft tissue thickness during submerged implant placement. Forty acellular dermal matrix-derived allogenic membranes (AlloDerm, BioHorizons, Birmingham, AL, USA) and 42 laser-modified surface internal hex implants (BioHorizons Tapered Laser Lok, Birmingham, AL, USA) were placed in submerged approach in 40 patients (15 males and 25 females, mean age 42.5 ± 1.7) with a thin vertical soft tissue thickness of 2 mm or less. After 3 months, healing abutments were connected to implants, and the augmented soft tissue thickness was measured with periodontal probe. The gain in vertical soft tissue volume was calculated. Mann-Whitney U-test was applied and significance was set to 0.05. All 40 allografts healed successfully. Thin soft tissue before augmentation had an average thickness of 1.54 ± 0.51 mm SD (range, 0.5-2.0 mm, median 1.75 mm), and after soft tissue augmentation with acellular dermal matrix, thickness increased to 3.75 ± 0.54 mm SD (range, 3.0-5.0 mm, median 4.0 mm) at 3 months after placement. This difference between medians was found to be statistically significant (P < 0.001). Mean increase in soft tissue thickness was 2.21 ± 0.85 mm SD (range, 1.0-4.5 mm, median 2.0 mm). It can be concluded that acellular dermal matrix membrane can be successfully used for vertical soft tissue augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Soft tissue molding technique in cleft lip and palate patient using laser surgery in combination with orthodontic appliance: A case report.

PubMed

Theerasopon, Pornpat; Wangsrimongkol, Tasanee; Sattayut, Sajee

2017-03-31

Although surgical treatment protocols for cleft lip and palate patients have been established, many patients still have some soft tissue defects after complete healing from surgical interventions. These are excess soft tissue, high attached fraena and firmed tethering scares. These soft tissue defects resulted shallowing of vestibule, restricted tooth movement, compromised periodontal health and trended to limit the maxillary growth. The aim of this case report was to present a method of correcting soft tissue defects after conventional surgery in cleft lip and palate patient by using combined laser surgery and orthodontic appliance. A bilateral cleft lip and palate patient with a clinical problem of shallow upper anterior vestibule after alveolar bone graft received a vestibular extension by using CO 2 laser with ablation and vaporization techniques at 4 W and continuous wave. A customized orthodontic appliance, called a buccal shield, was placed immediately after surgery and retained for 1 month to 3 months until complete soft tissue healing. The procedures were performed 2 episodes. Both interventions used the same CO 2 laser procedure. The first treatment resulted in partial re-attachment of soft tissue at surgical area. The second laser operation with the proper design of buccal shield providing passive contact with more extended flange resulting in a favorable outcome from 1 year follow up. Then the corrective orthodontic treatment could be continued effectively. The CO 2 laser surgery was a proper treatment for correcting soft tissue defects and the design of buccal shield was a key for success in molding surgical soft tissue.

Biological N2 fixation mainly controlled by Sphagnum tissue N:P ratio in ombrotrophic bogs

NASA Astrophysics Data System (ADS)

Zivkovic, Tatjana; Moore, Tim R.

2017-04-01

Most of the 18 Pg nitrogen (N) accumulated in northern nutrient-poor and Sphagnum-dominated peatlands (bogs and fens) can be attributed to N2-fixation by diazotrophs either associated with the live Sphagnum or non-symbiotically in the deeper peat such as through methane consumption close to the water table. Where atmospheric N deposition is low (< 0.2 g m-2 y-1), ombrotrophic bogs rely on N2-fixation as the primary source of N that sustains primary production. Due to high energetic requirements, N2-fixation depends on the available phosphorus (P). Anthropogenic impacts in the last 200 years increased atmospheric N deposition, resulting in a switch from N to P limitation in Sphagnum, suggested by the increase in tissue N:P to >16. It is unclear how Sphagnum-hosted diazotrophic activity may be affected by N deposition and thus changes in N:P ratio. First, we investigated the effects of long-term addition of different sources of nitrogen (0, 1.6, 3.2 and 6.4 g N m-2 y-1as NH4Cl and NaNO3), and phosphorus (5 g P m-2 y-1as KH2PO4) on Sphagnum nutrient status (N, P and N:P ratio), net primary productivity (NPP) and Sphagnum-associated N2fixation at Mer Bleue, a temperate ombrotrophic bog. We show that N concentration in Sphagnum tissue increased with larger rates of N addition, with a stronger effect on Sphagnum from NH4 than NO3. The addition of P created a 3.5 fold increase in Sphagnum P content compared to controls. Sphagnum NPP decreased linearly with the rise in N:P ratio, while linear growth declined exponentially with increase in Sphagnum N content. Rates of N2-fixation determined in the laboratory significantly decreased in response to even the smallest addition of both N species. In contrast, the addition of P increased N2 fixation by up to 100 times compared to N treatments and up to 5-30 times compared to controls. The change in N2-fixation was best modeled by the N:P ratio, across all experimental treatments. Secondly, to test the role of N:P ratio on N2-fixation across a range of bogs, eight study sites along the latitudinal gradient from temperate, boreal to subarctic zone in eastern Canada were selected. From each bog, two predominant microptopographies, hummocks and hollows, were tested for both N2-fixation activity in the laboratory and Sphagnum tissue concentrations of N, P and N:P ratio. We found that 65% of the variance in the increase of N2-fixation activity was explained by the decrease in N:P ratio in hollows (n = 73) but only about 20% in hummocks (n = 78). Changes in neither N or P concentration alone explained the increase in N2-fixation better than N:P ratio. We interpret that the difference between hollows and hummocks results from the availability of moisture that further limits N2-fixation. When moisture is not a limiting factor, i.e. in hollows, N:P ratio will be the best predictor of N2-fixation in bogs. Both studies suggest that the relative P availability to Sphagnum-associated diazotrophs, measured as a tissue N:P ratio, best describes N2-fixation activity in bogs, especially ones exposed to larger N deposition.

Non-interventional 1-year follow-up study of peri-implant soft tissues following previous soft tissue augmentation and crown insertion in single-tooth gaps.

PubMed

Huber, Samuel; Zeltner, Marco; Hämmerle, Christoph H F; Jung, Ronald E; Thoma, Daniel S

2018-04-01

To assess peri-implant soft tissue dimensions at implant sites, previously augmented with a collagen matrix (VCMX) or an autogenous subepithelial connective tissue graft (SCTG), between crown insertion and 1 year. Twenty patients with single-tooth implants received soft tissue augmentation prior to abutment connection randomly using VCMX or SCTG. Following abutment connection 3 months later, final reconstructions were fabricated and inserted (baseline). Patients were recalled at 6 months (6M) and at 1 year (FU-1). Measurements included clinical data, soft tissue thickness, volumetric outcomes and patient-reported outcome measures (PROMs). The buccal soft tissue thickness showed a median decrease of -0.5 mm (-1.0;0.3) (VCMX) and 0.0 mm (-0.5;1.0) (SCTG) (p = .243) up to FU-1. The soft tissue volume demonstrated a median decrease between BL and FU-1 of -0.1 mm (-0.2;0.0) (p = .301) for VCMX and a significant decrease of -0.2 mm (-0.4; -0.1) (p = .002) for SCTG, respectively. Intergroup comparisons did not reveal any significant differences between the groups for peri-implant soft tissue dimensions and changes up to FU-1 (p > .05). PROMs did not show any significant changes over time nor differences between the groups. Between crown insertion and 1 year, the buccal peri-implant soft tissue dimensions remained stable without relevant differences between sites that had previously been grafted with VCMX or SCTG. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Factors influencing soft tissue profile changes following orthodontic treatment in patients with Class II Division 1 malocclusion.

PubMed

Maetevorakul, Suhatcha; Viteporn, Smorntree

2016-01-01

Several studies have shown soft tissue profile changes after orthodontic treatment in Class II Division 1 patients. However, a few studies have described factors influencing the soft tissue changes. The purpose of this study was to investigate the factors influencing the soft tissue profile changes following orthodontic treatment in Class II Division 1 patients. The subjects comprised 104 Thai patients age 8-16 years who presented Class II Division 1 malocclusions and were treated with different orthodontic modalities comprising cervical headgear, Class II traction and extraction of the four first premolars. The profile changes were evaluated from the lateral cephalograms before and after treatment by means of the X-Y coordinate system. Significant soft tissue profile changes were evaluated by paired t test at a 0.05 significance level. The correlations among significant soft tissue changes and independent variables comprising treatment modality, age, sex, pretreatment skeletal, dental and soft tissue morphology were evaluated by stepwise multiple regression analysis at a 0.05 significance level. The multiple regression analysis indicated that different treatment modalities, age, sex, pretreatment skeletal, dental and soft tissue morphology were related to the profile changes. The predictive power of these variables on the soft tissue profile changes ranged from 9.9 to 40.3%. Prediction of the soft tissue profile changes following treatment of Class II Division 1 malocclusion from initial patient morphology, age, sex and types of treatment was complicated and required several variables to explain their variations. Upper lip change in horizontal direction could be found only at the stomion superius and was less predictable than those of the lower lip. Variations in upper lip retraction at the stomion superius were explained by types of treatment (R(2) = 0.099), whereas protrusion of the lower lip at the labrale inferius was correlated with initial inclination of the lower incisor (L1 to NB), jaw relation (ANB angle), lower lip thickness and sex (R(2) = 0.403). Prediction of chin protrusion at the soft tissue pogonion was also low predictable (R(2) = 0.190) depending upon sex, age and initial mandibular plane angle (SN-GoGn). Additionally, age and sex also had mainly effect on change of the soft tissue profile in the vertical direction.

Orthodontic-periodontal interactions: Orthodontic extrusion in interdisciplinary regenerative treatments.

PubMed

Paolone, Maria Giacinta; Kaitsas, Roberto

2018-06-01

Orthodontics is a periodontal treatment. "Guided orthodontic regeneration" (GOR) procedures use orthodontic movements in perio-restorative patients. The GOR technique includes a guided orthodontic "soft tissue" regeneration (GOTR) and a guided orthodontic "bone" regeneration (GOBR) with a plastic soft tissue approach and a regenerating reality. The increased amount of soft tissue gained with orthodontic movement can be used for subsequent periodontal regenerative techniques. The increased amount of bone can as well improve primary implant stability and, eventually, simplify a GTR technique to regenerate soft tissues, to restore tooth with external resorption in aesthetic zone or to extract a tooth to create new hard-soft tissue for adjacent teeth. Copyright © 2018. Published by Elsevier Masson SAS.

Histomorphometrical analysis following augmentation of infected extraction sites exhibiting severe bone loss and primarily closed by intrasocket reactive soft tissue.

PubMed

Mardinger, Ofer; Vered, Marilena; Chaushu, Gavriel; Nissan, Joseph

2012-06-01

Intrasocket reactive soft tissue can be used for primary closure during augmentation of infected extraction sites exhibiting severe bone loss prior to implant placement. The present study evaluated the histological characteristics of the initially used intrasocket reactive soft tissue, the overlying soft tissue, and the histomorphometry of the newly formed bone during implant placement. Thirty-six consecutive patients (43 sites) were included in the study. Extraction sites demonstrating extensive bone loss on preoperative periapical and panoramic radiographs served as inclusion criteria. Forty-three implants were inserted after a healing period of 6 months. Porous bovine xenograft bone mineral was used as a single bone substitute. The intrasocket reactive soft tissue was sutured over the grafting material to seal the coronal portion of the socket. Biopsies of the intrasocket reactive soft tissue at augmentation, healed mucosa, and bone cores at implant placement were retrieved and evaluated. The intrasocket reactive soft tissue demonstrated features compatible with granulation tissue and long junctional epithelium. The mucosal samples at implant placement demonstrated histopathological characteristics of keratinized mucosa with no residual elements of granulation tissue. Histomorphometrically, the mean composition of the bone cores was - vital bone 40 ± 19% (13.7-74.8%); bone substitute 25.7 ± 13% (0.6-51%); connective tissue 34.3 ± 15% (13.8-71.9%). Intrasocket reactive soft tissue used for primary closure following ridge augmentation is composed of granulation tissue and long junctional epithelium. At implant placement, clinical and histological results demonstrate its replacement by keratinized gingiva. The histomorphometrical results reveal considerable bone formation. Fresh extraction sites of hopeless teeth demonstrating chronic infection and severe bone loss may be grafted simultaneously with their removal. © 2010 Wiley Periodicals, Inc.

Analysis of formalin-fixed, paraffin-embedded (FFPE) tissue via proteomic techniques and misconceptions of antigen retrieval.

PubMed

O'Rourke, Matthew B; Padula, Matthew P

2016-01-01

Since emerging in the late 19(th) century, formaldehyde fixation has become a standard method for preservation of tissues from clinical samples. The advantage of formaldehyde fixation is that fixed tissues can be stored at room temperature for decades without concern for degradation. This has led to the generation of huge tissue banks containing thousands of clinically significant samples. Here we review techniques for proteomic analysis of formalin-fixed, paraffin-embedded (FFPE) tissue samples with a specific focus on the methods used to extract and break formaldehyde crosslinks. We also discuss an error-of-interpretation associated with the technique known as "antigen retrieval." We have discovered that this term has been mistakenly applied to two disparate molecular techniques; therefore, we argue that a terminology change is needed to ensure accurate reporting of experimental results. Finally, we suggest that more investigation is required to fully understand the process of formaldehyde fixation and its subsequent reversal.

Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix.

PubMed

Zafiropoulos, Gregory-George; Deli, Giorgio; Hoffmann, Oliver; John, Gordon

2016-01-01

The aim of this study was to determine the treatment outcome of the use of a porcine monolayer collagen matrix (mCM) to increase soft-tissue volume as a part of implant site development. Implants were placed in single sites in 27 patients. In the test group, mCM was used for soft-tissue augmentation. No graft was placed in the control group. Soft-tissue thickness (STTh) was measured at the time of surgery (T0) and 6 months postoperatively (T1) at two sites (STTh 1, 1 mm below the gingival margin; STTh 2, 3 mm below the mucogingival margin). Significant increases ( P < 0.001) in STTh (STTh 1 = 1.06 mm, 117%; STTh 2 = 0.89 mm, 81%) were observed in the test group. Biopsy results showed angiogenesis and mature connective tissue covered by keratinized epithelium. Within the limitations of this study, it could be concluded that mCM leads to a significant increase of peri-implant soft-tissue thickness, with good histological integration and replacement by soft tissue and may serve as an alternative to connective tissue grafting.

Epidemiologic study of soft tissue rheumatism in Shantou and Taiyuan, China.

PubMed

Zeng, Qing-yu; Zang, Chang-hai; Lin, Ling; Chen, Su-biao; Li, Xiao-feng; Xiao, Zheng-yu; Dong, Hai-yuan; Zhang, Ai-lian; Chen, Ren

2010-08-05

Soft tissue rheumatism is a group of common rheumatic disorders reported in many countries. For investigating the prevalence rate of soft tissue rheumatism in different population in China, we carried out a population study in Shantou rural and Taiyuan urban area. Samples of 3915 adults in an urban area of Taiyuan, Shanxi Province, and 2350 in a rural area of Shantou, Guangdong Province were surveyed. Modified International League of Association for Rheumatology (ILAR)-Asia Pacific League of Association for Rheumatology (APLAR) Community Oriented Program for Control of Rheumatic Diseases (COPCORD) core questionnaire was implemented as screening tool. The positive responders were then all examined by rheumatologists. Prevalence rate of soft tissue rheumatism was 2.0% in Taiyuan, and 5.3% in Shantou. Rotator cuff (shoulder) tendinitis, adhesive capsulitis (frozen shoulder), lateral epicondylitis (tennis elbow), and digital flexor tenosynovitis (trigger finger) were the commonly seen soft tissue rheumatism in both areas. Tatarsalgia, plantar fasciitis, and De Quervain's tenosynovitis were more commonly seen in Shantou than that in Taiyuan. Only 1 case of fibromyalgia was found in Taiyuan and 2 cases in Shantou. The prevalence of soft tissue rheumatism varied with age, sex and occupation. Soft tissue rheumatism is common in Taiyuan and Shantou, China. The prevalence of soft tissue rheumatism was quite different with different geographic, environmental, and socioeconomic conditions; and varying with age, sex, and occupation. The prevalence of fibromyalgia is low in the present survey.

Factors influencing on retro-odontoid soft-tissue thickness: analysis by magnetic resonance imaging.

PubMed

Tojo, Shinjiro; Kawakami, Reina; Yonenaga, Takenori; Hayashi, Daichi; Fukuda, Kunihiko

2013-03-01

A retrospective, consecutive case series. To analyze the relationship between retro-odontoid soft-tissue thickness and patients' age, sex, and degenerative changes of cervical spine and to investigate the effect these factors have on retro-odontoid soft-tissue thickness. Thickening of the soft tissue posterior to the odontoid process can form a retro-odontoid pseudotumor causing symptoms of spinal cord compression. Rheumatoid arthritis and long-term dialysis have been reported as possible causes for this. However, there have been reports of retro-odontoid pseudotumors without coexisting diseases. Findings from a total of 503 cases of cervical spine magnetic resonance images were reviewed, and retro-odontoid soft-tissue thickness was measured. The values were matched for age, sex, presence of degenerative changes, rheumatoid arthritis, and dialysis and were analyzed for significance. Retro-odontoid soft tissue thickened with age, and this was also seen in male patients and patients with degenerative changes. Significant increase in thickness was also observed in patients undergoing dialysis and further increased with prolonged dialysis. There was no significant association with presence of rheumatoid arthritis. There is association between age, sex, degenerative cervical spine changes, and dialysis with retro-odontoid soft-tissue thickness. With dialysis, retro-odontoid soft-tissue thickness increases with increasing duration. Thus, reviewing magnetic resonance image from daily practice indicates that cervical spine degeneration is associated with the development of retro-odontoid pseudotumors.

[Inconformity between soft tissue defect and bony defect in incomplete cleft palate].

PubMed

Zhou, Xia; Ma, Lian

2014-12-01

To evaluate the inconformity between soft tissue defect and bony defect by observing the cleft extent of palate with complete secondary palate bony cleft in incomplete cleft palate patient. The patients with incomplete cleft palate treated in Hospital of Stomatology Peking University from July 2012 to June 2013 were reviewed, of which 75 cases with complete secondary palate bony cleft were selected in this study. The CT scan and intraoral photograph were taken before operation. The patients were classified as four types according to the extent of soft tissue defect. Type 1: soft tissue defect reached incisive foremen region, Type 2 was hard and soft cleft palate, Type 3 soft cleft palate and Type 4 submucous cleft palate. Type 1 was defined as conformity group (CG). The other three types were defined as inconformity group (ICG) and divided into three subgroups (ICG-I), (ICG-II) and (ICG-III). Fifty-seven patients were in ICG group, and the rate of inconformity was 76% (57/75). The percentage of ICG-I, ICG-II and ICG-III was 47% (27/57), 23% (13/57) and 30% (17/57), respevtively. There are different types of soft tissue deformity with complete secondary palate bony cleft. The inconformity between soft tissue and hard tissue defect exits in 3/4 of isolated cleft palate patients.

Noncontact measurement of elasticity for the detection of soft-tissue tumors using phase-sensitive optical coherence tomography combined with a focused air-puff system.

PubMed

Wang, Shang; Li, Jiasong; Manapuram, Ravi Kiran; Menodiado, Floredes M; Ingram, Davis R; Twa, Michael D; Lazar, Alexander J; Lev, Dina C; Pollock, Raphael E; Larin, Kirill V

2012-12-15

We report on an optical noncontact method for the detection of soft-tissue tumors based on the measurement of their elasticity. A focused air-puff system is used to excite surface waves (SWs) on soft tissues with transient static pressure. A high-speed phase-sensitive optical coherence tomography system is used to measure the SWs as they propagate from the point of excitation. To evaluate the stiffness of soft tissues, the Young's modulus is quantified based on the group velocity of SWs. Pilot experiments were performed on ex vivo human myxoma and normal fat. Results demonstrate the feasibility of the proposed method to measure elasticity and differentiate soft-tissue tumors from normal tissues.

Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications.

PubMed

Weber, Christian David; Hildebrand, Frank; Kobbe, Philipp; Lefering, Rolf; Sellei, Richard M; Pape, Hans-Christoph

2018-02-02

Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU ® ). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission. According to the soft tissue status, patients were divided either in the closed (CTF) or into the open fracture (OTF) group. The OTF group was subdivided according to the Gustilo/Anderson classification. Demographic data, injury mechanisms, injury severity, surgical fracture management, hospital and ICU length of stay and systemic complications (e.g., multiple organ failure (MOF), sepsis, mortality) were collected and analyzed by SPSS (Version 23, IBM Inc., NY, USA). Out of 148.498 registered patients between 1/2002 and 12/2013; a total of 4.940 met the inclusion criteria (mean age 46.2 ± 19.4 years, ISS 30.4 ± 12.6 points). The CTF group included 2000 patients (40.5%), whereas 2940 patients (59.5%) sustained open tibia fractures (I°: 49.3%, II°: 27.5%, III°: 23.2%). High-energy trauma was the leading mechanism in case of open fractures. Despite comparable ISS and NISS values in patients with closed and open tibia fractures, open fractures were significantly associated with higher volume resuscitation (p < 0.001), more blood (p < 0.001), and mass transfusions (p = 0.006). While the rate of external fixation increased with the severity of soft tissue injury (37.6 to 76.5%), no major effect on mortality and other major complications was observed. Open tibia fractures are common in multiple trauma patients and are therefore associated with increased resuscitation requirements, more surgical procedures and increased in-hospital length of stay. However, increased systemic complications are not observed if a soft tissue adapted surgical protocol is applied.

Complementary Constraints from Carbon (13C) and Nitrogen (15N) Isotopes on the Efficiency of the Glacial Ocean's Soft-Tissue Biological Pump

NASA Astrophysics Data System (ADS)

Schmittner, A.; Somes, C. J.

2016-12-01

A three-dimensional, process-based model of the ocean's carbon and nitrogen cycles, including 13C and 15N isotopes, is used to explore effects of idealized changes in the soft-tissue biological pump. Results are presented from one preindustrial control run and six simulations of the Last Glacial Maximum (LGM) with increasing values of the spatially constant maximum phytoplankton growth rate μmax, which mimicks iron fertilization. The default LGM simulation, without increasing μmax and with a shallower and weaker Atlantic Meridional Overturning Circulation and increased sea ice cover, leads to 280 Pg more respired organic carbon (Corg) than the pre-industrial control. Dissolved oxygen in the thermocline increase, which reduces water column denitrification and nitrogen fixation, thus increasing the ocean's fixed nitrogen inventory and decreasing δ15NNO3. This simulation already fits observed carbon and nitrogen isotopes relatively well, but it overestimates deep ocean δ13CDIC and underestimates δ15NNO3 at high latitudes. Increasing μmax enhances Corg and lowers deep ocean δ13CDIC, improving the fit. Modest increases in μmax result in higher subpolar δ15NNO3 due to enhanced local nutrient utilization, and better agreement with reconstructions. Large increases in nutrient utilization are inconsistent with nitrogen isotopes although they still fit the carbon isotopes reasonably well. The best fitting models with modest increases in μmax reproduce major features of the glacial δ13CDIC, δ15N, and oxygen reconstructions while simulating increased Corg by 510-670 Pg. These results are consistent with the idea that the soft-tissue pump was more efficient during the LGM. Both circulation and biological nutrient utilization contribute. However, these conclusions are preliminary given our idealized experiments, which do not consider changes in benthic denitrification and spatially inhomogenous changes in aeolian iron fluxes. The analysis illustrates interactions between the carbon and nitrogen cycles as well as the complementary constraints provided by their isotopes. Whereas carbon isotopes are sensitive to circulation changes and indicate well the three-dimensional Corg distribution, nitrogen isotopes are more sensitive to biological nutrient utilization.

Childhood Soft Tissue Sarcoma Treatment (PDQ®)—Patient Version

Cancer.gov

Childhood soft tissue sarcoma treatment options include surgery, radiation therapy, chemotherapy, observation, targeted therapy, immunotherapy and other medications.  Learn more about the diagnosis and treatment of the many types of childhood soft tissue sarcoma in this expert-reviewed summary.

Hard and soft tissue augmentation in a postorthodontic patient: a case report.

PubMed

Bonacci, Fred J

2011-02-01

A combination of hard and soft tissue grafting is used to augment a thin biotype. A 26-year-old woman with mandibular anterior flaring and Miller Class I and III recessions requested interceptive treatment. Surgery included a full-thickness buccal flap, intramarrow penetrations, bone graft placement, and primary flap closure. Postoperative visits were at 2 and 4 weeks and 2, 3, and 6 months. Stage-two surgery consisted of submerged connective tissue graft placement. Postoperative visits were completed at 2, 4, 6, and 8 weeks and 1 year. Follow-up was completed 3 years after the initial surgery. Interradicular concavities were resolved and gingival biotype was augmented. Soft tissue recession remained at 6 months. Reentry revealed clinical labial plate augmentation; 2 mm was achieved at the lateral incisors and the left central incisor and 3 mm was achieved at the right canine. No bone augmentation was achieved on the left canine and right central incisor. The dehiscence at the right central incisor appeared narrower. Overall, a 2- to 3-mm gain in alveolar bone thickness/height was observed. Two months after stage-two surgery, near complete root coverage was achieved; 1 mm of recession remained on the left central incisor. There was a soft tissue thickness gain of 2 mm without any visual difference in keratinized tissue height. Interradicular concavities were eliminated; the soft tissue was augmented and the gingival biotype was altered. Interdental soft tissue craters remained. One year after connective tissue graft placement, there was near complete root coverage at the left central incisor, which at 2 months experienced residual recession. Interradicular concavities and interdental soft tissue craters were eliminated with soft tissue augmentation, including clinical reestablishment of the mucogingival junction. Clinical stability remained 3 years after the initial surgery, with the patient noting comfort during mastication and routine oral hygiene. A clinical increase in labial plate thickness, in conjunction with soft tissue augmentation, appears to provide for continued stability and decreased potential for future clinical attachment loss.

Polymer structure-property requirements for stereolithographic 3D printing of soft tissue engineering scaffolds.

PubMed

Mondschein, Ryan J; Kanitkar, Akanksha; Williams, Christopher B; Verbridge, Scott S; Long, Timothy E

2017-09-01

This review highlights the synthesis, properties, and advanced applications of synthetic and natural polymers 3D printed using stereolithography for soft tissue engineering applications. Soft tissue scaffolds are of great interest due to the number of musculoskeletal, cardiovascular, and connective tissue injuries and replacements humans face each year. Accurately replacing or repairing these tissues is challenging due to the variation in size, shape, and strength of different types of soft tissue. With advancing processing techniques such as stereolithography, control of scaffold resolution down to the μm scale is achievable along with the ability to customize each fabricated scaffold to match the targeted replacement tissue. Matching the advanced manufacturing technique to polymer properties as well as maintaining the proper chemical, biological, and mechanical properties for tissue replacement is extremely challenging. This review discusses the design of polymers with tailored structure, architecture, and functionality for stereolithography, while maintaining chemical, biological, and mechanical properties to mimic a broad range of soft tissue types. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of Compressive Osseointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity.

PubMed

Goulding, Krista A; Schwartz, Adam; Hattrup, Steven J; Randall, R Lor; Lee, Donald; Rispoli, Damian M; Lerman, Daniel M; Beauchamp, Christopher

2017-06-01

Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb. (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique? A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant ® Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna. During the early part of that period, the indication for use of a compressive prosthesis in our centers was revision of a previous tumor reconstruction (allograft-prosthetic composite or stemmed endoprosthetic reconstruction) (three patients; five implants), or revision arthroplasty with massive bone loss (three patients, four implants); more recently, indications became somewhat more permissive and included posttraumatic bone loss (one patient, one implant), primary bone sarcoma, and resections with very short remaining end segments after diaphyseal resections (two patients, three implants). Minimum followup was 24 months; one patient (one implant) was lost to followup before that time with the implant intact at 14 months and no patients have died. The mean age of the patients was 45 years (range, 21-62 years). Mean followup was 68 months (range, 24-141 months). Implant revision for any cause and for failure of the CPS mechanism was recorded. Modes of failure were categorized as soft tissue, aseptic loosening, structural, infection, and tumor progression; CPS modes of failure were defined as lack of fixation, with or without bone or implant fracture. Of the 12 implants accounted for beyond 2 years, six had undergone revision of any kind. Only two revisions in two patients were attributable to lack of CPS fixation at the bone-implant interface; one of the patients also had periprosthetic and implant fracture develop through the traction bar. Other modes of failure were aseptic loosening of the standard ulnar component (two patients, two implants), bushing wear (one patient; one implant) and infection resulting in two-stage exchange and free soft tissue transfer with retention of the CPS spindle (one patient, one implant). Complications for all nine patients included one transient radial nerve palsy, one ulnar nerve sensory neurapraxia, one superficial infection, and two glenohumeral subluxations, one underwent revision surgery with implantation of a constrained liner. A compressive osseointegration endoprosthesis is an option for very difficult revisions or sarcoma resection in the upper extremity in which the remaining segment of host bone is too short for a conventional prosthesis. However, surgeons must inform patients that these are salvage operations, and revision surgery is common. Long-term followup of more patients is necessary to further document the survivorship of these implants in the upper extremity. Level IV, therapeutic study.

How to use PRICE treatment for soft tissue injuries.

PubMed

Norton, Cormac

2016-08-24

Rationale and key points This article assists nurses to use the acronym PRICE (protection, rest, ice, compression and elevation) to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs. » Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly. » Nurses should have an understanding of the rationale and evidence base supporting PRICE treatment of soft tissue injuries. » Providing accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time is an important aspect of treatment. » Further research is required to develop best practice in the treatment of soft tissue injuries. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing patients with soft tissue injuries to upper or lower limbs. 2. Positive elements of your current practice and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty

PubMed Central

Amiri, Shahram; Wilson, David R.

2012-01-01

Bicruciate retaining knee arthroplasty, although has shown improved functions and patient satisfaction compared to other designs of total knee replacement, remains a technically demanding option for treating severe cases of arthritic knees. One of the main challenges in bicruciate retaining arthroplasty is proper balancing of the soft tissue during the surgery. In this study biomechanics of soft tissue balancing was investigated using a validated computational model of the knee joint with high fidelity definitions of the soft tissue structures along with a Taguchi method for design of experiments. The model was used to simulate intraoperative balancing of soft tissue structures following the combinations suggested by an orthogonal array design. The results were used to quantify the corresponding effects on the laxity of the joint under anterior-posterior, internal-external, and varus-valgus loads. These effects were ranked for each ligament bundle to identify the components of laxity which were most sensitive to the corresponding surgical modifications. The resulting map of sensitivity for all the ligament bundles determined the components of laxity most suitable for examination during intraoperative balancing of the soft tissue. Ultimately, a sequence for intraoperative soft tissue balancing was suggested for a bicruciate retaining knee arthroplasty. PMID:23082090

Health, Maintenance, and Recovery of Soft Tissues around Implants.

PubMed

Wang, Yulan; Zhang, Yufeng; Miron, Richard J

2016-06-01

The health of peri-implant soft tissues is one of the most important aspects of osseointegration necessary for the long-term survival of dental implants. To review the process of soft tissue healing around osseointegrated implants and discuss the maintenance requirements as well as the possible short-comings of peri-implant soft tissue integration. Literature search on the process involved in osseointegration, soft tissue healing and currently available treatment modalities was performed and a brief description of each process was provided. The peri-implant interface has been shown to be less effective than natural teeth in resisting bacterial invasion because gingival fiber alignment and reduced vascular supply make it more vulnerable to subsequent peri-implant disease and future bone loss around implants. And we summarized common procedures which have been shown to be effective in preventing peri-implantitis disease progression as well as clinical techniques utilized to regenerate soft tissues with bone loss in advanced cases of peri-implantitis. Due to the difference between peri-implant interface and natural teeth, clinicians and patients should pay more attention in the maintenance and recovery of soft tissues around implants. © 2015 Wiley Periodicals, Inc.

A novel laparoscopic grasper with two parallel jaws capable of extracting the mechanical behaviour of soft tissues.

PubMed

Nazarynasab, Dariush; Farahmand, Farzam; Mirbagheri, Alireza; Afshari, Elnaz

2017-07-01

Data related to force-deformation behaviour of soft tissue plays an important role in medical/surgical applications such as realistically modelling mechanical behaviour of soft tissue as well as minimally invasive surgery (MIS) and medical diagnosis. While the mechanical behaviour of soft tissue is very complex due to its different constitutive components, some issues increase its complexity like behavioural changes between the live and dead tissues. Indeed, an adequate quantitative description of mechanical behaviour of soft tissues requires high quality in vivo experimental data to be obtained and analysed. This paper describes a novel laparoscopic grasper with two parallel jaws capable of obtaining compressive force-deformation data related to mechanical behaviour of soft tissues. This new laparoscopic grasper includes four sections as mechanical hardware, sensory part, electrical/electronical part and data storage part. By considering a unique design for mechanical hardware, data recording conditions will be close to unconfined-compression-test conditions; so obtained data can be properly used in extracting the mechanical behaviour of soft tissues. Also, the other distinguishing feature of this new system is its applicability during different laparoscopic surgeries and subsequently obtaining in vivo data. However, more preclinical examinations are needed to evaluate the practicality of the novel laparoscopic grasper with two parallel jaws.

Facial soft tissue thickness in skeletal type I Japanese children.

PubMed

Utsuno, Hajime; Kageyama, Toru; Deguchi, Toshio; Umemura, Yasunobu; Yoshino, Mineo; Nakamura, Hiroshi; Miyazawa, Hiroo; Inoue, Katsuhiro

2007-10-25

Facial reconstruction techniques used in forensic anthropology require knowledge of the facial soft tissue thickness of each race if facial features are to be reconstructed correctly. If this is inaccurate, so also will be the reconstructed face. Knowledge of differences by age and sex are also required. Therefore, when unknown human skeletal remains are found, the forensic anthropologist investigates for race, sex, and age, and for other variables of relevance. Cephalometric X-ray images of living persons can help to provide this information. They give an approximately 10% enlargement from true size and can demonstrate the relationship between soft and hard tissue. In the present study, facial soft tissue thickness in Japanese children was measured at 12 anthropological points using X-ray cephalometry in order to establish a database for facial soft tissue thickness. This study of both boys and girls, aged from 6 to 18 years, follows a previous study of Japanese female children only, and focuses on facial soft tissue thickness in only one skeletal type. Sex differences in thickness of tissue were found from 12 years of age upwards. The study provides more detailed and accurate measurements than past reports of facial soft tissue thickness, and reveals the uniqueness of the Japanese child's facial profile.

Non Lipomatous Benign Lesions Mimicking Soft-tissue Sarcomas: A Pictorial Essay

PubMed Central

CORAN, ALESSANDRO; ORSATTI, GIOVANNA; CRIMÌ, FILIPPO; RASTRELLI, MARCO; DI MAGGIO, ANTONIO; PONZONI, ALBERTO; ATTAR, SHADY; STRAMARE, ROBERTO

2018-01-01

The incidental finding of soft tissue masses is a challenge for the radiologist. Benign and malignant lesions can be differentiated relying on patient history, symptoms and mostly with the help of imaging. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) become fundamental in order to distinguish these lesions but the radiologist needs to know the main characteristics of benign soft tissue masses and sarcomas. Herein, we present a pictorial review of lesions mimicking soft tissue sarcomas features. PMID:29475903

Fabrication of polyurethane and polyurethane based composite fibres by the electrospinning technique for soft tissue engineering of cardiovascular system.

PubMed

Kucinska-Lipka, J; Gubanska, I; Janik, H; Sienkiewicz, M

2015-01-01

Electrospinning is a unique technique, which provides forming of polymeric scaffolds for soft tissue engineering, which include tissue scaffolds for soft tissues of the cardiovascular system. Such artificial soft tissues of the cardiovascular system may possess mechanical properties comparable to native vascular tissues. Electrospinning technique gives the opportunity to form fibres with nm- to μm-scale in diameter. The arrangement of obtained fibres and their surface determine the biocompatibility of the scaffolds. Polyurethanes (PUs) are being commonly used as a prosthesis of cardiovascular soft tissues due to their excellent biocompatibility, non-toxicity, elasticity and mechanical properties. PUs also possess fine spinning properties. The combination of a variety of PU properties with an electrospinning technique, conducted at the well tailored conditions, gives unlimited possibilities of forming novel polyurethane materials suitable for soft tissue scaffolds applied in cardiovascular tissue engineering. This paper can help researches to gain more widespread and deeper understanding of designing electrospinable PU materials, which may be used as cardiovascular soft tissue scaffolds. In this paper we focus on reagents used in PU synthesis designed to increase PU biocompatibility (polyols) and biodegradability (isocyanates). We also describe suggested surface modifications of electrospun PUs, and the direct influence of surface wettability on providing enhanced biocompatibility of scaffolds. We indicate a great influence of electrospinning parameters (voltage, flow rate, working distance) and used solvents (mostly DMF, THF and HFIP) on fibre alignment and diameter - what impacts the biocompatibility and hemocompatibility of such electrospun PU scaffolds. Moreover, we present PU modifications with natural polymers with novel approach applied in electrospinning of PU scaffolds. This work may contribute with further developing of novel electrospun PUs, which may be applied as soft tissue scaffolds of the cardiovascular system. Copyright © 2014. Published by Elsevier B.V.

Wound Healing Complications Following Guided Bone Regeneration for Ridge Augmentation: A Systematic Review and Meta-Analysis.

PubMed

Lim, Glendale; Lin, Guo-Hao; Monje, Alberto; Chan, Hsun-Liang; Wang, Hom-Lay

The rate of developing soft tissue complications that accompany guided bone regeneration (GBR) procedures varies widely, from 0% to 45%. The present review was conducted to investigate the rate for resorbable versus nonresorbable membranes and the timing of soft tissue complications. Electronic and manual literature searches were conducted by two independent reviewers using several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles published through July 2015, with no language restriction. Articles were included if they were clinical trials aimed at demonstrating the incidence of soft tissue complications following GBR procedures. Overall, 21 and 15 articles were included in the qualitative and quantitative synthesis, respectively. The weighted complication rate of the overall soft tissue complications, including membrane exposure, soft tissue dehiscence, and acute infection/abscess, into the calculation was 16.8% (95% CI = 10.6% to 25.4%). When considering the complication rate based on membrane type used, resorbable membrane was associated with a weighted complication rate of 18.3% (95% CI: 10.4% to 30.4%) and nonresorbable membrane with a rate of 17.6% (95% CI: 10.0% to 29.3%). Moreover, soft tissue lesions were reported as early as 1 week and as late as 6 months based on the included studies. Soft tissue complications after GBR are common (16.8%). Membrane type did not appear to significantly affect the complication rate, based on the limited number of data retrieved in this study. Technique sensitivity (ie, soft tissue management) may still be regarded as the main component to avoid soft tissue complications and, hence, to influence the success of bone regenerative therapy.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1-Common Sarcomas: From the Radiologic Pathology Archives.

PubMed

Levy, Angela D; Manning, Maria A; Al-Refaie, Waddah B; Miettinen, Markku M

2017-01-01

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis.

Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases.

PubMed

Abdel-Hamid, Mohamed Zaki; Chang, Chung-Hsun; Chan, Yi-Sheng; Lo, Yang-Pin; Huang, Jau-Wen; Hsu, Kuo-Yao; Wang, Ching-Jen

2006-06-01

This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported. From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed. The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures. Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope. Level III, diagnostic study.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1—Common Sarcomas: From the Radiologic Pathology Archives

PubMed Central

Manning, Maria A.; Al-Refaie, Waddah B.; Miettinen, Markku M.

2017-01-01

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis. PMID:28287938

Quantitative Imaging of Young's Modulus of Soft Tissues from Ultrasound Water Jet Indentation: A Finite Element Study

PubMed Central

Lu, Min-Hua; Mao, Rui; Lu, Yin; Liu, Zheng; Wang, Tian-Fu; Chen, Si-Ping

2012-01-01

Indentation testing is a widely used approach to evaluate mechanical characteristics of soft tissues quantitatively. Young's modulus of soft tissue can be calculated from the force-deformation data with known tissue thickness and Poisson's ratio using Hayes' equation. Our group previously developed a noncontact indentation system using a water jet as a soft indenter as well as the coupling medium for the propagation of high-frequency ultrasound. The novel system has shown its ability to detect the early degeneration of articular cartilage. However, there is still lack of a quantitative method to extract the intrinsic mechanical properties of soft tissue from water jet indentation. The purpose of this study is to investigate the relationship between the loading-unloading curves and the mechanical properties of soft tissues to provide an imaging technique of tissue mechanical properties. A 3D finite element model of water jet indentation was developed with consideration of finite deformation effect. An improved Hayes' equation has been derived by introducing a new scaling factor which is dependent on Poisson's ratios v, aspect ratio a/h (the radius of the indenter/the thickness of the test tissue), and deformation ratio d/h. With this model, the Young's modulus of soft tissue can be quantitatively evaluated and imaged with the error no more than 2%. PMID:22927890

Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series.

PubMed

Urban, Istvan A; Monje, Alberto; Wang, Hom-Lay

2015-01-01

Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.

Proteomic Analysis of Gingival Tissue and Alveolar Bone during Alveolar Bone Healing*

PubMed Central

Yang, Hee-Young; Kwon, Joseph; Kook, Min-Suk; Kang, Seong Soo; Kim, Se Eun; Sohn, Sungoh; Jung, Seunggon; Kwon, Sang-Oh; Kim, Hyung-Seok; Lee, Jae Hyuk; Lee, Tae-Hoon

2013-01-01

Bone tissue regeneration is orchestrated by the surrounding supporting tissues and involves the build-up of osteogenic cells, which orchestrate remodeling/healing through the expression of numerous mediators and signaling molecules. Periodontal regeneration models have proven useful for studying the interaction and communication between alveolar bone and supporting soft tissue. We applied a quantitative proteomic approach to analyze and compare proteins with altered expression in gingival soft tissue and alveolar bone following tooth extraction. For target identification and validation, hard and soft tissue were extracted from mini-pigs at the indicated times after tooth extraction. From triplicate experiments, 56 proteins in soft tissue and 27 proteins in alveolar bone were found to be differentially expressed before and after tooth extraction. The expression of 21 of those proteins was altered in both soft tissue and bone. Comparison of the activated networks in soft tissue and alveolar bone highlighted their distinct responsibilities in bone and tissue healing. Moreover, we found that there is crosstalk between identified proteins in soft tissue and alveolar bone with respect to cellular assembly, organization, and communication. Among these proteins, we examined in detail the expression patterns and associated networks of ATP5B and fibronectin 1. ATP5B is involved in nucleic acid metabolism, small molecule biochemistry, and neurological disease, and fibronectin 1 is involved in cellular assembly, organization, and maintenance. Collectively, our findings indicate that bone regeneration is accompanied by a profound interaction among networks regulating cellular resources, and they provide novel insight into the molecular mechanisms involved in the healing of periodontal tissue after tooth extraction. PMID:23824910

Comparing different preparation methods to study human fibrin fibers and platelets using TEM.

PubMed

Buys, Antoinette V; Pretorius, Etheresia

2012-06-01

For the study of cellular ultrastructure, the sample needs to be stabilized by fixation, with the ultimate aim to preserve the native tissue organization and to protect the tissue against later stages of preparation. Chemical and freezing fixation are most used, and chemical fixation employs agents that permeate tissues and cells by diffusion and covalently bind with their major biochemical constituents to fix them. Most widely used chemical fixatives are aldehydes, e.g., formaldehyde and glutaraldehyde, which are noncoagulating, crosslinking agents. Cryofixation methods for ultrastructural studies are also popular, and high-pressure freezing immobilizes all cell constituents and arrests biological activity by removing the thermal energy from the system. In the current research, we used platelet-rich plasma (PRP) to study expansive fibrin fibers and platelet ultrastructure to compare the two fixation techniques. We also used thrombin and calcium chloride as a clotting agent to determine the technique most suitable for the formation of extensive fibrin networks. Chemically fixated fibrin fibers were more compact and condensed and also showed a banding pattern on longitudinal sections. High-pressure frozen samples were more dispersed while platelets fixated showed better preserved cellular membranes and organelle structure. PRP coagulated by addition of CaCl(2) showed blood platelets that are noticeably more activated compared with PRP; however, with thrombin, a sharp ultrastructure was seen. We conclude that PRP mixed with thrombin, and freeze substituted, is the most suitable method for the study of extensive fibrin fibers as well as platelets. Copyright © 2011 Wiley Periodicals, Inc.

Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review.

PubMed

Bassetti, Renzo G; Stähli, Alexandra; Bassetti, Mario A; Sculean, Anton

2017-01-01

The aim was to compile the current knowledge about the efficacy of different soft tissue correction methods around osseointegrated, already uncovered and/or loaded (OU/L) implants with insufficient soft tissue conditions. Procedures to increase peri-implant keratinized mucosa (KM) width and/or soft tissue volume were considered. Screening of two databases: MEDLINE (PubMed) and EMBASE (OVID), and manual search of articles were performed. Human studies reporting on soft tissue augmentation/correction methods around OU/L implants up to June 30, 2016, were considered. Quality assessment of selected full-text articles to weight risk of bias was performed using the Cochrane collaboration's tool. Overall, four randomized controlled trials (risk of bias = high/low) and five prospective studies (risk of bias = high) were included. Depending on the surgical techniques and graft materials, the enlargement of keratinized tissue (KT) ranged between 1.15 ± 0.81 and 2.57 ± 0.50 mm. The apically positioned partial thickness flap (APPTF), in combination with a free gingival graft (FGG), a subepithelial connective tissue graft (SCTG), or a xenogeneic graft material (XCM) were most effective. A coronally advanced flap (CAF) combined with SCTG in three, combined with allogenic graft materials (AMDA) in one, and a split thickness flap (STF) combined with SCTG in another study showed mean soft tissue recession coverage rates from 28 to 96.3 %. STF combined with XCM failed to improve peri-implant soft tissue coverage. The three APPTF-techniques combined with FGG, SCTG, or XCM achieved comparable enlargements of peri-implant KT. Further, both STF and CAF, both in combination with SCTG, are equivalent regarding recession coverage rates. STF + XCM and CAF + AMDA did not reach significant coverage. In case of soft tissue deficiency around OU/L dental implants, the selection of both an appropriate surgical technique and a suitable soft tissue graft material is of utmost clinical relevance.

ChainMail based neural dynamics modeling of soft tissue deformation for surgical simulation.

PubMed

Zhang, Jinao; Zhong, Yongmin; Smith, Julian; Gu, Chengfan

2017-07-20

Realistic and real-time modeling and simulation of soft tissue deformation is a fundamental research issue in the field of surgical simulation. In this paper, a novel cellular neural network approach is presented for modeling and simulation of soft tissue deformation by combining neural dynamics of cellular neural network with ChainMail mechanism. The proposed method formulates the problem of elastic deformation into cellular neural network activities to avoid the complex computation of elasticity. The local position adjustments of ChainMail are incorporated into the cellular neural network as the local connectivity of cells, through which the dynamic behaviors of soft tissue deformation are transformed into the neural dynamics of cellular neural network. Experiments demonstrate that the proposed neural network approach is capable of modeling the soft tissues' nonlinear deformation and typical mechanical behaviors. The proposed method not only improves ChainMail's linear deformation with the nonlinear characteristics of neural dynamics but also enables the cellular neural network to follow the principle of continuum mechanics to simulate soft tissue deformation.

The Adjunctive Soft-Tissue Diode Laser in Orthodontics.

PubMed

Borzabadi-Farahani, Ali

2017-04-01

Lasers are a relatively new addition to the orthodontist's armamentarium. This article reviews the fundamental basic science of available soft-tissue lasers, with an emphasis on diode lasers, and discusses various adjunct applications of the diode laser for soft-tissue orthodontic procedures. Diode lasers function by cutting with an initiated hot tip and produce minimal to no interaction with healthy dental hard tissue, making them suitable for soft-tissue procedures. The contact cutting mode provides enhanced bloodless site visibility and facility to perform delicate soft tissue procedures, which is important in areas with difficult access. Such adjunctive uses include laser gingivectomy to improve oral hygiene or bracket positioning, esthetic laser gingival recontouring, and laser exposure of superficially impacted teeth. Selected cases treated with a 940-nm indium-gallium-arsenide-phosphide (InGaAsP) diode laser will be presented.

Biomechanical and histologic evaluation of two application forms of surgical glue for mesh fixation to the abdominal wall.

PubMed

Ortillés, Á; Pascual, G; Peña, E; Rodríguez, M; Pérez-Köhler, B; Mesa-Ciller, C; Calvo, B; Bellón, J M

2017-11-01

The use of an adhesive for mesh fixation in hernia repair reduces chronic pain and minimizes tissue damage in the patient. This study was designed to assess the adhesive properties of a medium-chain (n-butyl) cyanoacrylate glue applied as drops or as a spray in a biomechanical and histologic study. Both forms of glue application were compared to the use of simple-loose or continuous-running polypropylene sutures for mesh fixation. Eighteen adult New Zealand White rabbits were used. For mechanical tests in an ex vivo and in vivo study, patches of polypropylene mesh were fixed to an excised fragment of healthy abdominal tissue or used to repair a partial abdominal wall defect in the rabbit respectively. Depending on the fixation method used, four groups of 12 implants each or 10 implants each respectively for the ex vivo and in vivo studies were established: Glue-Drops, Glue-Spray, Suture-Simple and Suture-Continuous. Biomechanical resistance in the ex vivo implants was tested five minutes after mesh fixation. In vivo implants for biomechanical and histologic assessment were collected at 14 days postimplant. In the ex vivo study, the continuous suture implants showed the highest failure sample tension, while the implants fixed with glue showed lower failure sample tension values. However, the simple and continuous suture implants returned the highest stretch values. In the in vivo implants, failure sample tension values were similar among groups while the implants fixed with a continuous running suture had the higher stretch values, and the glue-fixed implants the lower stretch values. All meshes showed good tissue integration within the host tissue regardless of the fixation method used. Our histologic study revealed the generation of a denser, more mature repair tissue when the cyanoacrylate glue was applied as a spray rather than as drops. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of radiology in paediatric soft tissue sarcomas

PubMed Central

van Rijn, R.; McHugh, K.

2008-01-01

Abstract Paediatric soft tissue sarcomas (STS) are a group of malignant tumours that originate from primitive mesenchymal tissue and account for 7% of all childhood tumours. Rhabdomyosarcomas (RMS) and undifferentiated sarcomas account for approximately 50% of soft tissue sarcomas in children and non-rhabdomyomatous soft tissue sarcomas (NRSTS) the remainder. The prognosis and biology of STS tumours vary greatly depending on the age of the patient, the primary site, tumour size, tumour invasiveness, histologic grade, depth of invasion, and extent of disease at diagnosis. Over recent years, there has been a marked improvement in survival rates in children and adolescents with soft tissue sarcoma and ongoing international studies continue to aim to improve these survival rates whilst attempting to reduce the morbidity associated with treatment. Radiology plays a crucial role in the initial diagnosis and staging of STS, in the long term follow-up and in the assessment of many treatment related complications. We review the epidemiology, histology, clinical presentation, staging and prognosis of soft tissue sarcomas and discuss the role of radiology in their management. PMID:18442956

Minipig model of maxillary distraction osteogenesis: immunohistochemical and histomorphometric analysis of the sequence of osteogenesis.

PubMed

Papadaki, Maria E; Kaban, Leonard B; Troulis, Maria J

2012-11-01

To document the sequence of bone formation in a minipig model of Le Fort I distraction osteogenesis (DO) using immunohistochemistry and histomorphometry. Female Yucatan minipigs (N = 9) in the mixed-dentition stage underwent bilateral maxillary DO. The distraction protocol was 0 days of latency, with a distraction rate of 1 mm/d for 12 days and 24 days of fixation. Specimens were harvested and divided between the central incisors (18 hemi-maxillae) at the end of DO (n = 6), at mid-fixation (n = 6), and at the end of fixation (n = 6). Sections, including the advancement zone, were stained with hematoxylin-eosin, collagen II, CD34, proliferating cell nuclear antigen, and tartrate-resistant acid phosphatase. Light and fluorescence microscope images (original magnification ×200) were obtained, and percentage of surface area (PSA) of the advancement zone occupied by fibrous tissue, vessels, proliferating cells, osteoid, and bone was determined. An intact maxilla served as the control. At the end of DO, in the advancement zone, the PSA (mean values) of proliferating cells was 33.16%; fibrous tissue, 52%; vessels, 4.35%; and new bone, 5.45%. At the end of fixation, the PSA of proliferating cells decreased to 10.53%, fibrous tissue to 2.3%, and vessels to 1.5% whereas the PSA of new bone increased to 44.9%. The results of this study indicate that the progression of osteogenesis in the maxillary DO wound begins with intense cellular proliferation and vascular fibrous tissue formation and progresses to mature, cancellous bone by the end of fixation. The PSA occupied by mature bone is significantly less than in the control maxilla at the end of fixation. This is consistent with the sequence in the mandibular DO wound. Published by Elsevier Inc.

Soft Tissue Tumor Immunohistochemistry Update: Illustrative Examples of Diagnostic Pearls to Avoid Pitfalls.

PubMed

Wei, Shi; Henderson-Jackson, Evita; Qian, Xiaohua; Bui, Marilyn M

2017-08-01

- Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses. These include the potential line of histogenesis and whether the tumor is benign or malignant, and low or high grade. Although molecular/genetic testing is increasingly finding its applications in characterizing soft tissue tumors, currently immunohistochemistry still not only plays an indispensable role in defining tumor histogenesis, but also serves as a surrogate for underlining molecular/genetic alterations. Objective- To provide an overview focusing on the current concepts in the classification and diagnosis of soft tissue tumors, incorporating immunohistochemistry. This article uses examples to discuss how to use the traditional and new immunohistochemical markers for the diagnosis of soft tissue tumors. Practical diagnostic pearls, summary tables, and figures are used to show how to avoid diagnostic pitfalls. - Data were obtained from pertinent peer-reviewed English-language literature and the authors' first-hand experience as bone and soft tissue pathologists. - -The ultimate goal for a pathologist is to render a specific diagnosis that provides diagnostic, prognostic, and therapeutic information to guide patient care. Immunohistochemistry is integral to the diagnosis and management of soft tissue tumors.

Clinical Presentation of Soft-tissue Infections and its Management: A Study of 100 Cases.

PubMed

Singh, Baldev; Singh, Sukha; Khichy, Sudhir; Ghatge, Avinash

2017-01-01

Soft-tissue infections vary widely in their nature and severity. A clear approach to the management must allow their rapid identification and treatment as they can be life-threatening. Clinical presentation of soft-tissue infections and its management. A prospective study based on 100 patients presenting with soft-tissue infections was done. All the cases of soft-tissue infections were considered irrespective of age, sex, etiological factors, or systemic disorders. The findings were evaluated regarding the pattern of soft-tissue infections in relation to age and sex, clinical presentation, complications, duration of hospital stay, management, and mortality. The most commonly involved age group was in the range of 41-60 years with male predominance. Abscess formation (45%) was the most common clinical presentation. Type 2 diabetes mellitus was the most common associated comorbid condition. Staphylococcus aureus was the most common culture isolate obtained. The most common complication seen was renal failure. Patients with surgical site infections had maximum duration of stay in the hospital. About 94% of the cases of soft-tissue infections were managed surgically. Mortality was mostly encountered in the cases of complications of cellulitis. Skin and soft-tissue infections are among the most common infections encountered by the emergency physicians. Ignorance, reluctance to treatment, economic constraints, and illiteracy delay the early detection and the initiation of proper treatment. Adequate and timely surgical intervention in most of the cases is of utmost importance to prevent the complications and reduce the mortality.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

PubMed

Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

2018-03-01

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

Surgical Management for Destructive Atlantoaxial Spondyloarthropathy in Long-Term Hemodialysis Patients.

PubMed

Jeong, Je Hoon; Kim, Hee Kyung; Im, Soo Bin

2017-01-01

Atlantoaxial spondyloarthropathy most often results from rheumatoid arthritis, cancer metastasis, or basilar invagination. Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy at the atlantoaxial joint. We report 2 patients on long-term hemodialysis who presented with atlantoaxial spondyloarthropathy. Two patients with end-stage renal failure presented with a history of progressively worsening neck pain, motion limitation, and gait disturbance. In both patients, radiologic findings showed a bone-destroying soft tissue mass lateral to C1 and C2, compressing the spinal cord and causing atlantoaxial instability. We performed a C1 laminectomy and C12 transarticular screw fixation and biopsied the osteolytic mass. The neck pain, hand numbness, and gait disturbance improved. Although the surgical management of these patients involves many challenges, appropriate decompression and fusion surgery is an effective treatment option. Copyright © 2016 Elsevier Inc. All rights reserved.

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia

PubMed Central

Mitsugi, Masaharu; Alcalde, Rafael E.; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-01-01

Backgrounds: The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. Methods: After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. Results: As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Conclusion Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained. PMID:26301156

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia.

PubMed

Ito, Osamu; Mitsugi, Masaharu; Alcalde, Rafael E; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-07-01

The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained.

The management of the painful bipartite patella: a systematic review.

PubMed

McMahon, Samuel E; LeRoux, Johannes A; Smith, Toby O; Hing, Caroline B

2016-09-01

This study aimed to identify the most effective method for the treatment of the symptomatic bipartite patella. A systematic review of the literature was completed, and all studies assessing the management of a bipartite patella were included. Owing to the paucity of randomised controlled trials, a narrative review of 22 studies was completed. A range of treatments were assessed: conservative measures, open and arthroscopic fixation or excision and soft tissue release and excision. All of the methods provided results ranging from good to excellent, with acceptable complication rates. This is a poorly answered treatment question. No firm guidance can be given as to the most appropriate method of treating the symptomatic bipartite patella. This study suggests that there are a number of effective treatments with acceptable complication rates and it may be that treatments that conserve the patella are more appropriate for larger fragments. IV.

Repair of large full-thickness articular cartilage defects in the rabbit: the effects of joint distraction and autologous bone-marrow-derived mesenchymal cell transplantation.

PubMed

Yanai, T; Ishii, T; Chang, F; Ochiai, N

2005-05-01

We produced large full-thickness articular cartilage defects in 33 rabbits in order to evaluate the effect of joint distraction and autologous culture-expanded bone-marrow-derived mesenchymal cell transplantation (ACBMT) at 12 weeks. After fixing the knee on a hinged external fixator, we resected the entire surface of the tibial plateau. We studied three groups: 1) with and without joint distraction; 2) with joint distraction and collagen gel, and 3) with joint distraction and ACBMT and collagen gel. The histological scores were significantly higher in the groups with ACBMT collagen gel (p < 0.05). The area of regenerated soft tissue was smaller in the group allowed to bear weight (p < 0.05). These findings suggest that the repair of large defects of cartilage can be enhanced by joint distraction, collagen gel and ACBMT.

[Selection of access and positioning for operative treatment of pelvic injuries. Decision-making strategies].

PubMed

Ossendorf, C; Hofmann, A; Rommens, P M

2013-03-01

Surgical treatment of pelvic ring injuries requires in-depth knowledge of the topographic anatomy of the pelvic bones, joints and soft tissue structures. A wide range of stabilizing techniques is available including bridging plate osteosynthesis, iliosacral compression screw osteosynthesis and transpubic positioning screws. In this article the different treatment strategies with the respective surgical approaches and patient positioning for pelvic ring fractures and combined lesions of the pelvic ring and acetabulum are presented. Pelvic ring lesions with rotational instability are approached from the anterior and occasionally from both the anterior and posterior based on the amount and localization of the instability. In vertically unstable lesions the most unstable part must be addressed first by reduction and fixation of the dislocated part to the axial skeleton. In combined fractures of the pelvis and acetabulum dorsal stabilization is carried out first.

[The use of Piezosurgery osteotomy in treatment of long-standing maxillary fractures: report of 12 consecutive patients].

PubMed

Guo, Zhao-Zhong; Liu, Xue; Li, Yan; Deng, Yan-Fang; Wang, Yang

2007-02-01

To evaluate the clinical applicability of Piezosurgery osteotomy: a new safe technique in managing long standing maxillary fractures. 12 patients with long-standing maxillary fractures were surgically treated using Le Fort I osteotomy. During operation, Piezosurgery osteotomy was used for bone cutting and splitting. After repositioning, the bone segments were rigidly fixed with micro Ti-plate, Ti-mesh. All the patients were followed up for 6 to 12 months, and the functional and esthetic results were evaluated. Ultrasonic microvibrations allow accurate bone cutting without oscillating injuries to the soft tissue. All the wounds healed primarily without complications. The postoperative occlusion and appearance were satisfactory. Maximal recovery of mastication and appearance can be achieved by using Piezosurgery osteotomy with fixation materials such as Ti-plates and Ti-meshes in selected patients with long-standing maxillary fractures.

Soft tissues store and return mechanical energy in human running.

PubMed

Riddick, R C; Kuo, A D

2016-02-08

During human running, softer parts of the body may deform under load and dissipate mechanical energy. Although tissues such as the heel pad have been characterized individually, the aggregate work performed by all soft tissues during running is unknown. We therefore estimated the work performed by soft tissues (N=8 healthy adults) at running speeds ranging 2-5 m s(-1), computed as the difference between joint work performed on rigid segments, and whole-body estimates of work performed on the (non-rigid) body center of mass (COM) and peripheral to the COM. Soft tissues performed aggregate negative work, with magnitude increasing linearly with speed. The amount was about -19 J per stance phase at a nominal 3 m s(-1), accounting for more than 25% of stance phase negative work performed by the entire body. Fluctuations in soft tissue mechanical power over time resembled a damped oscillation starting at ground contact, with peak negative power comparable to that for the knee joint (about -500 W). Even the positive work from soft tissue rebound was significant, about 13 J per stance phase (about 17% of the positive work of the entire body). Assuming that the net dissipative work is offset by an equal amount of active, positive muscle work performed at 25% efficiency, soft tissue dissipation could account for about 29% of the net metabolic expenditure for running at 5 m s(-1). During running, soft tissue deformations dissipate mechanical energy that must be offset by active muscle work at non-negligible metabolic cost. Copyright © 2016 Elsevier Ltd. All rights reserved.

SU-C-213-01: 3D Printed Patient Specific Phantom Composed of Bone and Soft Tissue Substitute Plastics for Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ehler, E; Sterling, D; Higgins, P

Purpose: 3D printed phantoms constructed of multiple tissue approximating materials could be useful in both clinical and research aspects of radiotherapy. This work describes a 3D printed phantom constructed with tissue substitute plastics for both bone and soft tissue; air cavities were included as well. Methods: 3D models of an anonymized nasopharynx patient were generated for air cavities, soft tissues, and bone, which were segmented by Hounsfield Unit (HU) thresholds. HU thresholds were chosen to define air-to-soft tissue boundaries of 0.65 g/cc and soft tissue-to-bone boundaries of 1.18 g/cc based on clinical HU to density tables. After evaluation of severalmore » composite plastics, a bone tissue substitute was identified as an acceptable material for typical radiotherapy x-ray energies, composed of iron and PLA plastic. PET plastic was determined to be an acceptable soft tissue substitute. 3D printing was performed on a consumer grade dual extrusion fused deposition model 3D printer. Results: MVCT scans of the 3D printed heterogeneous phantom were acquired. Rigid image registration of the patient and the 3D printed phantom scans was performed. The average physical density of the soft tissue and bone regions was 1.02 ± 0.08 g/cc and 1.39 ± 0.14 g/cc, respectively, for the patient kVCT scan. In the 3D printed phantom MVCT scan, the average density of the soft tissue and bone was 1.01 ± 0.09 g/cc and 1.44 ± 0.12 g/cc, respectively. Conclusion: A patient specific phantom, constructed of heterogeneous tissue substitute materials was constructed by 3D printing. MVCT of the 3D printed phantom showed realistic tissue densities were recreated by the 3D printing materials. Funding provided by intra-department grant by University of Minnesota Department of Radiation Oncology.« less

Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix

PubMed Central

Zafiropoulos, Gregory-George; Deli, Giorgio; Hoffmann, Oliver; John, Gordon

2016-01-01

Background: The aim of this study was to determine the treatment outcome of the use of a porcine monolayer collagen matrix (mCM) to increase soft-tissue volume as a part of implant site development. Materials and Methods: Implants were placed in single sites in 27 patients. In the test group, mCM was used for soft-tissue augmentation. No graft was placed in the control group. Soft-tissue thickness (STTh) was measured at the time of surgery (T0) and 6 months postoperatively (T1) at two sites (STTh 1, 1 mm below the gingival margin; STTh 2, 3 mm below the mucogingival margin). Results: Significant increases (P < 0.001) in STTh (STTh 1 = 1.06 mm, 117%; STTh 2 = 0.89 mm, 81%) were observed in the test group. Biopsy results showed angiogenesis and mature connective tissue covered by keratinized epithelium. Conclusions: Within the limitations of this study, it could be concluded that mCM leads to a significant increase of peri-implant soft-tissue thickness, with good histological integration and replacement by soft tissue and may serve as an alternative to connective tissue grafting. PMID:28298828

The experiment of magnesium ECAP miniplate as alternative biodegradable material (on male white New Zealand rabbits)

NASA Astrophysics Data System (ADS)

Wiwanto, Siska; Sulistyani, Lilies Dwi; Latief, Fourier Dzar Eljabbar; Supriadi, Sugeng; Priosoeryanto, Bambang Pontjo; Latief, Benny Syariefsyah

2018-02-01

Study of biodegradations of Magnesium ECAP (Equal Channel Angular Pressing) miniplate in the osteosynthesis system has been used as a new material for plate and screw in oral and maxillofacial surgery. This miniplate and screw that were made of Magnesium ECAP were implanted in the femurs of New Zealand rabbits. The degradation process was detected through pocket gas that appeared in hard and soft tissues surrounding in the implanted miniplates and screws. From the changes on the tissues, we can assess the biodegradation process by measuring the gas pocket through micro-CT Scan. Upon the first month of study we euthanized the rabbits and made a micro-CT Scan to see how far the effect of the gas pocket was. Histological analyses were performed to investigate the local tissue response adjacent to the Magnesium ECAP miniplates. We analyzed the femur of a rabbit a month, three months, and five months after implantation. The result showed a degradation rate in the implanted Magnesium ECAP miniplate of 0.61±0.39 mm/year. Unlike the screws, miniplates have higher water content and blood flow than bone, therefore they degrade faster. This study shows promising results for further development of Magnesium ECAP and in the production of osteosynthesis material for rigid fixation in Oral and Maxillofacial skeleton.

Postmortem changes in the neuroanatomical characteristics of the primate brain: the hippocampal formation

PubMed Central

Lavenex, Pierre; Lavenex, Pamela Banta; Bennett, Jeffrey L.; Amaral, David G.

2009-01-01

Comparative studies of the structural organization of the brain are fundamental to our understanding of human brain function. However, whereas brains of experimental animals are fixed by perfusion of a fixative through the vasculature, human or ape brains are fixed by immersion after varying postmortem intervals. Although differential treatments might affect the fundamental characteristics of the tissue, this question has not been evaluated empirically in primate brains. Monkey brains were either perfused, or acquired after varying postmortem intervals before immersion-fixation in 4% paraformaldehyde. We found that the fixation method affected the neuroanatomical characteristics of the monkey hippocampal formation. Soma size was smaller in Nissl-stained, immersion-fixed tissue, although overall brain volume was larger, as compared to perfusion-fixed tissue. Non-phosphorylated high-molecular-weight neurofilament immunoreactivity was lower in CA3 pyramidal neurons, dentate mossy cells and the entorhinal cortex, whereas it was higher in the mossy fiber pathway in immersion-fixed tissue. Serotonin-immunoreactive fibers were well-stained in perfused tissue but were undetectable in immersion-fixed tissue. Although regional immunoreactivity patterns for calcium-binding proteins were not affected, intracellular staining degraded with increasing postmortem intervals. Somatostatin-immunoreactive clusters of large axonal varicosities, previously reported only in humans, were observed in immersion-fixed monkey tissue. In addition, calretinin-immunoreactive multipolar neurons, previously observed only in rodents, were found in the rostral dentate gyrus in both perfused and immersion-fixed brains. In conclusion, comparative studies of the brain must evaluate the effects of fixation on the staining pattern of each marker in every structure of interest before drawing conclusions about species differences. PMID:18972553

Postmortem changes in the neuroanatomical characteristics of the primate brain: hippocampal formation.

PubMed

Lavenex, Pierre; Lavenex, Pamela Banta; Bennett, Jeffrey L; Amaral, David G

2009-01-01

Comparative studies of the structural organization of the brain are fundamental to our understanding of human brain function. However, whereas brains of experimental animals are fixed by perfusion of a fixative through the vasculature, human or ape brains are fixed by immersion after varying postmortem intervals. Although differential treatments might affect the fundamental characteristics of the tissue, this question has not been evaluated empirically in primate brains. Monkey brains were either perfused or acquired after varying postmortem intervals before immersion-fixation in 4% paraformaldehyde. We found that the fixation method affected the neuroanatomical characteristics of the monkey hippocampal formation. Soma size was smaller in Nissl-stained, immersion-fixed tissue, although overall brain volume was larger as compared to perfusion-fixed tissue. Nonphosphorylated high-molecular-weight neurofilament immunoreactivity was lower in CA3 pyramidal neurons, dentate mossy cells, and the entorhinal cortex, whereas it was higher in the mossy fiber pathway in immersion-fixed tissue. Serotonin-immunoreactive fibers were well stained in perfused tissue but were undetectable in immersion-fixed tissue. Although regional immunoreactivity patterns for calcium-binding proteins were not affected, intracellular staining degraded with increasing postmortem intervals. Somatostatin-immunoreactive clusters of large axonal varicosities, previously reported only in humans, were observed in immersion-fixed monkey tissue. In addition, calretinin-immunoreactive multipolar neurons, previously observed only in rodents, were found in the rostral dentate gyrus in both perfused and immersion-fixed brains. In conclusion, comparative studies of the brain must evaluate the effects of fixation on the staining pattern of each marker in every structure of interest before drawing conclusions about species differences.

Therapeutic Angiotensin-(1-7) in Treating Patients With Metastatic Sarcoma That Cannot Be Removed By Surgery

ClinicalTrials.gov

2018-02-27

Bone Cancer; Chondrosarcoma; Clear Cell Sarcoma of the Kidney; Metastatic Osteosarcoma; Ovarian Sarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Osteosarcoma; Recurrent Uterine Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage III Uterine Sarcoma; Stage IV Adult Soft Tissue Sarcoma; Stage IV Uterine Sarcoma

Ribociclib and Doxorubicin in Treating Patients With Metastatic or Advanced Soft Tissue Sarcomas That Cannot Be Removed by Surgery

ClinicalTrials.gov

2018-05-09

Metastatic Angiosarcoma; Metastatic Epithelioid Sarcoma; Metastatic Fibrosarcoma; Metastatic Leiomyosarcoma; Metastatic Liposarcoma; Metastatic Malignant Peripheral Nerve Sheath Tumor; Metastatic Synovial Sarcoma; Metastatic Undifferentiated Pleomorphic Sarcoma; Myxofibrosarcoma; Pleomorphic Rhabdomyosarcoma; Stage III Soft Tissue Sarcoma; Stage IV Soft Tissue Sarcoma; Undifferentiated (Embryonal) Sarcoma

Soft tissue balancing in total shoulder replacement.

PubMed

Mueller, Maike; Hoy, Gregory

2014-03-01

Total shoulder arthroplasty is now capable of recreating near anatomic reproduction of native bony shoulder anatomy, but the function and longevity of anatomic shoulder replacement is dependent on a competent soft tissue envelope and adequate motoring of all musculo-tendinous units about the shoulder. Balancing the soft tissues requires understanding of the anatomy and pathology, as well as technical skills. The advent of reverse shoulder biomechanics has brought with it special requirements of understanding of the soft tissue elements still left in the shoulder despite major rotator cuff deficiency.

Soft tissue coverage of the elbow in a developing country.

PubMed

Pirela-Cruz, Miguel A; Reddy, Kartheek K; Higgs, Matthew

2007-09-01

Two cases that required soft tissue coverage to the anterior aspect of the elbow are presented. A fasciocutaneous intercostal perforator chest wall flap was used for one patient when only skin and fascia coverage was required. A latissimus dorsi myocutaneous flap was used to provide soft tissue coverage and supply motor power for elbow flexion after contracture release in the other. The surgical techniques for each of these flaps are discussed in the context of addressing soft tissue traumatic injuries about the elbow in a developing country with limited resources.

Relevance of infiltration analgesia in pain relief after total knee arthroplasty

PubMed Central

Znojek-Tymborowska, Justyna; Kęska, Rafał; Paradowski, Przemysław T.; Witoński, Dariusz

2013-01-01

OBJECTIVE: The aim of the study was to assess the effect of different types of anesthesia on pain intensity in early postoperative period. PATIENTS AND METHODS: A total of 87 patients (77 women, 10 men) scheduled for total knee arthroplasty (TKA) were assigned to receive either subarachnoid anesthesia alone or in combination with local soft tissue anesthesia, local soft tissue anesthesia and femoral nerve block and pre-emptive infiltration together with local soft tissue anesthesia. We assessed the pain intensity, opioid consumption, knee joint mobility, and complications of surgery. RESULTS: Subjects with pre-emptive infiltration and local soft tissue anesthesia had lower pain intensity on the first postoperative day compared to those with soft tissue anesthesia and femoral nerve block (P=0.012, effect size 0.68). Subjects who received pre-emptive infiltration and local soft-tissue anesthesia had the greatest range of motion in the operated knee at discharge (mean 90 grades [SD 7], P=0.01 compared to those who received subarachnoid anesthesia alone, and P=0.001 compared to those with subarachnoid together with soft tissue anesthesia). CONCLUSION: Despite the differences in postoperative pain and knee mobility, the results obtained throughout the postoperative period do not enable us to favour neither local nor regional infiltration anesthesia in TKA. Level of Evidence II, Prospective Comparative Study. PMID:24453679

A large parosteal ossifying lipoma of lower limb encircling the femur

PubMed Central

2014-01-01

Introduction Lipoma is a benign soft tissue neoplasm that may contain mesenchymal elements, as a result of metaplastic process. Ossification in benign and malignant soft tissue tumors can also manifest due to metaplastic process. Case presentation A 45 year old woman presented with a large thigh mass. The mass was developed one and a half year ago which insidiously increased in size and was associated with movement restriction. Radiological findings revealed soft tissue neoplasm on antero-medial aspect of thigh encircling the femur and displacing adjacent muscles. Fine trabeculations were seen in neoplasm suggestive of ossification. Excision of the mass was performed and histopathology revealed adipocytes with mature bony trabeculae possessing prominent osteoblastic rimming suggestive of ossifying lipoma. Conclusion It is important to recognize this variant of lipoma as it is associated with a better clinical outcome in contrast to most of the deep seated soft tissue neoplasms. Secondly it should also be differentiated from myositis ossificans and heterologous differentiation in other soft tissue neoplasms. We suggest an algorithmic approach to the diagnosis of ossifying soft tissue neoplasms histopathologically. Mature bony trabeculae with prominent osteoblastic rimming in a soft tissue lesion are due to a metaplastic process and should not be confused with osteosarcoma. PMID:24433545

A mummified duck-billed dinosaur with a soft-tissue cock's comb.

PubMed

Bell, Phil R; Fanti, Federico; Currie, Philip J; Arbour, Victoria M

2014-01-06

Among living vertebrates, soft tissues are responsible for labile appendages (combs, wattles, proboscides) that are critical for activities ranging from locomotion to sexual display [1]. However, soft tissues rarely fossilize, and such soft-tissue appendages are unknown for many extinct taxa, including dinosaurs. Here we report a remarkable "mummified" specimen of the hadrosaurid dinosaur Edmontosaurus regalis from the latest Cretaceous Wapiti Formation, Alberta, Canada, that preserves a three-dimensional cranial crest (or "comb") composed entirely of soft tissue. Previously, crest function has centered on the hypertrophied nasal passages of lambeosaurine hadrosaurids, which acted as resonance chambers during vocalization [2-4]. The fleshy comb in Edmontosaurus necessitates an alternative explanation most likely related to either social signaling or sexual selection [5-7]. This discovery provides the first view of bizarre, soft-tissue signaling structures in a dinosaur and provides additional evidence for social behavior. Crest evolution within Hadrosaurinae apparently culminated in the secondary loss of the bony crest at the terminal Cretaceous; however, the new specimen indicates that cranial ornamentation was in fact not lost but substituted in Edmontosaurus by a fleshy display structure. It also implies that visual display played a key role in the evolution of hadrosaurine crests and raises the possibility of similar soft-tissue structures among other dinosaurs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

PubMed

Naemi, R; Chatzistergos, P; Suresh, S; Sundar, L; Chockalingam, N; Ramachandran, A

2017-04-01

To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed. Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ 2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence. The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Tissue preparation for immunocytochemistry.

PubMed Central

Williams, J H; Mepham, B L; Wright, D H

1997-01-01

AIMS: To investigate the effect of tissue preparation on immunostaining and to establish whether there is a standard tissue preparation schedule that allows optimal demonstration of all antigens. METHODS: Blocks of tonsil were subjected to variations to a standard fixation, processing, and section preparation schedule. The sections were stained with five antibodies-L26 (CD20), UCHL1 (CD45RO), CD3, vimentin, and anti-kappa light chain--using the streptavidinbiotin immunostaining technique. When further investigation was necessary, other tissues and antibodies were used and where weak immunostaining was obtained the use of microwave pretreatment to improve staining was tested. RESULTS: Several factors involved in fixation were found to affect immunoreactivity. These included the duration, pH, and type of fixative used. In tissue processing only temperature and the duration of the dehydration and wax infiltration steps affected immunoreactivity. Of all the factors investigated, the temperature and duration of the section drying had the greatest effect. In contrast, long term storage of cut sections before immunostaining had no effect on the reactivity of the antibodies tested. Antibodies were found to be affected by alterations to tissue preparation by varying degrees, UCHL1 and vimentin being the most susceptible to changes in fixation and L26 to changes in processing. Where weak staining occurred, microwave pretreatment was generally found to eliminate the problem. CONCLUSIONS: There is no standard tissue preparation schedule for the optimal demonstration of all antigens. Factors involved in all aspects of tissue preparation can affect immunoreactivity, so it is important that precise details of the preparation schedule are given when reporting immunocytochemical studies, rather than using the general term "routinely fixed and processed". Images PMID:9215127

The study on facial soft tissue thickness using Han population in Xinjiang.

PubMed

Wang, Jierui; Zhao, Xi; Mi, Congbo; Raza, Iqbal

2016-09-01

Facial profile is an important aspect in physical anthropology, forensic science, and cosmetic research. Thus, facial soft tissue measurement technology plays a significant role in facial restoration. A considerable amount of work has investigated facial soft tissue thickness, which significantly varies according to gender, age, and race. However, only few studies have considered the nutritional status of the investigated individuals. Moreover, no sufficient research among Chinese ethnic groups, particularly Xinjiang population in China, is currently available. Hence, the current study investigated the adaptability of facial soft tissue to the underlying hard tissue among young adults of Han population in Xinjiang, China; the analysis was performed on the basis of gender, skeletal class, and body mass index (BMI). Measurements were obtained from the lateral cephalometric radiographs of 256 adults aged 18-26 years old. Differences in soft tissue thickness were observed between genders and among skeletal classes. With regard to gender, significant differences in soft tissue thickness were found at rhinion, glabella, subnasale, stomion, labrale superius, pogonion, and gnathion among different BMI groups. Thus, nutritional status should be considered when reconstructing an individual's facial profile. Results showed that the thinnest and thickest craniofacial soft tissues existed in rhinion and lip regions, respectively. Overall, this research provides valuable data for forensic facial reconstruction and identification of young adults in Xinjiang, China. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures

PubMed Central

Neogi, Devdatta Suhas; Trikha, Vivek; Mishra, Kaushal Kant; Bandekar, Shivanand M.; Yadav, Chandra Shekhar

2015-01-01

Background: Bicondylar tibial plateau fractures are complex injuries and treatment is challenging. Ideal method is still controversial with risk of unsatisfactory results if not treated properly. Many different techniques of internal and external fixation are used. This study compares the clinical results in single locked plating versus dual plating (DP) using two incision approaches. Our hypothesis was that DP leads to less collapse and change in alignment at final followup compared with single plating. Materials and Methods: 61 cases of Type C tibial plateau fractures operated between January 2007 and June 2011 were included in this prospective study. All cases were operated either by single lateral locked plate by anterolateral approach or double plating through double incision. All cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 10.0 to analyze the data. Results: Twenty nine patients in a single lateral locked plate and 32 patients in a double plating group were followed for minimum 2 years. All fractures healed, however there was a significant incidence of malalignment in the single lateral plating group. Though there was a significant increase in soft tissue issues with the double plating group; however, there was only 3.12% incidence of deep infection. There was no significant difference in Hospital for special surgery score at 2 years followup. Conclusion: Double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate. PMID:26015609

What is the hardware removal rate after anteroinferior plating of the clavicle? A retrospective cohort study.

PubMed

Baltes, Thomas P A; Donders, Johanna C E; Kloen, Peter

2017-10-01

Plate position in the operative treatment of displaced midshaft clavicle fractures or nonunions is most often on the superior side. However, superior clavicular plating often results in complaints of plate prominence and local soft tissue irritation, necessitating hardware removal. We have used anteroinferior placement of the plate in the hope of increasing biomechanical stability and fixation and also of lowering complaints of plate prominence and soft tissue irritation. In this report, we set out to study the percentage of hardware removal in our group of patients treated with anteroinferior plating of the clavicle after long-term follow-up. In this retrospective review, we evaluated all patients who were surgically treated with anteroinferior plating for midshaft clavicle fracture, delayed union, or nonunion by the senior author between February 2003 and July 2015. Patients required a minimum age of 16 years at time of surgery and a follow-up of >12 months. Patients with malunion, plating on the superior aspect, or double plating were excluded. The medical records of 53 patients (54 fractures) were reviewed after a mean follow-up duration of 6.4 years (range, 1.1-13.1). The mean age at follow-up was 47.8 years (range, 20.4-80.7). All fractures and nonunions healed. In only 3 cases (5.6%), hardware removal was requested by the patient because of plate prominence. Anteroinferior plating of midshaft clavicle fractures, delayed unions, and nonunions resulted in low hardware removal rates in our cohort. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Advanced Hemophilic Arthropathy: Sensitivity of Soft Tissue Discrimination With Musculoskeletal Ultrasound.

PubMed

von Drygalski, Annette; Moore, Randy E; Nguyen, Sonha; Barnes, Richard F W; Volland, Lena M; Hughes, Tudor H; Du, Jiang; Chang, Eric Y

2018-01-24

Point-of-care musculoskeletal ultrasound (US) is increasingly used by hemophilia providers to guide management; however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which point-of-care musculoskeletal US can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. Thirty-six adult patients with hemophilia A/B were prospectively enrolled. Point-of-care musculoskeletal US examinations were performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a musculoskeletal US-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within 3 days, magnetic resonance imaging was performed using conventional and multiecho ultrashort echo time sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. There was perfect agreement between the modalities on the presence of abnormal soft tissue (34 of 36 cases). However, musculoskeletal US was unable to discriminate between coagulated blood, synovium, intrasynovial or extrasynovial fat tissue, or hemosiderin deposits because of wide variations in echogenicity. Musculoskeletal US is valuable for point-of-care imaging to determine the presence of soft tissue accumulation in discrete areas. However, because of limitations of musculoskeletal US in discriminating the nature of pathologic soft tissues and detecting hemosiderin, magnetic resonance imaging will be required if such discrimination is clinically important. © 2018 by the American Institute of Ultrasound in Medicine.

Imaging mammalian cells with soft x rays: The importance of specimen preparation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, J.T.; Meyer-Ilse, W.

1997-04-01

Studies of mammalian cell structure and spatial organization are a very prominent part of modern cell biology. The interest in them as well as their size make them very accommodating subject specimens for imaging with soft x-rays using the XM-1 transmission microscope built and operated by The Center for X-ray Optics on Beam Line 6.1 at the Advanced Light Source. The purpose of these experiments was to determine if the fixative protocols normally used in electron or visible light microscopy were adequate to allow imaging cells, either fibroblasts or neurons, with minimal visible radiation damage due to imaging with softmore » x-rays at 2.4 nm. Two cell types were selected. Fibroblasts are easily cultured but fragile cells which are commonly used as models for the detailed study of cell physiology. Neurons are complex and sensitive cells which are difficult to prepare and to culture for study in isolation from their connections with surrounding cells. These cell types pose problems in their preparation for any microscopy. To improve the contrast and to prevent postmortem alteration of the chemistry and hence the structure of cells extracted from culture or from living organisms, fixation and staining techniques are employed in electron and visible light microscopy. It has been accepted by biologists for years that these treatments create artifacts and false structure. The authors have begun to develop protocols for specimens of each of these two cell types for soft x-ray microscopy which will preserve them in as near normal state as possible using minimal fixation, and make it possible to image them in either a hydrated or dried state free of secondary addition of stains or other labels.« less

Soft tissue grafting to improve implant esthetics

PubMed Central

Kassab, Moawia M

2010-01-01

Dental implants are becoming the treatment of choice to replace missing teeth, especially if the adjacent teeth are free of restorations. When minimal bone width is present, implant placement becomes a challenge and often resulting in recession and dehiscence around the implant that leads to subsequent gingival recession. To correct such defect, the author turned to soft tissue autografting and allografting to correct a buccal dehiscence around tooth #24 after a malpositioned implant placed by a different surgeon. A 25-year-old woman presented with the chief complaint of gingival recession and exposure of implant threads around tooth #24. The patient received three soft tissue grafting procedures to augment the gingival tissue. The first surgery included a connective tissue graft to increase the width of the keratinized gingival tissue. The second surgery included the use of autografting (connective tissue graft) to coronally position the soft tissue and achieve implant coverage. The third and final surgery included the use of allografting material Alloderm to increase and mask the implant from showing through the gingiva. Healing period was uneventful for the patient. After three surgical procedures, it appears that soft tissue grafting has increased the width and height of the gingiva surrounding the implant. The accomplished thickness of gingival tissue appeared to mask the showing of implant threads through the gingival tissue and allowed for achieving the desired esthetic that the patient desired. The aim of the study is to present a clinical case with soft tissue grafting procedures. PMID:23662087

Application of 4-META/MMA-TBB resin for fixation of membrane to tooth in guided tissue regeneration in dog.

PubMed

Tomita, Sachiyo; Yamamoto, Shigeki; Shibukawa, Yoshihiro; Kaneko, Tadashi; Miyakoshi, Shoichi; Shimono, Masaki; Yamada, Satoru

2010-11-01

The aim of this study was to evaluate 4-META/MMA-TBB resin as an alternative to sling sutures for fixation of membrane to tooth in GTR in terms of its effect on tissue regeneration. Dehiscence periodontal defects were created in 6 dogs which were divided at random into two groups, 3 dogs in each group: an experimental group, in which non-absorbable or absorbable membrane was fixed to the teeth with 4-META/MMA-TBB resin; and a control group, in which sling sutures were applied to fix the two types of membrane. Histologic and histometric evaluation was carried out at 8 weeks post-operatively to determine healing response in each group. Both methods of achieving membrane fixation to tooth were effective in inhibiting epithelial migration and encouraging formation of regenerated periodontal tissues around the root surfaces. These results suggest that 4-META/MMA-TBB resin is as effective as sling sutures in achieving membrane fixation in GTR and is, moreover, easier to apply.

Optimization and real-time control for laser treatment of heterogeneous soft tissues.

PubMed

Feng, Yusheng; Fuentes, David; Hawkins, Andrea; Bass, Jon M; Rylander, Marissa Nichole

2009-01-01

Predicting the outcome of thermotherapies in cancer treatment requires an accurate characterization of the bioheat transfer processes in soft tissues. Due to the biological and structural complexity of tumor (soft tissue) composition and vasculature, it is often very difficult to obtain reliable tissue properties that is one of the key factors for the accurate treatment outcome prediction. Efficient algorithms employing in vivo thermal measurements to determine heterogeneous thermal tissues properties in conjunction with a detailed sensitivity analysis can produce essential information for model development and optimal control. The goals of this paper are to present a general formulation of the bioheat transfer equation for heterogeneous soft tissues, review models and algorithms developed for cell damage, heat shock proteins, and soft tissues with nanoparticle inclusion, and demonstrate an overall computational strategy for developing a laser treatment framework with the ability to perform real-time robust calibrations and optimal control. This computational strategy can be applied to other thermotherapies using the heat source such as radio frequency or high intensity focused ultrasound.

Improving Bone Formation in a Rat Femur Segmental Defect by Controlling Bone Morphogenetic Protein-2 Release

DTIC Science & Technology

2011-04-01

tissue and polymer: mineralized tissue stained dark green, osteoid and collagen bright red, soft tissue pink to light green, and erythrocytes bright...of bone, soft tissue , and polymer, high-resolution digital images were acquired at 1.25 · or 20 · . The area of interest comprising the bone defect...bone, soft tissue , and polymer (when present) within the defect were quantified using Metamorph software (Molecular Devices, Inc.) and were calculated

Tibial lengthening over intramedullary nails

PubMed Central

Burghardt, R. D.; Manzotti, A.; Bhave, A.; Paley, D.

2016-01-01

Objectives The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method. Methods In this matched case study, 16 adult patients underwent 19 tibial lengthening over nails (LON) procedures. For the matched case group, 17 patients who underwent 19 Ilizarov tibial lengthenings were retrospectively matched to the LON group. Results The mean external fixation time for the LON group was 2.6 months and for the matched case group was 7.6 months. The mean lengthening amounts for the LON and the matched case groups were 5.2 cm and 4.9 cm, respectively. The radiographic consolidation time in the LON group was 6.6 months and in the matched case group 7.6 months. Using a clinical and radiographic outcome score that was designed for this study, the outcome was determined to be excellent in 17 and good in two patients for the LON group. The outcome was excellent in 14 and good in five patients in the matched case group. The LON group had increased blood loss and increased cost. The LON group had four deep infections; the matched case group did not have any deep infections. Conclusions The outcomes in the LON group were comparable with the outcomes in the matched case group. The LON group had a shorter external fixation time but experienced increased blood loss, increased cost, and four cases of deep infection. The advantage of reducing external fixation treatment time may outweigh these disadvantages in patients who have a healthy soft-tissue envelope. Cite this article: J. E. Herzenberg. Tibial lengthening over intramedullary nails: A matched case comparison with Ilizarov tibial lengthening. Bone Joint Res 2016;5:1–10. doi: 10.1302/2046-3758.51.2000577 PMID:26764351

Treatment of segmental tibial fractures with supercutaneous plating.

PubMed

He, Xianfeng; Zhang, Jingwei; Li, Ming; Yu, Yihui; Zhu, Limei

2014-08-01

Segmental tibial fractures usually follow a high-energy trauma and are often associated with many complications. The purpose of this report is to describe the authors' results in the treatment of segmental tibial fractures with supercutaneous locking plates used as external fixators. Between January 2009 and March 2012, a total of 20 patients underwent external plating (supercutaneous plating) of the segmental tibial fractures using a less-invasive stabilization system locking plate (Synthes, Paoli, Pennsylvania). Six fractures were closed and 14 were open (6 grade IIIa, 2 grade IIIb, 4 grade II, and 2 grade I, according to the Gustilo classification). When imaging studies confirmed bone union, the plates and screws were removed in the outpatient clinic. Average time of follow-up was 23 months (range, 12-47 months). All fractures achieved union. Median time to union was 19 weeks (range, 12-40 weeks) for the proximal fractures and 22 weeks (range, 12-42 weeks) for the distal fractures. Functional results were excellent in 17 patients and good in 3. Delayed union of the fracture occurred in 2 patients. All patients' radiographs showed normal alignment. No rotational deformities and leg shortening were seen. No incidences of deep infection or implant failures occurred. Minor screw tract infection occurred in 2 patients. A new 1-stage protocol using supercutaneous plating as a definitive fixator for segmental tibial fractures is less invasive, has a lower cost, and has a shorter hospitalization time. Surgeons can achieve good reduction, soft tissue reconstruction, stable fixation, and high union rates using supercutaneous plating. The current patients obtained excellent knee and ankle joint motion and good functional outcomes and had a comfortable clinical course. Copyright 2014, SLACK Incorporated.

ACL graft constructs: In-vitro fatigue testing highlights the occurrence of irrecoverable lengthening and the need for adequate (pre)conditioning to avert the recurrence of knee instability.

PubMed

Blythe, A; Tasker, T; Zioupos, P

2006-01-01

The performance of ACL grafts in both the short and long term is only as good as the condition of the graft at the time of surgery. If the graft lengthens under load at the two fixation ends incorporation will take longer to occur. Previous studies have shown that the various grafts currently used are strong enough. However, data on strength came primarily from quasistatic single pull to failure tests with, in some cases, modest cycling to precondition the grafts. The present study examined the in-vitro biomechanical behaviour of model ACL grafts, which have been fatigue cycled to failure over a wide range of loads in physiological ambient conditions. Load/deformation curves and the stretch of the grafts was continuously recorded until final rupture. The grafts demonstrated typical creep-rupture like behaviour with elongation (non-recoverable stretch) and loss of stiffness leading to gradual failure. Some of the graft designs were consistently shown to elongate up to 20 mm in length within the first 2000 cycles at moderate physiological loads and a further 10 mm of elongation occurred between the initial preconditioned state and just prior to complete rupture. Not enough attention has been paid previously to the likely long term elongation patterns of ACL grafts post-surgery and even after the usual empirical preconditioning has been performed by the surgeon. Increased graft dimensions may result in recurrent knee instability and may also lead to failure of the graft to incorporate. Preconditioning in-vitro may still be a way to remove some slack and prepare the graft for its operational environment by stiffening in particular the tissue/fixation interface for those grafts that use soft polymer fixation ends.

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

PubMed

Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

2017-12-01

Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

Influence of Abutment Color and Mucosal Thickness on Soft Tissue Color.

PubMed

Ferrari, Marco; Carrabba, Michele; Vichi, Alessandro; Goracci, Cecilia; Cagidiaco, Maria Crysanti

Zirconia (ZrO₂) and titanium nitride (TiN) implant abutments were introduced mainly for esthetic purposes, as titanium's gray color can be visible through mucosal tissues. This study was aimed at assessing whether ZrO₂ and TiN abutments could achieve better esthetics in comparison with titanium (Ti) abutments, regarding the appearance of soft tissues. Ninety patients were included in the study. Each patient was provided with an implant (OsseoSpeed, Dentsply Implant System). A two-stage surgical technique was performed. Six months later, surgical reentry was performed. After 1 week, provisional restorations were screwed onto the implants. After 8 weeks, implant-level impressions were taken and soft tissue thickness was recorded, ranking thin (≤ 2 mm) or thick (≥ 2 mm). Patients were randomly allocated to three experimental groups, based on abutment type: (1) Ti, (2) TiN, and (3) ZrO₂. After 15 weeks, the final restorations were delivered. The mucosal area referring to each abutment was measured for color using a clinical spectrophotometer (Easyshade, VITA); color measurements of the contralateral areas referring to natural teeth were performed at the same time. The data were collected using the Commission Internationale de l'Eclairage (CIE) L*a*b* color system, and ΔE was calculated between peri-implant and contralateral soft tissues. A critical threshold of ΔE = 3.7 was selected. The chi-square test was used to identify statistically significant differences in ΔE between thin and thick mucosal tissues and among the abutment types. Three patients were lost at follow-up. No statistically significant differences were noticed as to the abutment type (P = .966). Statistically significant differences in ΔE were recorded between thick and thin peri-implant soft tissues (P < .001). Only 2 out of 64 patients with thick soft tissues showed a ΔE higher than 3.7: 1 in the TiN group and 1 in the ZrO₂ group. All the patients with thin soft tissues reported color changes that exceeded the critical threshold. The different abutment materials showed comparable results in terms of influence on soft tissue color. Regarding peri-implant soft tissue thickness, the influence of the tested abutments on soft tissue color became clinically relevant for values ≤ 2 mm.

Influence of Microbial Biofilms on the Preservation of Primary Soft Tissue in Fossil and Extant Archosaurs

PubMed Central

Peterson, Joseph E.; Lenczewski, Melissa E.; Scherer, Reed P.

2010-01-01

Background Mineralized and permineralized bone is the most common form of fossilization in the vertebrate record. Preservation of gross soft tissues is extremely rare, but recent studies have suggested that primary soft tissues and biomolecules are more commonly preserved within preserved bones than had been presumed. Some of these claims have been challenged, with presentation of evidence suggesting that some of the structures are microbial artifacts, not primary soft tissues. The identification of biomolecules in fossil vertebrate extracts from a specimen of Brachylophosaurus canadensis has shown the interpretation of preserved organic remains as microbial biofilm to be highly unlikely. These discussions also propose a variety of potential mechanisms that would permit the preservation of soft-tissues in vertebrate fossils over geologic time. Methodology/Principal Findings This study experimentally examines the role of microbial biofilms in soft-tissue preservation in vertebrate fossils by quantitatively establishing the growth and morphology of biofilms on extant archosaur bone. These results are microscopically and morphologically compared with soft-tissue extracts from vertebrate fossils from the Hell Creek Formation of southeastern Montana (Latest Maastrichtian) in order to investigate the potential role of microbial biofilms on the preservation of fossil bone and bound organic matter in a variety of taphonomic settings. Based on these analyses, we highlight a mechanism whereby this bound organic matter may be preserved. Conclusions/Significance Results of the study indicate that the crystallization of microbial biofilms on decomposing organic matter within vertebrate bone in early taphonomic stages may contribute to the preservation of primary soft tissues deeper in the bone structure. PMID:20967227

Influence of microbial biofilms on the preservation of primary soft tissue in fossil and extant archosaurs.

PubMed

Peterson, Joseph E; Lenczewski, Melissa E; Scherer, Reed P

2010-10-12

Mineralized and permineralized bone is the most common form of fossilization in the vertebrate record. Preservation of gross soft tissues is extremely rare, but recent studies have suggested that primary soft tissues and biomolecules are more commonly preserved within preserved bones than had been presumed. Some of these claims have been challenged, with presentation of evidence suggesting that some of the structures are microbial artifacts, not primary soft tissues. The identification of biomolecules in fossil vertebrate extracts from a specimen of Brachylophosaurus canadensis has shown the interpretation of preserved organic remains as microbial biofilm to be highly unlikely. These discussions also propose a variety of potential mechanisms that would permit the preservation of soft-tissues in vertebrate fossils over geologic time. This study experimentally examines the role of microbial biofilms in soft-tissue preservation in vertebrate fossils by quantitatively establishing the growth and morphology of biofilms on extant archosaur bone. These results are microscopically and morphologically compared with soft-tissue extracts from vertebrate fossils from the Hell Creek Formation of southeastern Montana (Latest Maastrichtian) in order to investigate the potential role of microbial biofilms on the preservation of fossil bone and bound organic matter in a variety of taphonomic settings. Based on these analyses, we highlight a mechanism whereby this bound organic matter may be preserved. Results of the study indicate that the crystallization of microbial biofilms on decomposing organic matter within vertebrate bone in early taphonomic stages may contribute to the preservation of primary soft tissues deeper in the bone structure.

Hindfoot containment orthosis for management of bone and soft-tissue defects of the heel.

PubMed

Johnson, Jeffrey E; Rudzki, Jonas R; Janisse, Erick; Janisse, Dennis J; Valdez, Ray R; Hanel, Douglas P; Gould, John S

2005-03-01

Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.

Peri-implant soft tissue colour around titanium and zirconia abutments: a prospective randomized controlled clinical study.

PubMed

Cosgarea, Raluca; Gasparik, Cristina; Dudea, Diana; Culic, Bogdan; Dannewitz, Bettina; Sculean, Anton

2015-05-01

To objectively determine the difference in colour between the peri-implant soft tissue at titanium and zirconia abutments. Eleven patients, each with two contralaterally inserted osteointegrated dental implants, were included in this study. The implants were restored either with titanium abutments and porcelain-fused-to-metal crowns, or with zirconia abutments and ceramic crowns. Prior and after crown cementation, multi-spectral images of the peri-implant soft tissues and the gingiva of the neighbouring teeth were taken with a colorimeter. The colour parameters L*, a*, b*, c* and the colour differences ΔE were calculated. Descriptive statistics, including non-parametric tests and correlation coefficients, were used for statistical analyses of the data. Compared to the gingiva of the neighbouring teeth, the peri-implant soft tissue around titanium and zirconia (test group), showed distinguishable ΔE both before and after crown cementation. Colour differences around titanium were statistically significant different (P = 0.01) only at 1 mm prior to crown cementation compared to zirconia. Compared to the gingiva of the neighbouring teeth, statistically significant (P < 0.01) differences were found for all colour parameter, either before or after crown cementation for both abutments; more significant differences were registered for titanium abutments. Tissue thickness correlated positively with c*-values for titanium at 1 mm and 2 mm from the gingival margin. Within their limits, the present data indicate that: (i) The peri-implant soft tissue around titanium and zirconia showed colour differences when compared to the soft tissue around natural teeth, and (ii) the peri-implant soft tissue around zirconia demonstrated a better colour match to the soft tissue at natural teeth than titanium. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Sorafenib in Treating Patients With Metastatic, Locally Advanced, or Recurrent Sarcoma

ClinicalTrials.gov

2014-05-07

Adult Angiosarcoma; Adult Epithelioid Sarcoma; Adult Leiomyosarcoma; Adult Malignant Fibrous Histiocytoma; Adult Neurofibrosarcoma; Adult Synovial Sarcoma; Ovarian Sarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Uterine Sarcoma; Stage III Adult Soft Tissue Sarcoma; Stage III Uterine Sarcoma; Stage IV Adult Soft Tissue Sarcoma; Stage IV Uterine Sarcoma; Uterine Carcinosarcoma; Uterine Leiomyosarcoma

Isolated Limb Perfusion With Melphalan in Treating Patients With Stage IIIB-IV Melanoma or Sarcoma

ClinicalTrials.gov

2015-07-22

Basal Cell Carcinoma of the Skin; Eccrine Carcinoma of the Skin; Recurrent Adult Soft Tissue Sarcoma; Recurrent Melanoma; Recurrent Skin Cancer; Squamous Cell Carcinoma of the Skin; Stage III Adult Soft Tissue Sarcoma; Stage IIIB Melanoma; Stage IIIC Melanoma; Stage IV Adult Soft Tissue Sarcoma; Stage IV Melanoma

The use of time-of-flight camera for navigating robots in computer-aided surgery: monitoring the soft tissue envelope of minimally invasive hip approach in a cadaver study.

PubMed

Putzer, David; Klug, Sebastian; Moctezuma, Jose Luis; Nogler, Michael

2014-12-01

Time-of-flight (TOF) cameras can guide surgical robots or provide soft tissue information for augmented reality in the medical field. In this study, a method to automatically track the soft tissue envelope of a minimally invasive hip approach in a cadaver study is described. An algorithm for the TOF camera was developed and 30 measurements on 8 surgical situs (direct anterior approach) were carried out. The results were compared to a manual measurement of the soft tissue envelope. The TOF camera showed an overall recognition rate of the soft tissue envelope of 75%. On comparing the results from the algorithm with the manual measurements, a significant difference was found (P > .005). In this preliminary study, we have presented a method for automatically recognizing the soft tissue envelope of the surgical field in a real-time application. Further improvements could result in a robotic navigation device for minimally invasive hip surgery. © The Author(s) 2014.

Options to avoid the second surgical site: a review of literature.

PubMed

Ramachandra, Srinivas Sulugodu; Rana, Ritu; Reetika, Singhal; Jithendra, K D

2014-09-01

As esthetics gain importance, periodontal plastic surgical procedures involving soft tissue grafts are becoming commoner both around natural teeth as well as around implants. Periodontal soft tissue grafts are primarily used for the purpose of root coverage and in pre-prosthetic surgery to thicken a gingival site or to improve the crestal volume. Soft tissue grafts are usually harvested from the palate. Periodontal plastic surgical procedures involving soft tissue grafts harvested from the palate have two surgical sites; a recipient site and another donor site. Many patients are apprehensive about the soft tissue graft procedures, especially the creation of the second/donor surgical site in the palate. In the past decade, newer techniques and products have emerged which provide an option for the periodontist/patient to avoid the second surgical site. MucoMatrixX, Alloderm(®), Platelet rich fibrin, Puros(®) Dermis and Mucograft(®) are the various options available to the practicing periodontist to avoid the second surgical site. Use of these soft tissue allografts in an apprehensive patient would decrease patient morbidity and increase patient's acceptance towards periodontal plastic surgical procedures.

[Research on adaptive quasi-linear viscoelastic model for nonlinear viscoelastic properties of in vivo soft tissues].

PubMed

Wang, Heng; Sang, Yuanjun

2017-10-01

The mechanical behavior modeling of human soft biological tissues is a key issue for a large number of medical applications, such as surgery simulation, surgery planning, diagnosis, etc. To develop a biomechanical model of human soft tissues under large deformation for surgery simulation, the adaptive quasi-linear viscoelastic (AQLV) model was proposed and applied in human forearm soft tissues by indentation tests. An incremental ramp-and-hold test was carried out to calibrate the model parameters. To verify the predictive ability of the AQLV model, the incremental ramp-and-hold test, a single large amplitude ramp-and-hold test and a sinusoidal cyclic test at large strain amplitude were adopted in this study. Results showed that the AQLV model could predict the test results under the three kinds of load conditions. It is concluded that the AQLV model is feasible to describe the nonlinear viscoelastic properties of in vivo soft tissues under large deformation. It is promising that this model can be selected as one of the soft tissues models in the software design for surgery simulation or diagnosis.

Hard tissue pediatric facial trauma: a review.

PubMed

Hogg, Nicholas J V; Horswell, Bruce B

2006-01-01

Although hard tissue injuries are uncommon in the pediatric patient, dentists may be involved in the initial assessment of these patients. In this paper, we review fractures of the facial skeleton with a focus on dentoalveolar injuries. Minimally displaced fractures in pediatric patients can be managed conservatively, while displaced fractures may require open approaches and rigid fixation. New fixation stratagems are presented, and possible facial growth disturbances resulting from trauma are discussed.

Histology without formalin?

PubMed

Buesa, René J

2008-12-01

Because formalin is toxic, carcinogenic, and a poor preserver of nucleic acids, for more than 20 years, there have been numerous attempts to find a substitute, with as many different alternative fixatives, none totally successful. With a fast penetration, formaldehyde is a slow and reversible fixative that requires 24 to 48 hours to completely bind to tissue; thus, any surgical specimen arriving to the laboratory between 8 AM and 4 PM and processed conventionally for the slides to be ready the following day will be only between 30% and 66% bound and even less fixed when the dehydration starts, resulting in an additional and also incomplete alcoholic fixation. This causes infiltration problems and can affect subsequent tests, especially immunohistochemistry. Formaldehyde fixation is tissue thickness independent between 16 microm and 4 mm but is faster at above room temperature, so the fixation of specimens with less than 24 hours in formalin can be improved if the fixing stations in the conventional tissue processors are set at 40 degrees C. If the safety measures are improved to offer a work environment with a time weighted average level of 0.4 ppm, and the contact with formalin is reduced to a minimum by discouraging its neutralization and limiting the recycling practice to filtering methods, formalin could remain as the routine fixative, with modified methacarn for those specimens requiring nucleic acids studies. This is a preferred solution than having to validate all the standard and special procedures, including those US Food and Drug Administration approved, if formalin is replaced by another fixative without its advantages. To the question posed in the title of this article, the answer is "Yes, it can be done, but that is neither likely nor worth it!"

Magnetic Field Apparatus (MFA) Hardware Test

NASA Technical Reports Server (NTRS)

Anderson, Ken; Boody, April; Reed, Dave; Wang, Chung; Stuckey, Bob; Cox, Dave

1999-01-01

The objectives of this study are threefold: (1) Provide insight into water delivery in microgravity and determine optimal germination paper wetting for subsequent seed germination in microgravity; (2) Observe the behavior of water exposed to a strong localized magnetic field in microgravity; and (3) Simulate the flow of fixative (using water) through the hardware. The Magnetic Field Apparatus (MFA) is a new piece of hardware slated to fly on the Space Shuttle in early 2001. MFA is designed to expose plant tissue to magnets in a microgravity environment, deliver water to the plant tissue, record photographic images of plant tissue, and deliver fixative to the plant tissue.

Early fixation of cobalt-chromium based alloy surgical implants to bone using a tissue-engineering approach.

PubMed

Ogawa, Munehiro; Tohma, Yasuaki; Ohgushi, Hajime; Takakura, Yoshinori; Tanaka, Yasuhito

2012-01-01

To establish the methods of demonstrating early fixation of metal implants to bone, one side of a Cobalt-Chromium (CoCr) based alloy implant surface was seeded with rabbit marrow mesenchymal cells and the other side was left unseeded. The mesenchymal cells were further cultured in the presence of ascorbic acid, β-glycerophosphate and dexamethasone, resulting in the appearance of osteoblasts and bone matrix on the implant surface. Thus, we succeeded in generating tissue-engineered bone on one side of the CoCr implant. The CoCr implants were then implanted in rabbit bone defects. Three weeks after the implantation, evaluations of mechanical test, undecalcified histological section and electron microscope analysis were performed. Histological and electron microscope images of the tissue engineered surface exhibited abundant new bone formation. However, newly formed bone tissue was difficult to detect on the side without cell seeding. In the mechanical test, the mean values of pull-out forces were 77.15 N and 44.94 N for the tissue-engineered and non-cell-seeded surfaces, respectively. These findings indicate early bone fixation of the tissue-engineered CoCr surface just three weeks after implantation.

Early Fixation of Cobalt-Chromium Based Alloy Surgical Implants to Bone Using a Tissue-engineering Approach

PubMed Central

Ogawa, Munehiro; Tohma, Yasuaki; Ohgushi, Hajime; Takakura, Yoshinori; Tanaka, Yasuhito

2012-01-01

To establish the methods of demonstrating early fixation of metal implants to bone, one side of a Cobalt-Chromium (CoCr) based alloy implant surface was seeded with rabbit marrow mesenchymal cells and the other side was left unseeded. The mesenchymal cells were further cultured in the presence of ascorbic acid, β-glycerophosphate and dexamethasone, resulting in the appearance of osteoblasts and bone matrix on the implant surface. Thus, we succeeded in generating tissue-engineered bone on one side of the CoCr implant. The CoCr implants were then implanted in rabbit bone defects. Three weeks after the implantation, evaluations of mechanical test, undecalcified histological section and electron microscope analysis were performed. Histological and electron microscope images of the tissue engineered surface exhibited abundant new bone formation. However, newly formed bone tissue was difficult to detect on the side without cell seeding. In the mechanical test, the mean values of pull-out forces were 77.15 N and 44.94 N for the tissue-engineered and non-cell-seeded surfaces, respectively. These findings indicate early bone fixation of the tissue-engineered CoCr surface just three weeks after implantation. PMID:22754313

Biomechanical properties of the forefoot plantar soft tissue as measured by an optical coherence tomography-based air-jet indentation system and tissue ultrasound palpation system.

PubMed

Chao, Clare Y L; Zheng, Yong-Ping; Huang, Yan-Ping; Cheing, Gladys L Y

2010-07-01

The forefoot medial plantar area withstand high plantar pressure during locomotion, and is a common site that develops foot lesion problems among elderly people. The aims of the present study were to (1) determine the correlation between the biomechanical properties of forefoot medial plantar soft tissue measured by a newly developed optical coherence tomography-based air-jet indentation system and by tissue ultrasound palpation system, and (2) to compare the biomechanical properties of plantar soft tissues of medial forefoot between a young and old adult group. Thirty healthy subjects were classified as the young or older group. The biomechanical properties of plantar soft tissues measured at the forefoot by the air-jet indentation system and tissue ultrasound palpation system were performed, and the correlation of the findings obtained in the two systems were compared. A strong positive correlation was obtained from the findings in the two systems (r=0.88, P<0.001). The forefoot plantar soft tissue of the older group was significantly stiffer at the second metatarsal head and thinner at both metatarsal heads than that of the young group (all P<0.05). The stiffness coefficient at the second metatarsal head was 28% greater than that at the first metatarsal head in both study groups. Older subjects showed a loss of elasticity and reduced thickness in their forefoot plantar soft tissue, with the second metatarsal head displaying stiffer and thicker plantar tissue than the first metatarsal head. The air-jet indentation system is a useful instrument for characterizing the biomechanical properties of soft tissue. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-centre, triple-blind, split-mouth, randomized, controlled clinical study. Part 2 - evaluation of the interdental soft tissue.

PubMed

Kaya, Y; Yalim, M; Bahçecitapar, M; Baloş, K

2009-07-01

To date, there have been many studies clinically evaluating periodontal regenerative procedures by the help of routinely used hard and soft tissue parameters; however, these parameters are not capable of assessing interdental soft tissue located above the regenerative periodontal surgery area. The purpose of this study was to assess interproximal soft tissue changes following application of (i) particulate form demineralized bone matrix (DBM), (ii) putty form DBM and (ii) open flap debridement (OFD, control), using modified curtain technique in the treatment of interproximal suprabony (horizontal) defects located in anterior maxillary region, as previously reported. Twenty-five chronic periodontitis patients with 125 interproximal surgery sites (radiologically >or=4 mm horizontal bone defect) were also participate in this second stage of the triple-blind, split mouth, randomized, controlled clinical trial. Surgery sites were assessed by (i) plaque index (PI), (ii) gingival index (GI), (iii) the presence of interdental soft tissue clefts or craters and (iv) the loss of interdental papilla height by using papilla presence index (PPI), during the healing period. At the baseline and 3, 6, 9 and 12 months after the operations, these measurements were repeated. In all groups, there is a significant increase in the prevalence of soft tissue cleft and crater formation (P < 0.01), with increase in PI and GI scores at interdental soft tissue defect areas (P < 0.001), 3 months after the operations. There was also an increase in PPI scores after the operations in all treatment groups (P < 0.01). Three procedures affected the interproximal soft tissues similarly. There was no significant difference among groups in terms of all parameters (P > 0.05). Particulate DBM, putty DBM and OFD demostrated similar interproximal soft tissue changes especially increasing interproximal PI and GI scores in 3 months follow-up.

Can the shell of the green-lipped mussel Perna viridis from the west coast of Peninsular Malaysia be a potential biomonitoring material for Cd, Pb and Zn?

NASA Astrophysics Data System (ADS)

Yap, C. K.; Ismail, A.; Tan, S. G.; Abdul Rahim, I.

2003-07-01

The distributions of Cd, Pb and Zn in the total soft tissues and total shells of the green-lipped mussel Perna viridis were studied in field collected samples as well as from laboratory experimental samples. The results showed that Cd, Pb and Zn were readily accumulated in the whole shells. In mussels sampled from 12 locations along the west coast of Peninsular Malaysia, the ratios of the shell metals to the soft tissue metals were different at each sampling site. Nevertheless, the Cd and Pb levels in the shells were always higher than those in the soft tissues, while the Zn level was higher in the soft tissues than in the shells. In comparison with soft tissues, the degrees of variability for Pb and Cd concentrations in the shells were lower. The lower degrees of variability and significant ( P<0.05) correlation coefficients of Cd and Pb within the shells support the use of the mussel shell as a suitable biomonitoring material for the two metals rather than the soft tissue since this indicated that there is more precision (lower CV) in the determination of metal concentrations in the shell than in the soft tissue. Experimental work showed that the pattern of depuration in the shell was not similar to that of the soft tissue although their patterns of accumulation were similar. This indicated that the depuration of heavy metals in the shell was not affected by the physiological conditions of the mussels. Although Zn could be regulated by the soft tissue, the incorporated Cd, Pb and Zn remained in the shell matrices. The present results support the use of the total shell of P. viridis as a potential biomonitoring material for long-term contamination of Cd, Pb and Zn.

Non Lipomatous Benign Lesions Mimicking Soft-tissue Sarcomas: A Pictorial Essay.

PubMed

Coran, Alessandro; Orsatti, Giovanna; Crimì, Filippo; Rastrelli, Marco; DI Maggio, Antonio; Ponzoni, Alberto; Attar, Shady; Stramare, Roberto

2018-01-01

The incidental finding of soft tissue masses is a challenge for the radiologist. Benign and malignant lesions can be differentiated relying on patient history, symptoms and mostly with the help of imaging. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) become fundamental in order to distinguish these lesions but the radiologist needs to know the main characteristics of benign soft tissue masses and sarcomas. Herein, we present a pictorial review of lesions mimicking soft tissue sarcomas features. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews.

PubMed

Jung, Sung-ah; Choi, Yoon Jeong; Lee, Dong-Won; Kim, Kyung-Ho; Chung, Chooryung J

2015-05-01

To investigate the prevalence of distinguishable soft tissue scarring after the removal of temporary anchorage devices (TADs) such as orthodontic miniscrews and to analyze the factors associated with scar formation. The prevalence of soft tissue scarring in 66 patients (202 miniscrew removal sites) was clinically investigated at least 1 year after miniscrew removal. To determine the clinical factors associated with soft tissue scar formation, miniscrew stability; host factors including age, gender, and gingival biotype; and miniscrew-related factors such as insertion site, vertical position, and insertion period were evaluated. The prevalence of a distinguishable scar remaining at least 1 year after miniscrew removal was 44.6%. Patients with flat gingiva showed a significantly higher prevalence of soft tissue scar formation than did those with pronounced scalloped gingiva (P < .05). Maxillary buccal removal sites showed a significantly higher prevalence of soft tissue scar formation than did those in the mandible or palatal slope (P < .05). Miniscrew sites at the alveolar mucosa showed a significantly lower prevalence of soft tissue scar formation than did those in the mucogingival junction or the attached gingiva (P < .01). The prevalence of distinguishable scarring after miniscrew removal was fairly high. On the basis of our results, patients with flat gingiva and buccal interdental gingival insertion sites are more susceptible to scar formation.

Influence of abutment material on peri-implant soft tissues in anterior areas with thin gingival biotype: a multicentric prospective study.

PubMed

Lops, Diego; Stellini, Edoardo; Sbricoli, Luca; Cea, Niccolò; Romeo, Eugenio; Bressan, Eriberto

2017-10-01

The aim of the present clinical trial was to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri-implant soft tissue in patients with thin gingival biotype. Thirty-seven patients received an endosseous dental implant in the anterior maxilla. At time of each definitive prosthesis delivery, an all-ceramic crown has been tried on gold, titanium and zirconia abutment. Peri-implant soft-tissue color has been measured through a spectrophotometer after the insertion of each single abutment. Also facial peri-implant soft-tissue thickness was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a standardized tissue area and to collect the data before the statistical analysis in Lab* color space. ΔE parameters of the selected abutments were tested for correlation with mucosal thickness. Pearson correlation test was used. Only 15 patients met the study inclusion criteria on peri-implant soft-tissue thickness. Peri-implant soft-tissue color was different from that around natural teeth, no matter which type of restorative material was selected. Measurements regarding all the abutments were above the critical threshold of ΔE 8.74 for intraoral color distinction by the naked eye. The ΔE mean values of gold and zirconium abutments were similar (11.43 and 11.37, respectively) and significantly lower (P = 0.03 and P = 0.04, respectively) than the titanium abutment (13.55). In patients with a facial soft-tissue thickness ≤2 mm, the ΔE mean value of gold and zirconia abutments was significantly lower than that of titanium abutments (P = 0.03 and P = 0.04, respectively) and much more close to the reference threshold of 8.74. For peri-implant soft tissue of ≤2 mm, gold or zirconia abutments could be selected in anterior areas treatment. Moreover, the thickness of the peri-implant soft tissue seemed to be a crucial factor in the abutment impact on the color of soft tissues with a thickness of ≤2 mm. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Biological characterization of soft tissue sarcomas.

PubMed

Hayashi, Takuma; Horiuchi, Akiko; Sano, Kenji; Kanai, Yae; Yaegashi, Nobuo; Aburatani, Hiroyuki; Konishi, Ikuo

2015-12-01

Soft tissue sarcomas are neoplastic malignancies that typically arise in tissues of mesenchymal origin. The identification of novel molecular mechanisms leading to mesenchymal transformation and the establishment of new therapies and diagnostic biomarker has been hampered by several critical factors. First, malignant soft tissue sarcomas are rarely observed in the clinic with fewer than 15,000 newly cases diagnosed each year in the United States. Another complicating factor is that soft tissue sarcomas are extremely heterogeneous as they arise in a multitude of tissues from many different cell lineages. The scarcity of clinical materials coupled with its inherent heterogeneity creates a challenging experimental environment for clinicians and scientists. Faced with these challenges, there has been extremely limited advancement in clinical treatment options available to patients as compared to other malignant tumours. In order to glean insight into the pathobiology of soft tissue sarcomas, scientists are now using mouse models whose genomes have been specifically tailored to carry gene deletions, gene amplifications, and somatic mutations commonly observed in human soft tissue sarcomas. The use of these model organisms has been successful in increasing our knowledge and understanding of how alterations in relevant oncogenic and/or tumour suppressive signal cascades, i.e., interferon-γ (IFN-γ), tumour protein 53 (TP53) and/or retinoblastoma (RB) pathway directly impact sarcomagenesis. It is the goal of many in the physiological community that the use of several mouse models will serve as powerful in vivo tools for further understanding of sarcomagenesis and potentially identify new diagnostic biomarker and therapeutic strategies against human soft tissue sarcomas.

Prevalence, Type and Etiology of Dental and Soft Tissue Injuries in Children in Croatia.

PubMed

Škaričić, Josip; Vuletić, Marko; Hrvatin, Sandra; Jeličić, Jesenka; Čuković-Bagić, Ivana; Jurić, Hrvoje

2016-06-01

The prevalence, type and etiology of dental and soft tissue injuries and relationship between the time of arrival and sustaining soft tissue injury were analyzed in this retrospective study conducted at the Department of Pediatric Dentistry, University Dental Clinic in Zagreb, Croatia, during the 2010-2014 period using documentation on 447 patients (264 male and 183 female) aged 1-16 years with injuries of primary and permanent teeth. The highest prevalence of traumatic dental injury (TDI) was found in the 7-12 age group and maxillary central incisors were most frequently affected (80.9%) in both primary and permanent dentitions. Enamel-dentin fracture without pulp exposure (31.9%) was the most common TDI of dental hard tissue in both dentitions, whereas subluxation (27.3%) was the most common periodontal tissue injury type. The most frequent location, cause and seasonal variation of trauma were at home, falling and spring. Soft tissue injuries were observed in 203 (45.4%) patients. Soft tissue injuries were less likely when fewer teeth were traumatized (p<0.001). Comparison of children with and without soft tissue injuries yielded a statistically significant difference in the time to arrival between primary and permanent teeth (p<0.01). Because soft tissue injuries include bleeding and clinical presentation appears more dramatic, the time elapsed between injury and initial treatment was shorter than in non-bleeding injuries, pointing to the need of education focused on parents and school teachers regarding the importance of immediate therapy for both bleeding and non-bleeding TDIs.

Reversing the effects of formalin fixation with citraconic anhydride and heat: a universal antigen retrieval method.

PubMed

Namimatsu, Shigeki; Ghazizadeh, Mohammad; Sugisaki, Yuichi

2005-01-01

Formalin is a commonly used fixative for tissue preservation in pathology laboratories. A major adverse effect of this fixative is the concealing of tissue antigens by protein cross-linking. To achieve a universal antigen retrieval method for immunohistochemistry under a constant condition, we developed a new method in which the effects of formalin fixation were reversed with citraconic anhydride (a reversible protein cross-linking agent) plus heating. Formalin-fixed, paraffin-embedded tissues from various organs were examined for immunohistochemical localization of a wide variety of antigens. Deparaffinized tissue sections were placed in an electric kitchen pot containing 0.05% citraconic anhydride solution, pH 7.4, and the pot was set at "keep warm" temperature mode of 98C for 45 min. This mode allowed heating the sections at a constant temperature. The sections were then washed in buffer solution and immunostained using a labeled streptavidin-biotin method using an automated stainer. In general, formalin-fixed tissues demonstrated specific immunostainings comparable to that in fresh frozen tissues and significantly more enhanced than after conventional antigen retrieval methods. In particular, even difficult-to-detect antigens such as CD4, cyclin D1, granzyme beta, bcl-6, CD25, and lambda chain revealed distinct immunostainings. Different classes of antigens such as cellular markers and receptors, as well as cytoplasmic and nuclear proteins, consistently produced enhanced reactions. This method provides efficient antigen retrieval for successful immunostaining of a wide variety of antigens under an optimized condition. It also allows standardization of immunohistochemistry for formalin-fixed tissues in pathology laboratories, eliminating inter-laboratory discrepancies in results for accurate clinical and research studies.

Estimation of the viscous properties of skin and subcutaneous tissue in uniaxial stress relaxation tests.

PubMed

Wu, John Z; Cutlip, Robert G; Welcome, Daniel; Dong, Ren G

2006-01-01

Knowledge of viscoelastic properties of soft tissues is essential for the finite element modelling of the stress/strain distributions in finger-pad during vibratory loading, which is important in exploring the mechanism of hand-arm vibration syndrome. In conventional procedures, skin and subcutaneous tissue have to be separated for testing the viscoelastic properties. In this study, a novel method has been proposed to simultaneously determine the viscoelastic properties of skin and subcutaneous tissue in uniaxial stress relaxation tests. A mathematical approach has been derived to obtain the creep and relaxation characteristics of skin and subcutaneous tissue using uniaxial stress relaxation data of skin/subcutaneous composite specimens. The micro-structures of collagen fiber networks in the soft tissue, which underline the tissue mechanical characteristics, will be intact in the proposed method. Therefore, the viscoelastic properties of soft tissues obtained using the proposed method would be more physiologically relevant than those obtained using the conventional method. The proposed approach has been utilized to measure the viscoelastic properties of soft tissues of pig. The relaxation curves of pig skin and subcutaneous tissue obtained in the current study agree well with those in literature. Using the proposed approach, reliable material properties of soft tissues can be obtained in a cost- and time-efficient manner, which simultaneously improves the physiological relevance.

Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.

PubMed

Melham, T J; Sevier, T L; Malnofski, M J; Wilson, J K; Helfst, R H

1998-06-01

This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.

Traumatic hallux varus repair utilizing a soft-tissue anchor: a case report.

PubMed

Labovitz, J M; Kaczander, B I

2000-01-01

Hallux varus is usually iatrogenic in nature; however, congenital and acquired etiologies have been described in the literature. The authors present a case of traumatic hallux varus secondary to rupture of the adductor tendon. Surgical correction was performed using a soft tissue anchor for maintenance of the soft tissues utilized for repair.

75 FR 9422 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... repair of soft tissue injuries of the medial meniscus. In repairing and reinforcing medial meniscal... zone of the meniscus to provide sufficient vascularization. The CS reinforces soft tissue and provides a resorbable scaffold that is replaced by the patient's own soft tissue. The CS is not a prosthetic...

Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

PubMed Central

Wussow, Annekatrin

2015-01-01

Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV) and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS), radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS) under number DRKS00007537. PMID:26000309

Pediatric facial fractures: evolving patterns of treatment.

PubMed

Posnick, J C; Wells, M; Pron, G E

1993-08-01

This study reviews the treatment of facial trauma between October 1986 and December 1990 at a major pediatric referral center. The mechanism of injury, location and pattern of facial fractures, pattern of facial injury, soft tissue injuries, and any associated injuries to other organ systems were recorded, and fracture management and perioperative complications reviewed. The study population consisted of 137 patients who sustained 318 facial fractures. Eighty-one patients (171 fractures) were seen in the acute stage, and 56 patients (147 fractures) were seen for reconstruction of a secondary deformity. Injuries in boys were more prevalent than in girls (63% versus 37%), and the 6- to 12-year cohort made up the largest group (42%). Most fractures resulted from traffic-related accidents (50%), falls (23%), or sports-related injuries (15%). Mandibular (34%) and orbital fractures (23%) predominated; fewer midfacial fractures (7%) were sustained than would be expected in a similar adult population. Three quarters of the patients with acute fractures required operative intervention. Closed reduction techniques with maxillomandibular fixation were frequently chosen for mandibular condyle fractures and open reduction techniques (35%) for other regions of the facial skeleton. When open reduction was indicated, plate-and-screw fixation was the preferred method of stabilization (65%). The long-term effects of the injuries and the treatment given on facial growth remain undetermined. Perioperative complication rates directly related to the surgery were low.

Eccentric Exercise Versus Eccentric Exercise and Soft Tissue Treatment (Astym) in the Management of Insertional Achilles Tendinopathy

PubMed Central

McCormack, Joshua R.; Underwood, Frank B.; Slaven, Emily J.; Cappaert, Thomas A.

2016-01-01

Background: Eccentric exercise is commonly used in the management of Achilles tendinopathy (AT) but its effectiveness for insertional AT has been questioned. Soft tissue treatment (Astym) combined with eccentric exercise could result in better outcomes than eccentric exercise alone. Hypothesis: Soft tissue treatment (Astym) plus eccentric exercise will be more effective than eccentric exercise alone for subjects with insertional AT. Study Design: Prospective randomized controlled trial. Level of Evidence: Level 2. Methods: Sixteen subjects were randomly assigned to either a soft tissue treatment (Astym) and eccentric exercise group or an eccentric exercise–only group. Intervention was completed over a 12-week period, with outcomes assessed at baseline, 4, 8, 12, 26, and 52 weeks. Outcomes included the Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A), the numeric pain rating scale (NPRS), and the global rating of change (GROC). Results: Significantly greater improvements on the VISA-A were noted in the soft tissue treatment (Astym) group over the 12-week intervention period, and these differences were maintained at the 26- and 52-week follow-ups. Both groups experienced a similar statistically significant improvement in pain over the short and long term. A significantly greater number of subjects in the soft tissue treatment (Astym) group achieved a successful outcome at 12 weeks. Conclusion: Soft tissue treatment (Astym) plus eccentric exercise was more effective than eccentric exercise only at improving function during both short- and long-term follow-up periods. Clinical Relevance: Soft tissue treatment (Astym) plus eccentric exercise appears to be a beneficial treatment program that clinicians should consider incorporating into the management of their patients with insertional AT. PMID:26893309