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Bone Flaps (bone + flap)
Selected AbstractsOrthostatic Headaches in the Syndrome of the Trephined: Resolution Following CranioplastyHEADACHE, Issue 7 2010Bahram Mokri MD Objective., To draw attention to the syndrome of the trephined as a potential cause for orthostatic headaches without cerebrospinal fluid (CSF) leak. Background., Orthostatic headaches typically result from CSF leaks but sometimes may occur in conditions without any evidence of CSF leakage. Methods., A 37-year-old right-handed woman became comatose after a motor vehicle accident with cerebral contusions and massive left cerebral edema. A large frontoparietal craniectomy was carried out. In 5 months, she made good neurologic recovery. Freeze-preserved bone flap was placed back. In several weeks she was functionally near normal. Two years later, she began to complain of orthostatic headache and gradually additional manifestations appeared including progressive gait unsteadiness, imprecise speech, cognitive difficulties, and an increasing left hemiparesis along with progressive sinking of the skull defect and shift of the midline and ventricular distortion. She underwent removal of resorptive sinking bone flap and construction of an acrylic cranioplasty. Results., At 6-month follow-up, there was complete resolution of the orthostatic headaches, remarkable neurologic improvement along with resolution of midline shift and ventricular distortion. Conclusion., The syndrome of the trephined is yet another cause of orthostatic headaches without CSF leak. [source] Vascularized Cadaveric Fibula Flap for Treatment of Erectile Dysfunction Following Failure of Penile ImplantsTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Christopher J. Salgado MD ABSTRACT Introduction., Postpriapism erectile dysfunction in patients with sickle cell disease is a particularly devastating condition. Where penile implants have failed, there is no good surgical alternative at present. Free tissue transfer is fraught with risks in patients with sickle cell disease and are not the best option for treatment. Aim., To describe a new surgical technique involving prefabrication of a bone flap for treatment of erectile dysfunction in a patient with sickle cell disease. Methods., The descending branch of the lateral circumflex femoral artery was isolated and implanted within a cadaveric bone segment. The prefabricated flap was then transferred 2 months later as a neophallus for penile autoaugmentation. Results., Bone scan showed viability of the bone flap after transfer. The patient was able to have vaginal intercourse and successfully achieve orgasm 2 months after the second stage surgery. Conclusions., Prefabrication of a cadaveric bone flap and subsequent transfer is a novel and effective technique for treatment of erectile dysfunction refractory to medical management. This technique may be particularly useful for "implant cripples," who have no other surgical option. Salgado CJ, Chim H, Rowe D, and Bodner DR. Vascularized cadaveric fibula flap for treatment of erectile dysfunction following failure of penile implants. J Sex Med 2010;7:3504,3509. [source] Increasing Use of the Scapula Osteocutaneous Free Flap ,THE LARYNGOSCOPE, Issue 9 2000Sean C. Coleman MD Abstract Objectives To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity. Study Design Retrospective review and prospective physical therapy evaluation. Methods A computer database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive 2-year intervals (1992,1999). A single physical therapist performed a structured evaluation of the donor site. Results Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increased from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SOFF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm2 (range, 48,200 cm2) compared with 55.4 cm2 (range, 25,102 cm2) and 77.6 cm2 (range, 50,120 cm2) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibula, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedures versus 2.8% for the fibula flap procedures. There were no significant complications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as "mild," for pain, mobility, and strength. There were no complaints of poor appearance of the donor site. Activities of daily living were judged as "not limited" or "limited a little" in the majority of patients. Objective measurements of range of motion revealed an average reduction of 1° to 12° in five different shoulder functions. Elbow and arm ranges of motion were not limited. Strength was minimally reduced in the shoulder, while the arm and forearm showed no reduction in strength. Conclusions The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of significant donor site morbidity have caused its use to increase significantly. [source] Spatial and temporal patterns of bone formation in ectopically pre-fabricated, autologous cell-based engineered bone flaps in rabbitsJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 4 2008Oliver Scheufler Abstract Biological substitutes for autologous bone flaps could be generated by combining flap pre-fabrication and bone tissue engineering concepts. Here, we investigated the pattern of neotissue formation within large pre-fabricated engineered bone flaps in rabbits. Bone marrow stromal cells from 12 New Zealand White rabbits were expanded and uniformly seeded in porous hydroxyapatite scaffolds (tapered cylinders, 10,20 mm diameter, 30 mm height) using a perfusion bioreactor. Autologous cell-scaffold constructs were wrapped in a panniculus carnosus flap, covered by a semipermeable membrane and ectopically implanted. Histological analysis, substantiated by magnetic resonance imaging (MRI) and micro-computerized tomography scans, indicated three distinct zones: an outer one, including bone tissue; a middle zone, formed by fibrous connective tissue; and a central zone, essentially necrotic. The depths of connective tissue and of bone ingrowth were consistent at different construct diameters and significantly increased from respectively 3.1 ± 0.7 mm and 1.0 ± 0.4 mm at 8 weeks to 3.7± 0.6 mm and 1.4 ± 0.6 mm at 12 weeks. Bone formation was found at a maximum depth of 1.8 mm after 12 weeks. Our findings indicate the feasibility of ectopic pre-fabrication of large cell-based engineered bone flaps and prompt for the implementation of strategies to improve construct vascularization, in order to possibly accelerate bone formation towards the core of the grafts. [source] Transplantation of a vascularized rabbit femoral diaphyseal segment: Mechanical and histologic properties of a new living bone transplantation modelMICROSURGERY, Issue 4 2008Goetz A. Giessler M.D. A new vascularized bone transplantation model is described, including the anatomy and surgical technique of isolating a rabbit femoral diaphyseal segment on its nutrient vascular pedicle. The histologic and biomechanical parameters of pedicled vascularized femoral autotransplants were studied following orthotopic reimplantation in the resulting mid-diaphyseal defect. Vascularized femur segments were isolated in 10 rabbits on their nutrient pedicle, and then replaced orthotopically with appropriate internal fixation. Postoperative weightbearing and mobility were unrestricted, and the contralateral femora served as no-treatment controls. After 16 weeks, the bone flaps were evaluated by x-ray (bone healing), mechanical testing (material properties), microangiography (quantification of intraosseous vasculature), histology (bone viability), and histomorphometry (bone remodeling). Bone healing occurred by 2 weeks, with further callus remodeling throughout the survival period. Eight transplants healed completely, while two had a distal pseudarthrosis. Microangiography demonstrated patent pedicles in all transplants. Intraosseous vessel densities were comparable to nonoperated (control) femora. We found ultimate strength and elastic modulus to be significantly reduced when compared to normal controls. Viable bone, increased mineral apposition rate, and bone turnover were demonstrated in all transplants. The method described, and the data provided will be of value for the further study of isolated segments of living bone, and in particular, for investigations of reconstruction of segmental bone loss in weight-bearing animal models. This study also provides important normative data on living autologous bone flap material properties, vascularity, and bone remodeling. We intend to use this method and data for comparison in subsequent studies of large bone vascularized allotransplantation. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Cryo-assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most casesACTA OPHTHALMOLOGICA, Issue 6 2010Nachum Rosen Acta Ophthalmol. 2010: 88: 675,680 Abstract. Purpose:, To describe and evaluate a cryo-assisted, minimally invasive, anterior approach for orbital tumour surgery. Methods:, Retrospective, non-comparative, consecutive, interventional case series of 103 patients who were operated on by the same surgeon for retroocular orbital tumours over the last 16 years. Results:, A cryo-assisted, minimally invasive, anterior approach was employed in 63 out of the 103 patients (61.2%). In 37 patients (35.9%), anterior orbitotomy without the use of cryoprobe was employed for biopsy or excision of small, anteriorly located lesions. Lateral orbitotomy was used in three patients (2.9%). In a subgroup of 61 patients with circumscribed lesions (mainly cavernous haemangiomas and schwannomas), cryoextraction was used in 51 (83.6%). None of the procedures required conversion to lateral orbitotomy and there were no intraoperative complications. Conclusion:, In contrast to other reports on the treatment of orbital lesions, in the current case series surgery of most solid tumours and many other cystic or infiltrative lesions was achieved here via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favourable consideration because the combination of the anterior approach with the use of cryoprobe and surgical microscope can yield successful results, even in patients with large or deeply located tumours , obviating in most of them the need for lateral or transcranial orbitotomies with bone flaps. [source] 1353: Cryo-assisted anterior approach for surgery of retro-ocular orbital tumoursACTA OPHTHALMOLOGICA, Issue 2010N ROSEN Purpose The aim of this course is to share our experience with transconjunctival or transcutaneous anterior orbitotomy using surgical microscope and cryoextraction approach for surgery of retroocular orbital tumors. Methods Data regarding the used of this anterior surgical approach to retro-ocular orbital tumors was collected from our case series of 103 patients who, over 16 years, were operated on for retroocular orbital tumors and from a newer case series of 24 patients who, over the last 5 years were operated on for orbital cavernous hemangioma. Results A cryo-assisted, minimally invasive, anterior approach was employed in most patients. During more than 20 years lateral orbitotomy was needed only in 3 patients. The operations with anterior approach lasted 57.9 + 15.0 minutes. In none there was need for transformation into lateral orbitotomy and there were no intra-operative complications. No post operative deterioration of visual acuity was evident. Conclusion In contrast to other reports on treatment of orbital lesions, in our experience, surgery of most solid tumors and of many other cystic or infiltrative lesions can be achieved via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favorable consideration as it can yield successful results even in cases with large or deeply located tumors. In most cases it obviates the need for extra-ocular muscle disinsersion and lateral or transcranial orbitotomies with bone flaps. [source] | ||||||||||