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Exposed Bone (exposed + bone)
Selected AbstractsSingle-stage Matriderm® and skin grafting as an alternative reconstruction in high-voltage injuriesINTERNATIONAL WOUND JOURNAL, Issue 5 2010Henning Ryssel This article presents a retrospective analysis of a series of nine patients requiring reconstruction of exposed bone, tendons or joint capsules as a result of acute high-voltage injuries in a single burn centre. As an alternative to free tissue transfer, the dermal substitute Matriderm® was used in a one-stage procedure in combination with split-thickness skin grafts (STSG) for reconstruction. Nine patients, in the period between 2005 and 2009 with extensive high-voltage injuries to one or more extremities which required coverage of exposed functional structures as bone, tendons or joint capsule, were included. A total of 11 skin graftings and 2 local flaps were performed. Data including regrafting rate, complications, hospital stays, length of rehabilitation and time until return to work were collected. Eleven STSG in combination with Matriderm® were performed on nine patients (success rate 89%). One patient died. One patient needed a free-flap coverage as a secondary procedure. The median follow-up was 30 months (range 6,48 months). The clinical results of these nine treated patients concerning skin-quality and coverage of exposed tendons or joint capsule were very good. In high-voltage injuries free-flap failure occurs between 10% and 30% if performed within the first 4,6 weeks after trauma. The use of single-stage Matriderm® and skin grafting for immediate coverage described in this article is a reliable alternative to selected cases within this period. [source] Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrixINTERNATIONAL WOUND JOURNAL, Issue 3 2005Article first published online: 7 SEP 200 Conditionnement d'une plaie créant un défect tissulaire exposant l'os après excision tumorale par Matrice de PROMOGRAN, une matrice modulant les protéases. L'étude d'un cas clinique rapportant le succès thérapeutique sur un patient atteint d'un carcinome baso-cellulaire est relatée. Du fait d'une infiltration cancéreuse profonde, une excision large incluant la résection du tissu osseux, était nécessaire. .Le défect tissulaire profond a été traité par Matrice PROMOGRAN, une matrice modulant les protéases, pour promouvoir le tissu de bourgeonnement et s'assurer que la peau greffée prenne de façon normale. Dans le cas clinique décrit ici, un rapide développement du tissu de bourgeonnement sur la surface osseuse exposée a été observée. Les bénéfices de ce type de pansement ont permis à la greffe de peau d'épaisseur partielle de prendre rapidement et d'aboutir à un résultat satisfaisant sur le plan esthétique et fonctionnel. Wundkonditionierung eines tiefen Gewebedefekts mit freiliegenden Knochen nach Tumorentfernung durch Anwendung einer Promogron Matrix- einer proteasenmodulierenden Matrix Berichtet wird eine Fallstudie nach erfolgreicher Behandlung eines Patienten mit Basalzellcarcinom. Aufgrund der ausgedehnten Tumorinfiltration war eine ausgedehnte Excision des Gewebes unter Einschluss von Knochengewebe erforderlich. Der Tiefe Gewebedefekt wurde mit Promogran, einer proteasemodulierenden Matrix behandelt, um die Granulation zu fördern und eine erfolgreiche Hautransplantation anzuschließen. In dem berichteten Fall konnte eine rasche Ausbildung von Granulationsgewebe auf der Knochenoberfläche beobachtet werden. Dadurch war eine erfolgreiche Spalthauttransplantation mit einem sehr guten ästhetischen und funktionalen Ergebnis möglich. Decorso di una ferita con difetto tessutale profondo, incluso l'esposizione di tessuto osseo dopo escissione di un tumore, dopo utilizzo della matrice Promogran®, una matrice che modula le proteasi. Viene messo in risalto un caso clinico di un paziente trattato con successo per un carcinoma basocellulare. Dal momento che il carcinoma era infiltrato in profondità, è stata necessaria una escissione molto ampia che includesse la rimozione di tessuto osseo. La profonda soluzione di continuo che si è creata è stata trattata con la matrice Promogran®, una matrice che modula le metalloproteasi, per promuovere il tessuto di granulazione ed assicurare che la cute trapiantata avesse buon attecchimento. In questo caso è stato osservato un rapido sviluppo di tessuto di granulazione sulla parte esposta dell'osso. I vantaggi della medicazione hanno consentito l'applicazione di un innesto a spessore parziale che ha portato ad un risultato funzionale ed estetico molto buoni. Acondicionamiento de la herida de un defecto tisular profundo, incluyendo hueso expuesto, tras la escisión de un tumor mediante la matriz PROMOGRAN*, una matriz moduladora de proteasas Se presenta el estudio de un caso informando sobre el tratamiento satisfactorio de un paciente afecto de un carcinoma basocelular. Dado que el carcinoma había causado una infiltración profunda, fue necesario practicar una escisión amplia incluyendo la extirpación de tejido óseo. El defecto tisular profundo fue tratado con la matriz PROMOGRAN*, una matriz moduladora de proteasas, para fomentar la granulación y asegurar que la piel transplantada actuara con éxito. En el estudio de este caso se observó un rápido desarrollo de tejido de granulación sobre la superficie ósea expuesta. Los beneficios del apósito permitieron la realización de un injerto de piel laminar satisfactorio que proporcionó muy buenos resultados estéticos y funcionales. Sårbetingning vid djup vävnadsskada med blottställt ben efter tumör excision, med hjälp av PROMOGRAN* Matrix, ett proteas-modulerande matrix En fallstudie som rapporterar lyckad behandling av en patient med basalcellcancer framställs. En omfattande excision, som inkluderar avlägsnandet av benvävnad, var nödvändig emedan cancern hade infiltrerat djupt. Den djupa vävnadsskadan behandlades med PROMOGRAN* Matrix, ett protease-modulerande matrix, för att befrämja granulation och för att säkerställa lyckad inläkning av hudtransplantatet. I denna fallstudie iakttogs en snabb uppkomst av granulationsvävnad på den blottställda benytan. Den fördelaktiga effekten av sårförbandet möjliggjorde en lyckad ,split-thickness' hudtransplantation med mycket gott estetiskt och funktionellt resultat. [source] Wound conditioning of a deep tissue defect including exposed bone after tumour excision using PROMOGRAN* Matrix, a protease-modulating matrixINTERNATIONAL WOUND JOURNAL, Issue 3 2005Anne-Kathrin Tausche MD Abstract A case study reporting on the successful treatment of a patient affected by a basal cell carcinoma is submitted. Because the carcinoma had infiltrated deeply, a wide excision was necessary, including the removal of bone tissue. The deep tissue defect was treated with PROMOGRAN* Matrix, a protease-modulating matrix, to promote granulation and ensure that the skin graft do survive and heal successfully. In this case study, a rapid development of granulation tissue on the exposed surface of the bone was observed. The benefits of the dressing enabled a successful split-thickness skin grafting to be carried out which gave very good aesthetic and functional results. [source] Bisphosphonate-Associated Osteonecrosis of the Jaw: Report of a Task Force of the American Society for Bone and Mineral Research,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2007Sundeep Khosla (Chair) Abstract ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. Introduction: The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. Materials and Methods: A multidisciplinary expert group reviewed all pertinent published data on bisphosphonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. Results and Conclusions: A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1,10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined. [source] Anterior versus posterior approach in reconstruction of infected nonunion of the tibia using the vascularized fibular graft: potentialities and limitationsMICROSURGERY, Issue 3 2002Sherif M. Amr M.D. The potentialities, limitations, and technical pitfalls of the vascularized fibular grafting in infected nonunions of the tibia are outlined on the basis of 14 patients approached anteriorly or posteriorly. An infected nonunion of the tibia together with a large exposed area over the shin of the tibia is better approached anteriorly. The anastomosis is placed in an end-to-end or end-to-side fashion onto the anterior tibial vessels. To locate the site of the nonunion, the tibialis anterior muscle should be retracted laterally and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. All the scarred skin over the anterior tibia should be excised, because it becomes devitalized as a result of the exposure. To cover the exposed area, the fibula has to be harvested with a large skin paddle, incorporating the first septocutaneous branch originating from the peroneal vessels before they gain the upper end of the flexor hallucis longus muscle. A disadvantage of harvesting the free fibula together with a skin paddle is that its pedicle is short. The skin paddle lies at the antimesenteric border of the graft, the site of incising and stripping the periosteum. In addition, it has to be sutured to the skin at the recipient site, so the soft tissues (together with the peroneal vessels), cannot be stripped off the graft to prolong its pedicle. Vein grafts should be resorted to, if the pedicle does not reach a healthy segment of the anterior tibial vessels. Defects with limited exposed areas of skin, especially in questionable patency of the vessels of the leg, require primarily a fibula with a long pedicle that could easily reach the popliteal vessels and are thus better approached posteriorly. In this approach, the site of the nonunion is exposed medial to the flexor digitorum muscle and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. No attempt should be made to strip the scarred skin off the anterior aspect of the bone lest it should become devitalized. Any exposed bone on the anterior aspect should be left to granulate alone. This occurs readily when stability has been regained at the fracture site after transfer of the free fibula. The popliteal and posterior tibial vessels are exposed, and the microvascular anastomosis placed in an end-to-side fashion onto either of them, depending on the length of the pedicle and the condition of the vessels themselves. To obtain the maximal length of the pedicle of the graft, the proximal osteotomy is placed at the neck of the fibula after decompressing the peroneal nerve. The distal osteotomy is placed as distally as possible. After detaching the fibula from the donor site, the proximal part of the graft is stripped subperiosteally, osteotomized, and discarded. Thus, a relatively long pedicle could be obtained. To facilitate subperiosteal stripping, the free fibula is harvested without a skin paddle. In this way, the use of a vein graft could be avoided. Patients presenting with infected nonunions of the tibia with extensive scarring of the lower extremity, excessively large areas of skin loss, and with questionable patency of the anterior and posterior tibial vessels are not suitable candidates for the free vascularized fibular graft. Although a vein graft could be used between the recipient popliteal and the donor peroneal vessels, its use decreases flow to the graft considerably. These patients are better candidates for the Ilizarov bone transport method with or without free latissimus dorsi transfer. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:91,107 2002 [source] The dental implications of bisphosphonates and bone diseaseAUSTRALIAN DENTAL JOURNAL, Issue 2005A. Cheng Abstract In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non-healing extraction wounds of the jaws. All were middle-aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non-healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates, pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non-osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients. [source] How we do it: The viability of free mucosal grafts on exposed bone in lacrimal surgery , a prospective studyCLINICAL OTOLARYNGOLOGY, Issue 4 2006S. Mahendran Keypoints ,,To ascertain viability of free mucosal of grafts on bare bone and degree of contracture in vivo. ,,Prospective study to ascertain graft survival where a small piece of mucosa, with a single centrally placed prolene suture for future identification, removed during endoscopic dacrocystorhinostomy (DCR) was replaced to cover exposed bone at the end of the procedure. The presence of the graft and the degree of contracture was assessed endoscopically in outpatients at the second and fourth weeks. ,,All patients who fulfilled the inclusion criteria who underwent DCR in the study period April,October 2002. ,,All the grafts survived intact at 4 weeks after the operation. Grafts underwent up to 20% contracture over this period. ,,Free mucosal grafts survive well when applied to denuded bone in DCR operation. [source] | ||||||||||