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Successful Reconstruction (successful + reconstruction)

Distribution by Scientific Domains

Medical Sciences	60%

Selected Abstracts

Algorithm for Reconstruction After Endoscopic Pituitary and Skull Base Surgery,

THE LARYNGOSCOPE, Issue 7 2007
Abtin Tabaee MD
Abstract Introduction: The expanding role of endoscopic skull base surgery necessitates a thorough understanding of the indications, techniques, and limitations of the various approaches to reconstruction. The technique and outcomes of endoscopic skull base reconstruction remain incompletely described in the literature. Study Design and Methods: Patients undergoing endoscopic skull base surgery underwent an algorithmic approach to reconstruction based on tumor location, defect size, and presence of intraoperative cerebrospinal fluid (CSF) leak. A prospective database was reviewed to determine the overall efficacy of reconstruction and to identify risk factors for postoperative CSF leak. Results: The diagnosis in the 127 patients in this series included pituitary tumor in 70 (55%) patients, encephalocele in 16 (12.6%) patients, meningioma in 11 (8.7%) patients, craniopharyngioma in 9 (7.1%) patients, and chordoma in 6 (4.7%) patients. Successful reconstruction was initially achieved in 91.3% of patients. Eleven (8.7%) patients experienced postoperative CSF leak, 10 of which resolved with lumbar drainage alone. One (0.8%) patient required revision surgery. Correlation between postoperative CSF leak and study variables revealed a statistically significant longer duration of surgery (243 vs. 178 min, P = .008) and hospitalization (12.1 vs. 4.5 days, P < .0001) and a trend toward larger tumors (mean, 3.2 vs. 2.3 cm; P = .058) in patients experiencing postoperative CSF leak. Conclusion: The algorithm for reconstruction after endoscopic surgery presented in this study is associated with excellent overall efficacy. A greater understanding of risk factors for postoperative CSF leak is imperative to achieve optimal results. [source]

Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients

MICROSURGERY, Issue 8 2005
Betul Gozel Ulusal M.D.
In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7,73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n = 21), ankle (n = 12), medial (n = 6), lateral (n = 6), posterior heel (n = 2), and distal sole (n = 3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27,76 cm2 (mean, 36.4 cm2). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects. © 2005 Wiley-Liss, Inc. Microsurgery 25:581,588, 2005. [source]

Pilot study of latewood-width of conifers as an indicator of variability of summer rainfall in the North American monsoon region

INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 6 2001
David M. Meko
Abstract The variability of the North American Monsoon System (NAMS) is important to the precipitation climatology of Mexico and the southwestern United States. Tree-ring studies have been widely applied to climatic reconstruction in western North America, but as yet, have not addressed the NAMS. One reason is the need for highly resolved seasonal dendroclimatic information. Latewood-width, the portion of the annual tree ring laid down late in the growing season, can potentially yield such information. This paper describes a pilot study of the regional summer precipitation signal in latewood-width from a network of five Pseudotsuga menziesii chronologies developed in the heart of the region of NAMS influence in Arizona, USA. Exploratory data analysis reveals that the summer precipitation signal in latewood is strong, but not equally so over the full range of summer precipitation. Scatter in the relationship increases toward higher levels of precipitation. Adjustment for removal of inter-correlation with earlywood-width appears to strengthen the summer precipitation signal in latewood-width. To demonstrate a possible application to climatic reconstruction, the latewood precipitation signal is modelled using a nonlinear model,a binary recursive classification tree (CT) that attempts to classify summers as dry or not dry from threshold values of latewood-width. The model identifies narrow latewood-width as an effective predictor of a dry summer. Of 14 summers classified dry by latewood-width for the period 1868,1992, 13 are actually dry by the instrumental precipitation record. The results suggest that geographical expansion of coverage by latewood-width chronologies and further development of statistical methods may lead to successful reconstruction of variability of the NAMS on century time scales. Copyright © 2001 Royal Meteorological Society [source]

Generation of tendon-to-bone interface "enthesis" with use of recombinant BMP-2 in a rabbit model

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 11 2007
Yusuke Hashimoto
Abstract The anatomical structure at bone-tendon and bone-ligament interfaces is called the enthesis. Histologically, the enthesis is characterized by a transitional series of tissue layers from the end of the tendon to bone, including tendon, fibrocartilage, calcified fibrocartilage, and bone. This arrangement yields stronger direct connection of the soft tissues to bone. In surgical repair, the enthesis has proven difficult to reproduce, and the success of ligament-bone bonding has depended on the fibrous attachment that forms after any ligament reconstructions. In this study, we attempted to generate a direct-insertion enthesis in two stages. First, recombinant human bone morphogenetic protein-2 (rhBMP-2) was injected into the flexor digitorum communis tendon in the rabbit hind limb to induce ectopic ossicle formation. In a second step, the resultant tendon/ossicle complex was then surgically transferred onto the surface of the rabbit tibia to generate a stable tendon-bone junction. One month following surgery, histomorphological examination confirmed direct insertion of tendon-bone structures in the proximal tibia of the rabbit. Ultimate failure loads of the BMP-2-generated tendon-bone junction were significantly higher than in the control group (p,<,0.01). These findings suggest that it is possible to successfully regenerate a direct tendon-to-bone enthesis. Use of this approach may enable successful reconstruction of joints rendered unstable after ligamentous rupture or laxity after anterior cruciate ligament injury. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1415,1424, 2007 [source]

Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma,

THE LARYNGOSCOPE, Issue 7 2008
Aldo C. Stamm MD
Abstract Objectives/Hypothesis: To describe the utility of a large transnasal craniotomy and its reconstruction in the surgical management of patients with craniopharyngioma. Study Design: Observational retrospective cohort study. Methods: Retrospective review of patients treated in an academic neurosurgery/rhinology practice between 2000 and 2007. Patient characteristics (age, sex, follow-up), tumor factors (size, position extension, previous surgery), type of repair (pedicled mucosal flaps, free mucosal grafts), and outcomes (visual, endocrine, and surgical morbidity) were defined and sought in patients who had an entirely endoscopic resection of extensive craniopharyngioma (defined as requiring removal of the planum sphenoidale in addition to sella exposure in the approach). Results: Seven patients had an entirely endoscopic resection of extensive craniopharyngioma during the study period. Mean age was 23.4 years (standard deviation ± 16.3). Mean tumor size was 3.2 cm (standard deviation ± 2.0). The majority of these pathologies had extensive suprasellar disease, and two (28.6%) had ventricular disease. Cerebrospinal fluid leak rate was 29% (2 of 7). These leaks occurred only in reconstructions with free mucosal grafts. There were no cerebrospinal fluid leaks in patients who had vascularized pedicled septal flap repairs. Conclusions: The endoscopic management of large craniopharyngioma emphasizes recent advancements in endoscopic skull base surgery. The ability to provide exposure through a large (4 cm+) transnasal craniotomy, near-field assessment of neurovascular structures, and the successful reconstruction of a large skull defect have significantly advanced the field in the past decade. The use of a two-surgeon approach and bilateral pedicled septal mucosal flaps have greatly enhanced the reliability of this approach. [source]