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Healing Phase (healing + phase)
Selected AbstractsCosmetic Color Improvement of the Nipple-Areola Complex by Optimal Use of Tretinoin and HydroquinoneDERMATOLOGIC SURGERY, Issue 12 2002Kotaro Yoshimura MD background. A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small. objective. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC. methods. The protocol was composed of two phases: bleaching phase (4,8 weeks) and healing phase (4,6 weeks). 0.2,0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study. results. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course. conclusion. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far. [source] The initial phase of fracture healing is specifically sensitive to mechanical conditionsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2003Petra Klein Abstract Interfragmentary movements affect the quality and quantity of callus formation. The mounting plane of monolateral external fixators may give direction to those movements. Therefore, the aim of this study was to determine the influence of the fixator mounting plane on the process of fracture healing. Identically configured fixators were mounted either medially or anteromedially on the tibiae of sheep. Interfragmentary movements and ground reaction forces were evaluated in vivo during a nine week period. Histomorphological and biomechanical parameters described the bone healing processes. Changing only the mounting plane led to a modification of interfragmentary movements in the initial healing phase. The difference in interfragmentary movements between the groups was only significant during the first post-operative period. However, these initial differences in mechanical conditions influenced callus tissue formation significantly. The group with the anteromedially mounted fixator, initially showing significantly more interfragmentary movements, ended up with a significantly smaller callus diameter and a significantly higher callus stiffness as a result of advanced fracture healing. This demonstrates that the initial phase of healing is sensitive to mechanical conditions and influences the course of healing. Therefore, initial mechanical stability of an osteosynthesis should be considered an important factor in clinical fracture treatment. © 2003 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacingLASERS IN SURGERY AND MEDICINE, Issue 3 2009Mathew M. Avram MD Abstract Background Ablative fractional carbon dioxide (CO2) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO2 resurfacing. To date, scarring with fractional CO2 lasers has not been reported. Objective Five patients treated with the same fractional CO2 laser technology for photodamage of the neck were referred to our practices 1,3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 µm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO2 ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 µm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS). Results Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month. Conclusion As with traditional ablative CO2 laser resurfacing, HS is a potential complication of ablative fractional CO2 laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period. Lasers Surg. Med. 41:185,188, 2009. © 2009 Wiley-Liss, Inc. [source] Dimensional Stability of the Free Fascia Grafts: An Animal Experiment,THE LARYNGOSCOPE, Issue 4 2002Shabbir Indorewala MS (ENT) Abstract Objectives/Hypothesis It appears that autologous free fascia grafts (fascia lata and temporal fascia) change their dimensions during the vital first 5 days of healing. Poor dimensional stability of these grafts can be an important reason for failure of complete closure of tympanic membrane perforations in tympanoplasty operations. There has been no study regarding this dimensional instability. Study Design Prospectively dimensional instability of the free fascia grafts was studied in 14 mongrel dogs. Methods Fourteen healthy Mongrel dogs were operated on twice. During the first surgery, fascia lata and temporal fascia grafts of measured dimensions (length, breadth, and thickness) were implanted in the subcutaneous pockets on the thoracoabdominal wall of the same dog (autograft). Five dogs were operated on again after 2 days, and 7 dogs were operated on again after 5 days to harvest the implanted grafts. The dimensions of the harvested grafts were noted. Changes with respect to their implant dimensions after 2 days and after 5 days were calculated. Results It was found that free fascia lata exhibits significantly superior dimensional stability when compared with free temporal fascia during the early healing phase, before graft integration has occurred. Shrinking and thickening of temporal fascia are greaterand are also most unpredictable. Conclusions Poor dimensional stability of temporal fascia may compromise a well-sealed perforation at the time of surgery, and it may reopen by the 5th day. This must be one of the causes of failure of tympanoplasty, which needs to be studied further. [source] Bone healing and graft resorption of autograft, anorganic bovine bone and ,-tricalcium phosphate.CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2006A histologic, histomorphometric study in the mandibles of minipigs Abstract Objective: The purpose was to qualitatively and quantitatively compare the bone formation and graft resorption of two different bone substitutes used in both orthopedic and oral surgery, with autogenous bone as a positive control. Materials and methods: Three standardized bone defects were prepared in both mandibular angles of 12 adult minipigs. The defects were grafted with either autograft, anorganic bovine bone (ABB), or synthetic ,-tricalcium phosphate (,-TCP). Sacrifice was performed after 1, 2, 4, and 8 weeks for histologic and histomorphometric analysis. Results: At 2 weeks, more new bone formation was seen in defects filled with autograft than with ABB (P,0.0005) and ,-TCP (P,0.002). After 4 weeks, there was no significant difference between ,-TCP and the two other materials. Defects grafted with ABB still exhibited less bone formation as compared with autograft (P,0.004). At 8 weeks, more bone formation was observed in defects grafted with autograft (P,0.003) and ,-TCP (P,0.00004) than with ABB. No difference could be demonstrated between ,-TCP and autograft. ,-TCP resorbed almost completely over 8 weeks, whereas ABB remained stable. Conclusion: Both bone substitutes seemed to decelerate bone regeneration in the early healing phase as compared with autograft. All defects ultimately regenerated with newly formed bone and a developing bone marrow. The grafting materials showed complete osseous integration. Both bone substitutes may have a place in reconstructive surgery where different clinical indications require differences in biodegradability. [source] Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor?CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2005Gerry M. Raghoebar Abstract: The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on remodeling of autologous bone grafts used for augmentation of the floor of the maxillary sinus. In five edentulous patients suffering from insufficient retention of their upper denture related to a severely resorbed maxilla, the floor of both maxillary sinus was augmented with an autologous bone graft from the iliac crest. Randomly, PRP was added to the bone graft used to augment the floor of the left or right sinus (split-mouth design). Three months after the reconstruction, bone biopsies were taken with a trephine from the planned implant sites (N=30). Subsequently, three implants were placed in the left and right posterior maxilla. Microradiograms were made of all biopsies (N=30), whereafter the biopsies were processed for light microscopic examination. In addition, clinical parameters were scored. Wound healing was uneventful, clinically no difference was observed between the side treated with PRP or not. Also microradiographical and histomorphological examination of the biopsies revealed no statistical difference between the PRP- and non-PRP side. One implant placed in the PRP side of the graft was lost during the healing phase. Implant-retained overdentures were fabricated 6 months after implantation. All patients functioned well (follow-up 20.2±4.3 months). In this study, no beneficial effect of PRP on wound healing and bone remodeling was observed. It is posed that PRP has no additional value in promoting healing of grafted non-critical size defects. Résumé Le but de cette étude a été d'évaluer l'effet du plasma riche en plaquettes sur le remodelage de greffons osseux autogènes utilisés pour l'épaississement du plancher sinusal. Chez cinq patients édentés souffrant d'une rétention insuffisante de leur prothèse supérieure en relation avec un maxillaire sévèrement résorbé, les planchers sinusaux des deux maxillaires ont étéépaissis avec un greffon d'os autogène provenant de la crête iliaque. Au hasard, du plasma riche en plaquettes (PRP) a été ajouté au greffon osseux utilisé pour épaissir le plancher du sinus gauche ou droit (modèle de bouche divisée). Trois mois après la reconstruction, des biopsies osseuses ont été obtenues avec un trépan des sites planifiés pour placer des implants (N=30). Ensuite, trois implants ont été placés dans les parties maxillaires gauches et droites. Des microradiogrammes des 30 biopsies ont été effectuées, ces dernières ont ensuite été utilisées pour l'examen au microscope optique. De plus, des paramètres cliniques ont été enregistrés. La guérison a été parfaite, cliniquement aucune différence n'a été observée entre les sites traités avec PRP ou sans. L'examen microradiographique et histomorphologique des biopsies n'a révélé aucune différence significative entre les sites PRP et non-PRP. Un implant placé dans le site PRP du greffon a été perdu durant la phase de guérison. Des prothèses retenues sur implants ont été fabriquées six mois après l'insertion des implants. Tous les patients ont une mise en fonction excellente après un suivi de 20±4,3 mois. Dans cette étude, aucun effet bénéfique additionnel du PRP sur la guérison et le remodelage osseux n'a été observé. Le PRP n'aurait aucune valeur supplémentaire à promouvoir la guérison dans ce type d'opération. Zusammenfassung Das Ziel dieser Studie war, den Einfluss von plättchenreichem Plasma auf die Remodellierung von autologen Knochentransplantaten, welche für die Augmentation des Sinusbodens vom Sinus maxillaris verwendet wurden, auszuwerten. Bei 5 zahnlosen Patienten, welche aufgrund einer stark resorbierten Maxilla über einen ungenügenden Halt der Oberkieferprothese klagten, wurde der Sinus maxillaris mit autologem Knochen vom Beckenkamm augmentiert. Zufällig wurde dem Knochen, der zur Augmentation des rechten oder linken Sinusbodens verwendet wurde, plättchenreiches Plasma (PRP) hinzugefügt (unterschiedlich behandelte Seiten). Drei Monate nach der Augmentation wurden mittels Hohlfräsen Biopsien an den geplanten Implantatlokalisationen entnommen (N=30). Danach wurden je drei Implantate in die rechte und linke posteriore Maxilla eingesetzt. Von allen Biopsien wurde Mikroröntgenbilder angefertigt (N=30), danach wurden die Biopsien für die lichtmikroskopische Untersuchung aufgearbeitet. Zusätzlich wurden klinische Parameter aufgenommen. Die Wundheilung war unauffällig. Klinisch konnten keine Unterschiede zwischen den mit und ohne PRP behandelten Seiten beobachtet werden. Ebenso ergab die mikroradiographische und histomorphometrische Untersuchung der Biopsien keine statistisch signifikanten zwischen der PRP und nicht-PRP Seite. Ein Implantat, welches in eine PRP Seite eingesetzt worden war, ging während der Einheilphase verloren. Die implantatgetragenen Hybridprothesen wurden 6 Monate nach Implantation angefertigt. Alle Patienten funktionierten problemlos (Beobachtungszeit bis 20.2±4.3 Monate). In dieser Studie konnte kein positiver Einfluss des PRP auf die Wundheilung und die Knochenremodellierung beobachtet werden. Es wird vermutet, dass PRP keinen zusätzlichen Effekt bei der Förderung der Heilung von Transplantaten in Defekten mit nicht-kritischer Grösse hat. Resumen La intención de este estudio fue evaluar el efecto del plasma rico en plaquetas en el remodelado de injertos de hueso autólogo usado para aumento del suelo del seno maxilar. Se aumentó el suelo de ambos senos maxilares con injertos de hueso autólogo de la cresta iliaca en 5 pacientes edéntulos que padecían de insuficiente retención de su dentadura superior relacionada con un maxilar severamente reabsorbido. Aleatoriamente, se añadió plasma rico en plaquetas (PRP) al injerto óseo usado para aumentar el suelo del seno derecho o izquierdo (diseño de boca partida). Tres meses tras la reconstrucción, se tomaron biopsias de hueso con un trépano de los lugares de implantes planificados (N=30). Subsecuentemente se colocaron tres implantes en el maxilar posterior derecho e izquierdo. Se hicieron microrradiogramas de todas las biopsias (N=30), posteriormente las biopsias se procesaron para microscopía óptica. Además se tomaron parámetros clínicos. La cicatrización de la herida tuvo lugar sin incidentes. Clínicamente no se observó diferencia alguna entre el lado tratado con PRP o no. Tampoco el examen microrradiográfico e histomorfológico de las biopsias revelaron diferencias estadísticamente significativas entre los lados con o sin PRP. Un implante colocado en el lado del PRP se perdió durante la cicatrización. Las dentaduras implantorretenidas se fabricaron a los seis meses de la implantación. Todos los pacientes funcionaron bien (seguimiento de 20.2±4.3 meses). En este estudio no se observó ningún efecto beneficioso del PRP sobre la cicatrización y sobre el remodelado óseo. Se plantea que el PRP no tiene ningún valor adicional en promover la cicatrización de defectos no críticos injertados. [source] Predicting osseointegration by means of implant primary stabilityCLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2004A resonance-frequency analysis study with delayed, immediately loaded ITI SLA implants Abstract: The purpose of the present clinical study was (1) to evaluate the Osstell as a diagnostic tool capable of differentiating between stable and mobile ITI implants, (2) to evaluate a cut-off threshold implant stability quotient (ISQ) value obtained at implant placement (ISQitv) that might be predictive of osseointegration, (3) to compare the predictive ISQitv of immediately loaded (IL) implants and implants loaded after 3 months (DL). Two patient groups were enrolled, 18 patients received 63 IL implants and 18 patients were treated with 43 DL implants. The ISQ was recorded at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. All implants passed the 1-year loading control. Two implants failed, one DL implant with ISQ at placement (ISQi) of 48 and one IL implant with ISQi of 53. The resonance-frequency analysis (RFA) method was not a reliable diagnostic tool to identify mobile implants. However, implant stability could be reliably determined for implants displaying an ISQ,47. After 1 year of loading, all DL implants with an ISQi,49 and all IL implants with an ISQi,54 achieved and maintained osseointegration. By the end of 3 months, implants with ISQi<60 had an increase of stability. Implants with ISQi 60,69 had their stability decrease during 8 weeks before returning to their initial values. Implants with ISQ>69 had their stability decrease during the first 4 weeks before remaining stable. Although preliminary, these data might orient the practitioner to choose among various loading protocols and to selectively monitor implants during the healing phase. Résumé Le but de l'étude clinique présente a été 1) d'évaluer l'Osstell comme machine de diagnostic capable de différencier l'implant ITI stable et du mobile, 2) d'évaluer un niveau seuil de la valeur du quotient de stabilité implantaire obtenue lors du placement de l'implant (ISQitv) qui pourrait être prophétique pour l'ostéoïntégration, 3) de comparer le jugement ISQitv d'implants immédiatement mis en charge (IL) et d'implants chargés trois mois après leur placement(DL). Deux groupes de patients ont participéà cette étude : 18 patients ont reçu 63 implants IL et 18 autres ont été traités avec 43 implants DL. Le ISQ a été enregistré lors du placement de l'implant et après 1, 2, 4, 6, 8, 10 et 12 semaines. Tous les implants ont passé le contrôle de mise en charge d'une année. Deux implants ont échoué, un DL avec un ISQ lors de son placement de 48 et un implant IL avec un ISQi de 53 lors de son placement. La méthode RFA n'était pas un outil de diagnostic fiable pour identifier les implants mobiles. Cependant la stabilité implantaire pouvait être déterminée de manière sûre pour les implants qui avaient un ISQi 47. Après une année de mise en charge, tous les implants DL avec un ISQi 49 et tous les implants IL avec un ISQi 54 atteignaient et maintenaient l'ostéoïntégration. Après trois mois, les implants avec ISQi 60 montraient une augmentation de stabilité. Les implants avec ISQi de 60 à 69 avaient une diminution de la stabilité durant huit semaines avant de revenir à leur valeur initiale. Les implants avec ISQ>69 voyaient leur stabilité diminuée durant les premières quatre semaines avant de rester stables. Bien que préliminaires, ces données peuvent orienter le praticien pour choisir parmi différents protocoles de mise en charge et de suivre de manière sélective les implants durant la phase de guérison. Zusammenfassung Das Ziel dieser klinischen Studie war, 1) das Osstell als diagnostisches Werkzeug zur Unterscheidung von stabilen und beweglichen ITI-Implantaten zu untersuchen, 2) einen verbindlichen Grenzwert zu bestimmen, der in Form eines Implantatstabilitätsquotienten zum Zeitpunkt der Implantation (ISQitv) erhoben wird, und der als Voraussagewert für die Osseointegration dienen könnte, 3) den ISQitv von sofortbelasteten Implantaten (IL) und von erst nach 3 Monaten belasteten Implantaten (DL) zu vergleichen. Es waren zwei Patientengruppen beteiligt, 18 Patienten erhielten 63 IL-Implantate und 18 Patienten wurden mit 43 DL-Implantaten behandelt. Den ISQ-Wert bestimmte man sofort nach der Implantation, sowie nach 1, 2, 4, 6, 8, 10 und 12 Wochen. Alle Implantate konnten nach einem Jahr überprüft und kontrolliert werden. 2 Implantate gingen verloren, ein DL-Implantat mit einem ISQ bei der Implantation (ISQi) von 48 und ein IL-Implantat mit einem ISQi von 53. Die RFA-Methode war kein verlässliches diagnostisches Werkzeug, um bewegliche Implantate zu erkennen. Man konnte aber für Implantate mit einem ISQ von>47 die Implantatstabilität verlässlich bestimmen. Nach einer Belastung über ein Jahr erreichten alle DL-Implantate mit einem ISQi von>49 und alle IL-Implantate mit einem ISQi von>54 eine stabile Osseointegration. Nach 3 Monaten, erreichten Implantate mit einem ISQi von<60 eine zunehmende Stabilität. Implantate mit einem ISQi von 60-69 verloren in den ersten 8 Wochen einen Teil ihrer Stabilität, bevor sie wieder zu den Anfangswerten zurückkehrten. Implantate mit einem ISQ>69 hatten ihre Stabilitätsabnahme in den ersten 4 Wochen, bevor sie wiederum dauerhaft stabil wurden. Obwohl es erste Daten sind, können sie dem Praktiker helfen, um zwischen den verschiedenen Belastungsprotokollen zu wählen, und um die Implantate ganz individuell durch die Heilungsphase hindurch zu betreuen. Resumen El propósito del presente estudio fue, 1) evaluar el Osstell como herramienta diagnóstica capaz de de diferenciar entre implantes ITI estables y móviles, 2) evaluar un valor de cociente de umbral de corte de estabilidad de implante obtenido al colocar el implante (ISQitv) que pueda ser predictivo de osteointegración, 3) comparar la predictibilidad del ISQitv de los implantes de carga inmediata (IL) e implantes cargados tras 3 meses (DL). Se enroló a dos grupos de pacientes, 18 pacientes recibieron 63 implantes IL y 18 pacientes se trataron con 43 implantes DL. Se recogieron los ISQ al colocar los implantes, tras 1, 2, 4, 6, 8, 10 y 12 semanas. Todos los implantes superaron el control del año. 2 implantes fracasaron, un implante DL con un ISQ al colocarlo (ISQi) de 48 y un implante IL con un ISQi de 53. El método RFA no fue una herramienta fiable para identificar implantes móviles. De todos modos, la estabilidad de los implantes pudo ser determinada con fiabilidad para los implantes que mostraron un ISQ,47. Tras 1 año de carga, todos los implantes DL con un ISQi,49 y todos los IL con ISQi,54 lograron y mantuvieron la osteointegración. Al final de los 3 meses, los implantes con ISQ<60 tuvieron un incremento en la estabilidad. Los implantes con un ISQi de 60-69 tuvieron un descenso de la estabilidad durante 8 semanas antes de volver a sus valores iniciales. Los implantes con ISQ>69 tuvieron un descenso de la estabilidad durante la primeras 4 semanas antes de estabilizarse. Aunque preliminares, estos datos pueden orientar al clínico a escoger entre varios protocolos de carga y monitorizar selectivamente los implantes durante la fase de cicatrización. [source] Effect of surface roughness and calcium phosphate coating on the implant/bone responseCLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2000Tohru Hayakawa The influence of surface roughness and calcium phosphate (Ca-P) coating on the bone response of titanium implants was investigated. Four types of titanium implants, i.e. as-machined, grit blasted, as-machined with Ca-P sputter coating, and grit blasted with Ca-P sputter coating, were prepared. The Ca-P sputter-coating, produced by using the RF magnetron sputter technique, was rapid heat-treated with infrared radiation at 600°C. These implants were inserted into the left and right femoral condyles and the left and right tibial diaphyses of the rabbits. After implantation periods of 2 and 12 weeks, the bone,implant interface was evaluated histologically and histomorphometrically. Histological evaluation revealed no new bone formation around different implant materials after 2 weeks of implantation. After 12 weeks, bone healing was almost completed. For both tibial and femoral implants, Ca-P coated implants always showed a higher amount of bone contact than either of the non-coated implants. On the other hand, surface roughness improved only the response to implants inserted into the tibial diaphysis. On the basis of these findings, we concluded that 1) deposition of a sputtered Ca-P coating on an implant has a beneficial effect on the bone response to this implant during the healing phase, and 2) besides implant surface conditions the bone response is also determined by local implant site conditions. [source] | ||||||||||