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Large Defects (large + defect)
Selected AbstractsModified Von Bruns' Technique for Total Lower Lip ReconstructionDERMATOLOGIC SURGERY, Issue 3 2004Neta Adler MD Background. Large defects of the lower lip represent a challenge to the reconstructive surgeon. The reconstructed lip should be sensate, retain muscle function, allow sufficient mouth opening for dentures, and have an acceptable aesthetic appearance. Many surgical techniques for lower lip reconstruction have been reported. We describe a modification of von Bruns' technique for reconstruction of the lower lip and both commissures. Objective. To present a surgical technique for reconstruction of the lower lip and both commissures, which we applied in a patient with a huge squamous cell carcinoma of the total lower lip and part of the upper lip. Methods. Two upper nasolabial flaps, one above the other, were used. The surgical technique is discussed. Conclusion. The technique is simple and is one stage. It provides complete support to the reconstructed lower lip and commissures. [source] Repair of a Large Wound of the Back, Post-Mohs Micrographical Excision, Using Chronic Skin ExpansionDERMATOLOGIC SURGERY, Issue 6 2003Ron M. Shelton MD Background. Large defects not otherwise closed primarily may be closed after chronic skin expansion. Objective. If chronic expansion were deemed indicated for the closure of a proposed defect expected to result from Mohs micrographic surgery, can it be performed before Mohs surgery, avoiding the increased chance of expander extrusion via the defect when done postoperatively? Methods. A team approach of a Mohs surgeon and a plastic surgeon coordinated scheduling an insertion of and staged infiltration of a tissue expander before Mohs surgical removal of a large basal cell carcinoma on the back of a young woman. The reconstruction after Mohs surgery was scheduled for the immediate postoperative period. Results. The Mohs surgery completed removed the carcinoma, and the expander was removed, enabling the surgeon to perform a side-to-side closure. Conclusion. Provided that there is not a great probability of the neoplasm extending significantly deeper or wider than expected and that the skin expander is placed so as not to disturb the plane of Mohs excision, this is a useful technique to close large Mohs defects. [source] Large Apical Muscular Ventricular Septal Defect: Asymptomatic due to Anomalous Muscle Bundles in the Right VentricleCONGENITAL HEART DISEASE, Issue 1 2007Anant Khositseth MD ABSTRACT This case report demonstrated an apical muscular ventricular septal defect (VSD) that was a large defect but behaved like a small defect because of the restrictive flow across the anomalous muscle bundles in the right ventricular (RV) apex. The anomalous muscle bundles separated the RV sinus into two parts: the RV apex connecting with the left ventricle through the apical muscular VSD on one side, and the rest of the RV sinus connecting with RV inflow and RV outflow on the other side. These findings explained why the 11-year-old girl in this study remained asymptomatic without evidence of volume load. Thus far, it was not necessary to close her defect because of the hemodynamic insignificance. [source] Formation and resolution of ankylosis under application of recombinant human bone morphogenetic protein-2 (rhBMP-2) to class III furcation defects in catsJOURNAL OF PERIODONTAL RESEARCH, Issue 4 2005D. Takahashi Objectives:, Periodontal regeneration under application of bone morphogenetic protein (BMP) is compromised by ankylosis. Ankylosis disappearance following application of BMP has been observed in the case of a small defect, which might be beneficial change for periodontal regeneration. However, the histological observation of ankylosis disappearance has not been demonstrated in a large defect. The purpose of this present study was to confirm resolution of ankylosis during periodontal regeneration by recombinant human BMP-2 (rhBMP-2) applied to class III furcation defects. Material and methods:, Class III furcation defects were created in the premolars of six adult cats. The rhBMP-2 material, prepared by applying rhBMP-2 to a combination of polylactic acid,polygricolic copolymer and gelatin sponge (PGS; 0.33 µg rhBMP-2/mm3 PGS) or control material containing only PGS, was implanted into each defect. The cats were killed at 3, 6 or 12 weeks after surgery and serial sections were prepared for histological and histometrical observation. Results:, Ankylosis was observed in some of the rhBMP-2/PGS group at 3 and 6 weeks, but not at 12 weeks. At 6 weeks, osteoclast-like cells were visible in the rhBMP-2/PGS group with ankylosis. Residual PGS was evident between the bone and root surface in the rhBMP-2/PGS group without ankylosis at 3 weeks. Conclusions:, Resolution of ankylosis by osteoclast-like cells possibly occurred under application of rhBMP-2. Residual PGS might play an important role in preventing ankylosis formation. [source] Repair of buccal defects with anterolateral thigh flapsMICROSURGERY, Issue 3 2006Ömer Özkan M.D. The ideal reconstructive method for the buccal mucosa should provide durable, stable coverage and a natural contour, while simultaneously minimizing morbidity of both the defect and donor sites. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. From March 2004,April 2005, 24 free anterolateral thigh flaps were used to reconstruct buccal defects, including the retromolar trigone and as far as the oral commissure, and in some cases with extension to the neighboring palatal region and tongue. The study comprised 1 female and 23 male patients, with ages ranging from 26,63 years (mean age, 45.8 years). Two flaps required reoperation due to vascular compromise, and both were salvaged with arterial and venous anastomosis revisions, giving an overall success rate of 100%. Primary thinning of the flap was performed in 10 cases. In 2 cases, additional vastus lateralis muscle was included in the flap to fill the large defect. In 2 cases, marginal necrosis with dehiscence of the flap was observed, one of these patients having a history of atherosclerosis and diabetes mellitus (marginal skin necrosis and infection of the donor area were also observed in this patient). In 2 patients, seroma collection was observed in the neck at the dissection site. Chart reviews showed that most patients had a history of betel-nut chewing (95.8%) or a combination of smoking and betel-nut chewing (79.2%). During the follow-up period of 4,12 months, a sufficient level of mouth-opening with interincisal distances of 34 mm, 44 mm, and 48 mm was achieved in all 3 cases reconstructed after release of the trismus. Although it has some variations in the vascular pedicle, irregularity in derivation from the main vessels, and minimal morbidity of the donor site, the anterolateral thigh flap, with its evident functional, structural, and cosmetic advantages, can be considered an excellent and ideal flap option, and a first choice for most buccal defects. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Use of a combination of flaps to achieve primary closure of defect following excision of keratocystic odontogenic tumour: a technical noteORAL SURGERY, Issue 3 2010J. Patel Abstract Aims:, Description of a case of a combination of flaps to achieve primary closure over large defect following the excision of a keratocystic odontogenic tumour. Materials:, Following the resection of a large keratocystic odontogenic tumour. Methods:, Combination of laterally positioned buccal flap, vascularised palatal connective tissue graft and buccal fat pad. Results:, Closure over the large defect. Conclusions:, Successful post-operative healing over the resected region allowing for future restoration space left in the dentition. [source] Management of complicated head and neck wounds with vacuum-assisted closure systemHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2006Brian T. Andrews MD Abstract Background The vacuum-assisted closure system (V.A.C.), or negative pressure dressings, has been successfully used to manage complex wounds of the torso and extremities, but its role in the head and neck region has not been frequently described. Methods A retrospective study was performed. The V.A.C. system (Kinetic Concepts Inc., San Antonio, TX) was used at the University of Iowa Hospitals and Clinics for management of complicated head and neck wounds. Results The V.A.C. system was utilized at 13 sites for 12 patients. Nine subjects had exposed calvarium (4 had failed pedicled reconstructive flaps, 3 had ablative or Moh's defects, and 2 had traumatic scalping injuries) necessitating bony coverage. Three subjects had the V.A.C. system used as a bolster dressing placed over split-thickness skin grafts (STSGs) used to reconstruct large defects of the face and skull, and 1 patient had a large soft tissue neck defect after radical surgical resection for necrotizing fascitis. One subject used the V.A.C. system for the management of 2 distinct wounds. All patients had successful healing of their wounds with the V.A.C. system without complication. All STSGs had 100% viability after 5 to 7 days of the V.A.C. system use as a bolster dressing. Conclusion This study demonstrates the V.A.C. system is a valuable tool in the management of complicated head and neck wounds. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Total upper lip reconstruction with a free temporal scalp flap: Long-term follow-up ,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2003Kao-Ping Chang MD Abstract Background. In men, reconstruction of large full-thickness defects of the upper lip requires both an inner layer to replace the mucosal lining and an outer hair-bearing layer. Methods. When locating the superficial temporal vessels, the design of the temporal flap is marked following the hairline needed. After meticulously dissecting the flap, it is inset and microanastomosed with the facial blood vessels. The internal mucosal layer of the flap is grafted on. During the follow-up period, the sensory recovery and motor functions are examined and recorded. Results. The postoperative courses were uneventful, and patients were satisfied with the results. One patient has a long follow-up period of 18 years. Conclusions. The free temporal scalp hair-bearing flap offers a reasonable alternative to conventional techniques in the reconstruction of large defects of the male upper lip or even a total upper lip. It is a single-staged, relatively simple method of providing hair-bearing skin to the upper lip. © 2003 Wiley Periodicals, Inc. Head Neck 25: 602,605, 2003 [source] Patent Ductus Arteriosus ClosureJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2006RICHARD A. KRASUSKI M.D. Patent ductus arteriosus is a common clinical lesion which increases the risk of endocarditis and may lead to heart failure and pulmonary hypertension. Devices and techniques have advanced to the point that in most patients percutaneous closure should be the procedure of choice. Devices are best selected by fully examining the anatomy of the defect. In general coils are best suited for smaller defects and the Amplatzer Duct Occluder excels in moderate to large defects. Follow-up should include echocardiography to ensure complete closure. [source] Opposed bilateral transposition flap: a simple and effective way to close large defects, especially of the limbsJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2008R Verdolini Abstract Background, Excision of large tumours, particularly of the limbs, can be challenging because of problems related to wound repair. This is especially true of the lower legs, where skin is often tight and difficult to mobilize. Closure by flap, which would represent the first choice for defects usually between 12,15 mm to 38,40 mm diameter, is at risk of developing complications, such as end-flap necrosis or dehiscence due to skin tension. For larger defects, usually more than 40 to 45 mm diameter, grafting still remains the only realistic option in the majority of cases, with all the various problems associated with this procedure, such as lengthy healing times and the risk of developing leg ulcers, above all in elderly patients with impaired blood circulation. Second intention healing implies extraordinarily long healing times with often unacceptable delays in normal ambulation and activity. Objective, To find an alternative to the usual repair techniques and to try to reduce the risk of complications. Conclusions, We developed a relatively simple but effective technique for the closure of large wounds resulting from the excision of tumours. Our technique consists of two longitudinal, parallel, transposition flaps obtained from two opposite sides of the wound, with major axes orientated in the cephalic-caudal direction. The two flaps are then rotated around two fulcra placed at two extremes of the wound by approximately 90°. This relatively simple technique has never caused any of the ordinarily associated problems in terms of necrosis or ulcer development. In addition, dehiscence of sutures never occurred, given the fact that suture tension is minimal. Quick healing has resulted in the majority of cases, avoiding all the problems associated with grafting or other traditional flap techniques. [source] The bipedicled latissimus dorsi myocutaneous free flap: Clinical experience with 53 patientsMICROSURGERY, Issue 3 2010Mehmet Veli Karaaltin M.D. The Latissimus dorsi musculocutaneous flap is a valuable workhorse of the microsurgeon, especially in closing large body defects. One of the pitfalls in harvesting the flap, is particularly in its inferior aspect which may be unreliable. Here we report a series of 53 patients who were undergone bipedicled free latissimus dorsi musculocutaneous free flaps for extensive tissue defects. The age of patients were between 5 and 64 and all of them were males. The wound sizes in these patients ranged between 31,35 × 10,12 cm and flap dimensions were between 38,48 × 6,8 cm. Perforator branches of the 10th intercostal vessels were dissected and supercharged to the flaps to reduce the risk of ischemia of the inferior cutaneous extensions. The secondary pedicles were anastomosed to recipient vessels other than the primary pedicles. Recipient areas were consisted of lower extremities. Four patients suffered of early arterial failure in the major pedicle and all revisions were successfully attempted. Neither sign of venous congestion nor arterial insufficiency were observed at the inferior cutaneous extensions of the flaps, and all defects were reconstructed successfully. All donor sites were primarily closed, only two patients suffered from a minor area of superficial epidermal loss at the donor site, without suffering any adjunct complications. In conclusion coverage of large defects can be safely performed with extending the skin paddle of latissimus dorsi flap as a bipedicled free flap. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] The distal superficial femoral arterial branch to the sartorius muscle as a recipient vessel for soft tissue defects around the knee: Anatomic study and clinical applicationsMICROSURGERY, Issue 6 2009Fernando A. Herrera M.D. Complex wounds surrounding the knee and proximal tibia pose a significant challenge for the reconstructive surgeon. Most of these defects can be managed using local or regional flaps alone. However, large defects with a wide zone of injury frequently require microvascular tissue transfers to aid in soft tissue coverage and closure of large cavities. We describe a unique recipient vessel for microvascular anastomosis for free flap reconstruction involving the knee and proximal tibia through anatomic and clinical studies. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source] The use of forearm free fillet flap in traumatic upper extremity amputationsMICROSURGERY, Issue 1 2009Isabel C. Oliveira M.D. Background: Complete traumatic upper extremity avulsions are an infrequent but devastating injury. These injuries are usually the result of massive blunt trauma to the upper limb. Intact issue from amputated or nonsalvageable limbs may be transferred for reconstruction of complex defects resulting from trauma when the indications for replantation are not met. This strategy allows preservation of stump length or coverage of exposed joints, and provides free flap harvest for reconstruction without additional donor-site morbidity. Methods: A retrospective review at Săo Joăo Hospital was performed on seven patients who had undergone immediate reconstruction with forearm free fillet flaps between 1992 and 2007. Results: There were six men and one woman, with patient age ranging from 17 to 74 years (mean, 41 years). Amputation sites were at the humeral neck (n = 1), at the humeral shaft (n = 5), and below the elbow (n = 1). The area of the forearm free fillet flap skin paddle was 352.14 ± 145.48 cm (mean ± SD). The two major complications were the flap loss and the patient death on postoperative day 3 in other case. The postoperative course in the remaining five cases was uneventful with good healing of the wounds. Minor complications included two small residual defects treated by split-thickness skin grafting and one wound infection requiring drainage and revision. Conclusions: The forearm free fillet flap harvested from the amputated limb provides reliable and robust tissue for reconstruction of large defects of the residual limb without additional donor-site morbidity. Microsurgical free fillet flap transfer to amputation sites is valuable for achieving wound closure, improving stump durability, and maximizing function via preservation of length. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source] Management of isolated orbital floor blow-out fractures: a survey of Australian and New Zealand oral and maxillofacial surgeonsCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2004Anthony J Lynham FRCS FRACDS(OMS) Abstract Background:,This is the first report of involvement of Australian and New Zealand oral and maxillofacial surgeons in the management of isolated orbital floor blow-out fractures and was conducted to obtain comparisons with the results from a recent similar survey of British oral and maxillofacial surgeons. Methods:,A questionnaire survey was sent to all 113 practising members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons in April 2002 with a second mailout 1 month later. Results:,Sixty-nine per cent of the respondents were referred isolated orbital floor blow-out fractures for management, and just over half of these respondents estimated that 50% or more of the cases went to surgery. The materials most commonly used in orbital floor reconstruction were resorbable membrane for small defects and autologous bone for large defects. Conclusion:,As in Britain, management of isolated orbital floor blow-out fractures comprises part of the surgical spectrum for many oral and maxillofacial surgeons in Australia and New Zealand. The management protocol was observed to be very similar between the two groups. [source] Aplasia cutis congenita of the scalp: How much therapy is necessary in large defects?ACTA PAEDIATRICA, Issue 6 2005B Bernbeck Abstract Aim: To show that local antibiotic management and a regular inspection of aplasia cutis congenita of the skull can give an excellent result. Method: This case reports a girl born with aplasia cutis congenita of the skull presenting with a large aplasia of the epidermis, dermis, subcutaneous tissue and galea, including a bone defect without any additional risk factor, e.g. early eschar formation, cerebrospinal fluid leakage or uncommon dural blood vessels. Results: A primarily conservative treatment with local wet and antibiotic dressings together with a systemic antibiotic treatment for the first 2 wk led to an excellent result and thus prevented untimely operative and peri-operative procedures. Conclusions: Here we have shown that conservative treatment might be an option, even if the wound diameter is greater than 1 cm2, to prevent infants from any untimely operative procedure with an elevated operative risk if any additional risk factors are excluded. [source] Biodegradable polylactide membranes for bone defect coverage: biocompatibility testing, radiological and histological evaluation in a sheep modelCLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2006Gerhard Schmidmaier Abstract: Large bony defects often show a delayed healing and have an increasing risk of infection. Several materials are used for the coverage of large defects. These materials must be biocompatible, easy to use, and must have an appropriate stability to present a mechanical hindrance. Aim of this study was to investigate two different biodegradable membranes for defect coverage in a sheep model. Round cranial defects (1.5 cm diameter) were created in sheep. Six different treatments were investigated: defects without membrane, defects covered with a poly(d,l -lactide) or with a 70/30 poly(l/d,l -lactide) membrane and all defects with or without spongiosa filling. The sheep were sacrificed 12 or 24 weeks postoperatively. Bone formation in the defects was quantified by computer-assisted measurements of the area of the residual defect on CT radiographs. Histomorphometry and host-tissue response were evaluated by light microscopy. The biocompatibility was investigated by analyzing the amount of osteoclasts and foreign body cells. Both membranes served as a mechanical hindrance to prevent the prolapse of soft tissue into the defect. The biocompatibility test revealed no differences in the amount and distribution of osteoclasts at the two investigated time points and between the investigated groups. No negative effect on the tissue regeneration was detectable between the investigated groups related to the type of membrane, but a foreign body reaction around the two membrane types was observed. In the membrane-covered defects, the spongiosa showed a progressing remodeling to the native bony structure of the cranium. The groups without spongiosa partly revealed new bone formation, without complete bridging in any group or at any time point. Comparing the 12 and 24 weeks groups, an increased bone formation was detectable at the later time point. In conclusion, the results of the present in vivo study reveal a good biocompatibility and prevention of soft tissue prolapse of the two used membranes without differences between the membranes. An enhanced remodeling of the spongiosa into native bony structures under the membranes was detectable, but no osteopromoting effect was observed due to the membranes. [source] | ||||||||||||||||||||||