ABSTRACT
@#Autologous fat transplantation in the treatment of velopharyngeal insufficiency has the advantages of good histocompatibility, small local trauma, few complications, reversible operation and simple postoperative nursing, which can effectively increase the velopharyngeal closure area. If the clinical effect is poor, other surgical methods can be used at any time for replacement. Although there are many advantages in the treatment of velopharyngeal insufficiency with autologous fat transplantation, there are still some problems in the selection of indication, donor site, injection dose, recipient site, follow-up evaluation, complications and prevention and treatment. Current research shows that autologous fat transplantation is mainly used in patients with mild or moderate velopharyngeal insufficiency, but with the improvement of fat acquisition and treatment techniques, the indications for autologous fat transplantation continue to expand, and autologous fat transplantation combined with palatoplasty or pharyngoplasty has been proposed for the treatment of severe velopharyngeal insufficiency. However, there are complications, such as fat absorption and obstructive sleep apnea syndrome. In addition, the application of autologous fat transplantation in severe VPI patients and how to improve the long-term stability of autologous fat transplantation need further study.
ABSTRACT
Background: Split skin grafting is widely used surgical procedure for the treatment of ulcers. Graft survival depends on number of factors like vascularity, wound infection etc, diabetes is associated with endothelial dysfunction, neuropathy, wound infection which collectively affect the graft survival. Objective of this study was to compare the amount of graft uptake, the post-operative complications and survival of split thickness skin graft in diabetic and non-diabetic ulcer.Methods: In our prospective comparative study total 112 patients with ulcer were included of which 56 were diabetic and 56 were non-diabetic. All of them underwent split skin grafting as part of their wound management. Comparison was made between two groups in terms of amount of graft uptake, post-operative wound infection, revisional surgery, donor site infection.Results: Compared with non-diabetics, diabetics have significantly less graft uptake (p<0.001). out of 56 patients in diabetic group 4 (66.7%) underwent revisional surgery, out of 56 patients in non-diabetic group 2 (33.3) patients underwent revisional surgery (p value is <0.68) which is statistically insignificant. 3 (60%) out of 56 in diabetic group developed post-operative graft infection, 2 (40%) out of 56 in non-diabetic group developed graft infection (p=1, not significant). One patient in the study developed donor site infection. Among 112 cases, only 1 case had donor site infection with diabetic.Conclusions: Diabetes is associated with poor graft uptake and post-operative complication rates in patients undergoing split skin grafting.
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Objective@#To explore the choice of the donor site of flap and the repair method of secondary wound of flap donor site in tissue repair and reconstruction operation.@*Methods@#From January 2014 to September 2018, 62 cases of scar contracture deformity, 15 cases of skin tumor, 20 cases of skin and soft tissue injury, and 25 cases of chronic wound were admitted to the Burn Center of People′s Liberation Army of First Affiliated Hospital of Air Force Medical University, with 84 males and 38 females, aged from 3 to 89 years. Four repair strategies adopted for tissue repair and reconstruction and good repair of the donor site of flap were as follows: designing the flap rationally according to the condition around the wound or the size and shape of wound, choosing pre-expanded technique of the donor site of flap for repair of scar deformity optimally, making full use of the surrounding condition of flap donor site, and repaired with the distal flap, i. e. replacing the important site with secondary site. The donor site of flap was repaired by direct suture or peripheral flap and distal flap. The wound size of patients ranged from 3.0 cm×2.0 cm to 20.0 cm×18.0 cm, and the flap area ranged from 3.5 cm×2.0 cm to 25.0 cm×22.0 cm. The survival condition of flap, healing condition of donor site and recipient site, and follow-up condition of donor site and recipient site were recorded.@*Results@#Wounds of 122 patients were repaired with a total of 148 flaps designed by the above four repair strategies. All the flaps survived well, and the wound and flap donor site healed well. Follow-up for 3 to 36 months showed that the shape and function of recipient site and flap donor site were satisfactory.@*Conclusions@#According to the specific condition of the wound and anatomical structure of the surrounding tissue of flap donor site, overall surgical design with flexibility and personalization can achieve effects of good repair of the wound and reduce the secondary damage of flap donor site.
ABSTRACT
STATEMENT OF PROBLEM: After placing the implant on the jaw, firm osseointegration between the implant interface and the bone should be achieved so that it can perform the same function as the normal teeth. That is, stability of the implant is required in order to form firm osseointegration. PURPOSE: This study was performed to evaluate the effect of implant preparation methods on primary implant stability in various bone qualities. MATERIAL AND METHODS: The recipient sites were prepared by various methods on 4 types of wooden plates (Osstem Co., Korea) which have similar mechanical properties with 4 types of human bone quality. The groups were divided according to implant preparation methods: In the control group the recipient sites were prepared from 1.8 mm guide drill, 2.0 mm initial drill, 2.7 mm pilot drill, 2.7 mm twist drill, 3.0 mm twist drill, 3.3 mm pilot drill, 3.3 mm twist drill, countersink drill, and tapping drill sequentially and 6 RBM surfaced GSII Osstem implants (Osstem Co., Korea) were installed in each type of wooden plates; In group 1, the recipient sites were prepared from 1.8 mm guide drill to 3.0 twist drill sequentially without countersink drill nor tapping drill and implants were placed; In group 2, the recipient sites were prepared from 1.8 mm guide drill to 3.0 mm twist drill, and countersink drill sequentially without tapping drill and implants were placed; In group 3, the recipient sites were prepared from 1.8 mm guide drill to 3.0 mm twist drill, countersink drill, and tapping drill sequentially and implants were placed; In group 4, the recipient sites were prepared from 1.8 mm guide drill to 3.3 mm twist drill sequentially without countersink drill nor tapping drill and implants were placed; In group 5, the recipient sites were prepared from 1.8 mm guide drill to 3.3 mm twist drill and countersink drill sequentially without tapping drill and implants were placed; In group 6, the recipient sites were prepared with 2.0 mm twist drill and 3.0 mm osteotome and implants were placed. The insertion torque was measured by INTRA surg(R)300 (KaVo., Germany). After installation of implants, the primary implant stability was measured by using Osstell(TM), Osstell(TM) mentor, and Periotest(R), and insertion torque test. The statistical analysis of the results was analyzed using SPSS ver. 12.0. Student t-tests and one-way analysis of variance (ANOVA) were used. RESULTS: The results obtained were as follows; 1. In type I and II bone quality plates, although the mean value of primary implant stability was somewhat different according to test methods, the primary implant stability of group 1 was significantly higher than those of other groups (p<0.05). 2. In type III bone quality plate, the primary implant stability of group 1 was significantly higher than those of other groups in Osstell(TM) test, the primary stability of group 1 and group 6 were significantly higher than those of other groups in Osstell(TM) mentor and Periotest(R), and the stability of group 6 was significantly higher than those of other groups in insertion torque test (p<0.05). 3. In type IV bone quality plate, the primary implant stability of group 6 was significantly higher than those of other groups (p<0.05). 4. As the quality of bone was softer, the primary implant stability tended to be lower in values. This tendency was not significantly different in Osstell(TM) and Osstell(TM) mentor tests, but it was significantly different in insertion torque test (p<0.05). 5. In type IV bone quality plate, the mean values of primary implant stability which were calculated by Osstell(TM) was 14.8+/-8.6 higher than the values calculated by Osstell(TM) mentor. CONCLUSION: These results suggest that the recipient implant preparation by using minimal drilling and osteotome may be useful in obtaining the primary implant stability and the insertion torque test seems be the most simple and predictable method.