Optimización del injerto conectivo subepitelial en la cobertura de recesiones gingivales múltiples contiguas: presentación de un caso clínico / Optimization of the subephitelial connectivetissue graft to treat adjacent multiple gingivalrecessions. Clinical case presentation

Objetivo: describir, mediante un caso clínico, una técnica quirúrgica para la optimización del injerto conectivo libre subepitelial en la cobertura de recesiones gingivales contiguas múltiples. Caso clínico: Una paciente de sexo femenino, de 57 años de edad, concurrió a la consulta con recesiones clase III de Miller, abfracciones, erosiones y malposición. El procedimiento quirúrgico elegido fue la técnica de desplazado coronal con incisiones oblicuas. Se realizó la toma de un injerto conectivo subepitelial y se lo optimizó en seis porciones trian-gulares, de manera tal que cada una abarcara una recesión desde el 13 hasta el 23. Se efectuó el seguimiento de la cicatrización y de la estabilidad de la cobertura radicular a los 90 días.Conclusión: Este nuevo abordaje quirúrgico es una alternativa válida para cubrir recesiones gingivales múltiples en un solo procedimiento, al poder aprovechar al máximo la utilización de un injerto conectivo libre subepitelial.

Aim: to present the surgical resolution of a clinical caseof multiple gingival recessions treated with a novel approach.Case report: A 57 year-old non-smoking female patientwith Miller Class III gingival recessions abfractions, erosionsand tooth malposition came to the consultation. The treatmentthat was chosen consisted in covering the gingival recessionswith a coronal advanced flap with oblique incisions. A subephitelialgingival graft was harvested from the palate andan optimization in triangular portions was made, in order touse one portion for each recession. Healing and stability wererecorded for a 90 days follow-up period.Conclusion: This new surgical approach could be analternative for the treatment of multiple gingival recessionsin a single procedure, as the use of the ILS could be maximized.

Interpositional Arthroplasty with Temporomyofascial Flap to Correct TMJ Reankylosis in Child: A Case Report.

Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the temporomandibular joint (TMJ) is replaced by scar tissue. Most frequently reported complications after surgical treatment are limited mouth opening and re-ankylosis. Reankylosis happens due to inadequate bone removal, lack of sufficient interpositional material, fibrous tissue adhesions and elongation of coronoid process and regrowth of bone in the sigmoid notch area. In gap arthroplasty treatment chances to recurrence is 53% than interpositional arthroplasy. We treated a case of right sided TMJ reankylosis by interpositional arthroplasty with temporomyofacial flap and physiotherapy was started 3 days after surgery and maintained for 6 months. In 2 years follow-up, no signs of recurrence and maximum mouth opening 45 mm were observed. The success in preventing reankylosis after TMJ interpositional arthroplasty with temporomyofacial flap is relatively better than gap arthroplasty alone.

Platelet-Rich Fibrin a Second Generation Autologous Platelet Concentrate for the Treatment of Inadequate Width of Attached Gingiva.

Along with the better understanding of the pathogenesis of periodontal diseases, the treatment modalities for various periodontal diseases have also gone a step ahead. One of the most important and currently unsolved problems in clinical periodontics is the predictable successful treatment of inadequate width of attached gingiva. Recently, importance has been given to the use of platelet-rich fibrin (PRF) for predictably treating periodontal diseases. PRF is an intimate assembly of glycan chains, glycoproteins, and cytokines. These are enmeshed in a slowly polymerized fibrin network which has the potential to accelerate soft and hard tissue healing. This article presents the clinical results of treatment of inadequate width of attached gingiva with PRF.

Técnica rollo modificado en H para mejorar el perfil de emergencia en implantes unitarios: reporte de un caso / H-modified roll technique to improve the emergence profile in single implants: report of a case

Uno de los principales problemas que tiene que afrontar la terapia periodontal e implantológica es la preservación del reborde alveolar y los tejidos blandos luego de la colocación de un implante dental más aún si se trata de la zona anterior en donde se requiere de una alta estética. Presentamos el caso de una paciente de sexo femenino que presenta defecto I de Seibert en lazona del implante inmediato post exodoncia de la pieza 1.2. Se decide realizar la Técnica de Rollo modificado en H para mejorar el aspecto vestibular del reborde reabsorbido. Se obtienen óptimos resultados, y una mejora substancial del aspecto estético vestibular al cabo de 3 meses de cicatrización.

Hiperplasia gingival fibrosa en sitio estético: enfoque quirúrgico ante recidiva / Fibrous gingival hyperplasia in esthetic zone: surgical approach on recurrence

Objetivo: aportar evidencia clínica sobre el abordaje de lesiones hiperplásicas en sitios estéticos y enfatizar la importancia de la planificación quirúrgica para reducir al mínimo su recidiva. Caso clínico: una paciente de 65 años de edad se presentó a la consulta con lesión nodular localizada en encía vestibular de pieza 21, con un período de evolución de 18 meses. Se describe el procedimiento quirúrgico inicial llevado a cabo para su tratamiento, el diagnóstico anatomopatológico, su evolución y recidiva, y un nuevo enfoque quirúrgico para su eliminación. Conclusiones: este informe enfatiza la importancia de una completa escisión de la lesión con margen de seguridad para evitar su recidiva, como objetivo primario en el abordaje quirúrgico. En sitios estéticos, la biopsia escisional, junto con la cirugía plástica periodontal, puede ser una opción para restaurar la salud gingival y devolver la estética y función al sitio

Recesión única en el maxilar superior, tratamiento mediante colgajo desplazado lateral avanzado coronalmente: reporte de casos / Isolated recession in the upper maxillary, treatment by means of coronally advanced lateral flap: report of cases

Describir el tratamiento quirúrgico realizado, como también evaluar la cicatrización y cobertura gingival obtenida en dos pacientes con recesiones gingivales únicas en vestibular del maxilar superior. Casos clínicos: en los dos casos presentados en este reporte se trataron quirúrgicamente dos recesiones clase I y II de Miller, mediante colgajo desplazado lateral avanzado coronalmente. Conclusiones: es de suma importancia preservar y/o recuperar los tejidos gingivales, no solamente desde el punto de vista estético sino también funcional. Debemos considerar los factores anatómicos locales que influyen en el resultado final y hacer un diagnóstico correcto del caso. Aprovechando las ventajas de esta técnica disminuiremos los fracasos...

Outcomes of breast reconstruction with pedicled transverse rectus abdominis myocutaneous [TRAM] flap at cancer institute: a retrospective study of 10 years of experience

Reconstruction of breast with transverse rectus abdominis myocutaneous [TRAM] flap is the standard for reconstruction of breast following mastectomy. In this article, authors report their experience with pedicled TRAM flap reconstruction of the breast. Records for the patients who had undergone breast reconstruction with pedicled TRAM flap were retrieved. Records of outpatient followups were also obtained. Patient satisfaction with the outcome of surgery was assessed using a detailed questionnaire including a linear visual analogue scale ranging from zero [not satisfied] to ten [most satisfied]. There were 61 reconstructions in 59 patients. In 42 [71.2%] cases a synthetic mesh and in 14 [23.7%] cases dermal graft was used for closure of the abdominal fascial defect. The mean hospital stay was 10.67 [1 - 72] days. Patients were followed up for a mean period of 621 days. The overall rates of complications were as follows: partial flap necrosis: 11 [18.6%], flap hematoma: 2 [3.4%], flap seroma: 7 [11.9%], flap wound infection: 7 [11.9%], abdominal wound hematoma: 9 [15.3%], abdominal wound seroma: 5 [8.5%], abdominal wound ischemia: 1 [1.7%], abdominal wound incisional hernia: 6 [10.2%], deep vein thrombosis: 1 [1.7%], complication requiring rehospitalization: 9 [15.3%], complication requiring reoperation: 8 [13.6%]. There were no abdominal wound infection, no umbilical necrosis, and no pulmonary embolism. Aesthetic results were classified as excellent [62%], good [28%], fair [10%]. The mean satisfaction score was 9.5 [range 6-10]. Breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap was associated with a low complication rate and a high level of patient satisfaction in our center

Primary closure of fistulectomy wound with island advancement flap in management of low peri-anal fistula: a new technique for rapid healing

Low perianal fistula can be treated by fistulotomy but this may involve prolonged wound healing and compromise anal continence. On the other hand, if fistulectomy is done, gapping of the wound occurs with further increase in the raw surface. Primary closure of the fistulectomy wound with island advancement composite flap to induce rapid healing and compare its clinical and anal manometric outcome with that of fistulotomy. This study was done on 49 patients with low perianal fistulas. All patients were subjected to anal manometric study preoperatively and 6 weeks and 3 months postoperatively including measurement of resting anal pressure [RAP], maximal squeeze anal pressure [MSP] and functional sphincteric length [FSL] of anal canal. The type of fistula was assessed and the radial distance of the external opening from the anal verge was measured. Patients were divided into 2 groups. FF group included 26 patients in whom fistulectomy with careful dissection of fistula tract from the external sphincter and primary closure of the raw surface with island advancement flap were done. F group included 23 patients in whom fistulotomy alone was done. Follow up was done for a mean period of 9.1 months to assess continence, healing and anal manometric parameters. In the FF group, intersphincteric fistula was found in 57.7% and trans-sphincteric fistula in 42.3%. The mean radial distance of external openings was 4.1cm. In the F group, intersphincteric fistula was found in 56.5% and trans-sphincteric fistula in 43.5%. The mean radial distance of the external openings was 4.2cm. In the FF group, all flaps were viable and healed primarily and the extra-anal stitches were removed by the end of the 3[rd] week. Two patients were incontinent to flatus [7.7%] and regained full continence by the end of follow up. No recurrence was recorded. In the F group, complete wound healing occurred after a mean period of 9.8 weeks, incontinence to flatus occurred in one patient and to both flatus and fluid stool in another 2 patients [13%]. Two of them regained full continence by the end of follow up but one still incontinent to flatus. Recurrence occurred in 2 patients [8.3%]. Anal manometric study showed insignificant change in the post-operative RAP and FSL in both groups as well as the MSP in the FF group. The MSP showed significant drop at 3 months in F group. On conclusion, fistulectomy with careful dissection of the fistula tract from the external anal sphincter and primary closure of the raw surface with island advancement flap resulted in more rapid healing with less deformity of the anus and preserve anal pressure and continence with no recurrence

Laparoscopic flip flap technique versus conventional inguinal hernia repair in children

Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Due to recent wide usage of laparoscopy in surgical practice, several techniques of pediatric laparoscopic inguinal hernia repair were introduced. There is still unresolved debate regarding the feasibility of laparoscopy for treating pediatric inguinal hernia. A retrospective cohort study was done enrolling 33 patients, who underwent congenital inguinal hernia repair in the pediatric surgery department, Zagazig University from July, 2004, to October, 2004, by either new laparoscopic flip flap technique or conventional open repair. Patients were divided into two groups according to the type of surgery done, Group A, who underwent the new laparoscopic technique and Group B, who underwent conventional open repair. Group A included 15 patients [mean age 39 months], Group B included 18 patients [mean age 44 months].The mean operative time was 47.5 minutes for Group A, while in Group B mean operative time was 27.5 minutes. In group A, Intraoperative complications included: injury of vas deferens in one patient [7%], and tearing of the flaps during suturing in 3 [20%]. No intraoperative complications were encountered in Group B. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up for 6 months revealed recurrence in 4 cases in Group A [27%], while no recurrences occurred in Group B. Our preliminary experience showed unsatisfactory outcome with the laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard in this age group

effect of coronally advanced flap in root coverage of miller class 1 recessions in single rooted teeth

Gingival recession has a high prevalence. Tooth sensitivity and esthetic problem are two complications of gingival recessions. This study was designed to evaluate the clinical outcome following treatment of localized gingival recessions using coronally advanced flaps [CAF]. Seven consecutively patients in Shahid Beheshty faculty of dentistry [2002] with buccal Class I Miller gingival recession having high level of oral hygiene, were included in this study. Blind calibrated evaluation, provided 20 sites in single-rooted teeth. Clinical measurements including recession height [RH], clinical attachment level [CAL], height of keratinized gingiva [KG] and probing depth [PD] were taken by means of Williams probe, Caliper and acrylic stent. During surgical procedures, CAF was similarly carried out in all of teeth. Clinical measurements were repeated fallowing 3 month post-surgery and areas of covered roots were calculated with AutoCad software by means of 5 points of each root. CAF resulted in a significant decrease in recession depth [2.39 +/- 0/82m, 60.8% and recession width [2/1 +/- 2 mm, 43/7%, P<0.002] and gain in CAL[2.63 +/- 0.9, P<0.001]. Area of covered root was 10.44 +/- 7.04mm in CAF [p<0.01] after the 3-month evaluation. PD and KG changes were small and not significant. Using CAF 55% of roots of the teeth were covered by more than 12.5 mm2 [two-third of highest value]. The CAF operation offers a predictable, simple and convenient approach to root coverage procedure in Miller Class I recession defects

Skin sparing mastectomy and immediate breast reconstruction

To evaluate skin sparing mastectomy[SSM] and immediate breast reconstruction[IBR] in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems. An interventional study. The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003. Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done. The patients' age ranged between 25-46 years. Two patients [7%] were nullipara. Tumor size was T1 in 10 [36%] and T2 in 18 patients [64%]. In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 [86%] and latissimus dorsi flap in 4 patients [14%]. All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 [10.5%], infection in 03 [10.5%], axillary seroma in 03 [10.5%] and abdominal seroma in 01 patient [3.5%]. As late complication 5 patients [19%] developed fat necrosis. Adjuvant chemotherapy was given in 6 [21%] and adjuvant radiotherapy in 4 patients [14%]. No recurrence encountered in maximum follow-up. We found an excellent aesthetic restoration in 23 [82%], good in 1 [3.5%] and fair in 4 patients [14%]. SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression

Técnica quirúrgica antifuga en el implante de catéter de Tenckhoff para diálisis peritoneal / Antileaking surgical technique in implantation of Tenckhoff's catheter for peritonal dialisis

Se realizó un estudio experimental, prospectivo, comparativo, de selección aleatoria y ciego en los Hospitales Nuevo Civil y México Americano de Guadalajara, de enero a diciembre de 1994, en que se analizaron dos procedimientos utilizados para disminuir hiperazoemia en pacientes con insuficiencia renal crónica o aguda, con la finalidad de establecer eficiencia obtenida mediante la aplicación de catéteres de diálisis peritoneal rectos y curvos a la cavidad peritoneal. En ambas técnicas se fijo firmemente el catéter a la aponeurosis peritoneal o posterior del músculo recto anterior del abdomen. Distribuimos 90 pacientes en dos grupos de 45, para comparar la técnica quirúrgica original de colocación de catéter de diálisis frente a una técnica que denominamos "antifuga". El objetivo principal es demostrar que utilizando la técnica antifuga y clasificando la consistencia de la aponeurosis posterior del músculo recto anterior del abdomen (APRA) y utilizando el grosor de la sutura según su firmeza, pudiera existir un menor número de fugas, infecciones del túnel subcutáneo e infección en el sitio de salida de la pared abdominal, además de disminuir otras complicaciones secundarias, como son: dehiscencia, herniación e infección de la herida quirúrgica. Con base a los resultados de este estudio experimental concluimos que existe correlación entre la fuga temprana de soluciones con la técnica original y con la edad, grado de obesidad y APRA de los pacientes. Además, que el de catéteres en espiral fallan que menor frecuencia que los rectos, por lo que recomendamos la técnica antifuga y el empleo de catéteres en espiral en el manejo de diálisis peritoneal ambulatoria para pacientes con insuficiencia renal crónica

Use of conventional forehead flaps for reconstruction of large full thickness nasal defects

We present our experience of seven years in using conventional median and modified median forehead flap for reconstruction of large full thickness nasal defects in 34 patients [followed-up for 3 to 84 months; mean 40.5 months]. In all cases the flap remained completely viable. Donor site deformity was minimal and well accepted. The flap provides a good solution to the challenging problem of partial and total nasal reconstruction in terms of simplicity, reliability and aesthetics

skin advancement flap as an adjustment for repairing angle of mouth in oral cancer

Oral cancer is difficult to repair if excision involves the lips and angle of the mouth. A successful primary repair becomes more important when there are economic constraints and the follow-up turn out is poor. In this case the cancer involved both lips and the commissure. Disease free margins were achieved following excision. An advancement flap was raised from the lower part of the face as an adjvant to the conventional Abbe Estlander and Karapandzic flaps to cover the defect. There was no speech defect or drooling of saliva. Mouth opening and cosmetic results were acceptable in a year's follow-up

Reparación de grandes defectos cutáneos con colgajos libres microvasculares / Skin coverage after surgical removal of extensive skin cancers with microvascular free flaps

Antecedentes: La reparación de grandes defectos cutáneos post-resección de tumores malignos representó durante años un desafío difícil de solucionar para el cirujano oncológico debido a las limitaciones impuestas por los procedimiento reconstructivos. Objetivo: Se analizó la experiencia de la División de Cirugía Oncológica del Hospital de Clínicas en las reconstrucciones post-resección de tumores cutáneos con colgajos libres microquirúrgicos entre los años 1986-1997. Diseño: Estudio retrospectivo. Población: Se analizaron 37 enfermos (31 con lesiones de cabeza y cuello, 4 en miembro superior y 2 en miembro inferior) en quienes se realizaron 39 colgajos sobre un total de 147 pts. reconstruidos con 153 colgajos, en quienes se realizaron 24 colgajos radiales, 14 paraescapulares, y 1 dorsal ancho. Métodos: Se realizó la revisión de las historias clínicas de pacientes portadores de tumores cutáneos, analizándose la aplicabilidad del método, las complicaciones y un análisis de resultados categorizándolos en buenos, regulares y malos. Resultados: Se registró un índice global de complicaciones de 13 por ciento (5 casos). En 2 casos necrosis del colgajo. No hubo mortalidad operatoria. 94 por ciento de los pts. tuvieron resultados buenos o regulares. Conclusiones: Las reconstrucciones con colgajos microquirúrgicos tienen distintas ventajas sobre las técnicas hasta ahora utilizadas. Por esta razón son preferidas para la reconstrucción de grandes defectos planos, en dos y o en tres dimensiones; en un tiempo operatorio, con escasa morbilidad y nula mortalidad, y resultados estéticos y funcionales superiores. El colgajo radial tiene un pedículo, puede disecarse y requiere el uso de injerto sobre la zona dadora. El paraescapular de fácil disección, provee una isla de piel delicada de gran extensión, tiene un pedículo confiable y permite el cierre primario de la zona dadora

Reconstruçäo total de lábio superior e columela com retalho musculocutânea em ilha do depressor do ângulo da boca / Depressor anguli oris myocutaneous island flap for total upper lip and columella recontruction

Os autores relatam caso de paciente que, após varias ressecçoes prévias de carcinomas de face, evoluiu com deformidade do labio superior, com comprometimento estético e funcional. Associadamente, apresentava perda total da columela. A reparaçao total do labio superior foi realizada por meio do retalho musculocutâneo, em ilha do depressor do ângulo da boca.

El colgajo de músculo intercostal en la protección de las suturas traqueobronquiales / Intercostal muscle flap to protect bronchial sutures

Se presenta la experiencia obtenida con el colgajo de músculos intercostales y su pedículo neurovascular intacto como método de protección de 49 suturas bronquiales en resecciones pulmonares; 1 sutura bronquial lateral por fístula esófago-bronquial; 1 sutura de carina por herida de arma de fuego y 2 suturas traqueales durante resecciones esofágicas. El colgajo se confeccionó con y sin resección costal. Los cierres bronquiales fueron ejecutados con sutura mecánica en 49 casos y manual en 1; las suturas de carina y tráquea se ejecutaron también en forma manual. En la serie no hubo ninguna fístula bronquial ni complicaciones atribuíbles al procedimiento

Salvataje de extremidad inferior en diabéticos: trasplante muscular microquirúrgico con y sin reconstrucción vascular previa / Salvage of low extremity in diabetics: microsurgical muscular transplantation with and without previous vascular reconstruction

Soft tissue wounds with or without bony involvement are a common problem and a cause of limb loss in diabetics. Usually local care, antibiotics, minor debridement and skin grafting are enough for successful handling of these lesions. When there proximal bony involvement and tendom exposure, the incidence of primary amputation rises, frequently being considered the only alternative. Two cases of diabetic patients with indication of primary amputation of a lower limb for large infected ulcers are reported. A microvascularized muscle transplant wa sused to cover large defects of soft tissue, tendoms and infected bone. One patient presented also critical ischaemia of the limb, requiring iliac angioplasty and a femoro-distal by-pass with in situ greater saphenous vein previous to the muscle graft. Both patients had no postoperative complications, being able to walk two months after the operation with their useful limb. Microvascularized muscle transplant with or without revascularization is a very useful alternative to amputation in the management of complex wounds of selected diabetic patients

Retalho livre lateral do braço: avaliaçäo de dez casos / Lateral arm free flap: evaluation of 10 cases

Os autores apresentam análise de dez casos de retalho livre lateral do braço, realizado em dez pacientes, no período de março de 1994 a agosto de 1996. Foram empregados no tratamento de lesöes cutâneas de membros superiores e inferiores de natureza diversa. Quanto à composiçäo dos tecidos, foram oito retalhos fasciocutâneos, um osteocutâneo e um osteocutâneo e tendinoso. Com relaçäo à viabilidade, todos os retalhos mantiveram-se viáveis, a despeito de um caso de trombose intra-operatória e um de necrose parcial de pele, resolvidos com trombectomia e enxerto de pele parcial, respectivamente. O retalho lateral do braço mostrou-se eficaz no tratamento de defeitos cutâneos isolados ou combinados, de pequenas e médias proporçoes, quando os recursos convencionais da cirurgia reparadora eram questionáveis.