Cobertura con colgajos de dispositivos ortopédicos en el miembro inferior: experiencia clínica / Covering with Orthopedic Devices Flaps in the Lower Limbs: A Clinical Experience

RESUMEN Introducción: La cobertura de dispositivos ortopédicos expuestos y las infecciones en el hueso con colgajos es un tema controvertido. No existe un consenso claro sobre el tratamiento de esta complicación. En los últimos años se aprecia una tendencia a mantener el material de osteosíntesis y a controlar la infección aportando tejido bien vascularizado en forma de colgajo muscular o fasciocutáneo. Objetivo: Evaluar el éxito reconstructivo con colgajos de defectos de partes blandas en miembros que han precisado de una osteosíntesis, en función de la presencia de infección y el estado de los dispositivos de implante en el momento de la reconstrucción. Métodos: Estudio retrospectivo de una serie de 15 casos con un defecto de partes blandas en las extremidades inferiores secundario a la implantación de dispositivos ortopédicos en el hueso. Todos los casos recibieron cobertura con un colgajo muscular o fasciocutáneo con o sin retirada de los implantes. Se estudió la presencia o ausencia de infección previa a la reconstrucción (signos clínicos, resultado del cultivo microbiológico y exposición del material ortopédico), la retirada o mantenimiento del implante durante la reconstrucción, y la presencia de complicaciones posoperatorias. Se relacionaron estas variables con el éxito reconstructivo posoperatorio. El análisis de las variables se realizó con los estadísticos chi cuadrado, Wilcoxon y U de Mann Whitney, según el tipo de variable, y para una significación de 0,05. Resultados: La frecuencia de éxito reconstructivo fue mayor en aquellos pacientes con cultivo negativo sin exposición de material óseo (p = 0,038). Se encontró menor tasa de complicaciones en los pacientes que presentaban infección antes de la reconstrucción (p = 0,039), y en aquellos con cultivo positivo y exposición del material previos a la cirugía, cuyos implantes habían sido retirados durante la reconstrucción (p = 0,032). Conclusiones: El aporte de tejido bien vascularizado en forma de colgajo permite el mantenimiento del material ortopédico con una frecuencia de éxito de 66,67 %, y resultados favorables de mediano a largo plazo. La exposición y el resultado del cultivo son indicadores predictivos de los resultados de la cirugía(AU)

ABSTRACT Introduction: The covering of exposed orthopedic devices and bone infections with flaps are a controversial issue. There is no clear consensus concerning the treatment of this complication. In recent years, there has been a trend to maintain the osteosynthesis material and to control the infection by providing well vascularized tissue in the form of a muscular or fasciocutaneous flap. Objective: To assess the reconstructive success with flaps of soft tissue defects in limbs that have required osteosynthesis, based on the presence of infection and the status of the implant devices at the time of reconstruction. Methods: Retrospective study of a series of 15 cases with soft tissue defect in the lower limbs after implantation of orthopedic devices to the bone. All the cases were covered with muscle or fasciocutaneous flap, with or without removal of the implants. The presence or absence of infection prior to reconstruction (clinical signs, results of microbiological culture, and exposure of the orthopedic material), removal or maintenance of the implant during reconstruction, and the presence of postoperative complications were studied. These variables were associated with postoperative reconstructive success. The analysis of the variables was performed using the chi-square, as well as Wilcoxon and Mann Whitney U tests, according to the type of variable, and for a significance of 0.05. Results: The frequency of reconstructive success was higher in those patients with negative culture and without exposure of bone material (P=0.038). A lower rate of complications was found in patients with infection before reconstruction (P=0.039), and in those with positive culture and exposure of the material prior to surgery, whose implants had been removed during reconstruction (P=0.032). Conclusions: The provision of well vascularized tissue in the form of flap allows maintenance of the orthopedic material with a success rate of 66.67%, as well as favorable outcomes in the mid to long terms. The results of exposure and culture are predictive indicators of surgery outcomes(AU)

Effects of contamination by either blood or a hemostatic agent on the shear bond strength of orthodontic buttons / 대한치과교정학회지

OBJECTIVE: To evaluate the effects of contamination by either blood or a hemostatic agent on the shear bond strength (SBS) of orthodontic buttons. METHODS: We used 45 freshly extracted, non-carious, impacted third molars that were divided into 3 groups of 15. Each tooth was etched with 37% phosphoric acid gel for 30 s. Human blood or the blood stopper agent was applied to the tooth surface in groups I and II, respectively. Group III teeth were untreated (controls). Orthodontic buttons were bonded to the teeth using light-curing composite resin. After bonding, the SBS of the button was determined using a Universal testing machine. Any adhesive remaining after debonding was assessed and scored according to the modified adhesive remnant index (ARI). ANOVA with post-hoc Tukey's test was used to determine significant differences in SBS and Fisher's exact test, to determine significant differences in ARI scores among groups. RESULTS: ANOVA indicated a significant difference between groups (p < 0.001). The highest SBS values were measured in group III (10.73 +/- 0.96 MPa). The SBS values for teeth in groups I and II were significantly lower than that of group III (p < 0.001). The lowest SBS values were observed in group I teeth (4.17 +/- 1.11 MPa) (p < 0.001). CONCLUSIONS: Contamination of tooth surfaces with either blood or hemostatic agent significantly decreased the SBS of orthodontic buttons. When the contamination risk is high, it is recommended to use the blood stopper agent when bonding orthodontic buttons on impacted teeth.

Effects of contamination by either blood or a hemostatic agent on the shear bond strength of orthodontic buttons / 대한치과교정학회지

OBJECTIVE: To evaluate the effects of contamination by either blood or a hemostatic agent on the shear bond strength (SBS) of orthodontic buttons. METHODS: We used 45 freshly extracted, non-carious, impacted third molars that were divided into 3 groups of 15. Each tooth was etched with 37% phosphoric acid gel for 30 s. Human blood or the blood stopper agent was applied to the tooth surface in groups I and II, respectively. Group III teeth were untreated (controls). Orthodontic buttons were bonded to the teeth using light-curing composite resin. After bonding, the SBS of the button was determined using a Universal testing machine. Any adhesive remaining after debonding was assessed and scored according to the modified adhesive remnant index (ARI). ANOVA with post-hoc Tukey's test was used to determine significant differences in SBS and Fisher's exact test, to determine significant differences in ARI scores among groups. RESULTS: ANOVA indicated a significant difference between groups (p < 0.001). The highest SBS values were measured in group III (10.73 +/- 0.96 MPa). The SBS values for teeth in groups I and II were significantly lower than that of group III (p < 0.001). The lowest SBS values were observed in group I teeth (4.17 +/- 1.11 MPa) (p < 0.001). CONCLUSIONS: Contamination of tooth surfaces with either blood or hemostatic agent significantly decreased the SBS of orthodontic buttons. When the contamination risk is high, it is recommended to use the blood stopper agent when bonding orthodontic buttons on impacted teeth.

Research combined surgery of spastic cerebral palsy / 中国矫形外科杂志

[Objective]To discuss the indication and attentive affairs among single and combined surgical treatments for spastic cerebral palsy by analyzing the therapeutic efficacy of different operations,such as lengthening tendon,osteotomy and neurectomy,etc.[Method]Six hundred and forty-two patients(aged 10 months to 37 years)were treated with combined operations of different operations,including traditional operations on soft tissue release,osteotomy,selective posterior rhizotomy,selective rhizotomy and converse anastomosis,neurectomy,etc.The follow-up period ranged from 6 months to 4 years(mean 18 months).[Result]The traditional soft tissue release and lengthening was still the major surgical treatment to cerebral palsy.It resulted on rectifying fixed contracure and deformity,although could not decrease muscular tension.The decisive processes lied on neurectomy.Though the selective posterior rhizotomy and selective peripheral neurectomy reduced muscular strength partially in the early stage,the muscular tension was also reduced,therefore the range of motion of joints was enlarged and the functions of extremities were strengthened.[Conclusion]Classifying the types of cerebral palsy carefully,mastering the indications of all sorts of surgical treatment strictly,realizing the latent complications of different operations,combining different processes of surgical treatment can enhance therapeutic efficacy,reduce recurrence of convulsion and malformed,as well as avoiding serious complications during therapy.In addition,postoperative exercise is also the basic treatment to spastic cerebral palsy.

Soft Tissue Surgery for Equinus Deformity in Spastic Hemiplegic Cerebral Palsy: Effects on Kinematic and Kinetic Parameters

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.