Dermis-fat graft for anophthalmic socket reconstruction: indications and outcomes / Enxerto dermo-adiposo para reconstrução da cavidade anoftálmica: indicações e resultados

ABSTRACT Purpose: To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. Methods: A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. Results: Mean age of the patients included in the study was 34.2 ± 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. Conclusion: Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare.

RESUMO Objetivo: Avaliar os resultados obtidos com o uso do enxerto dermo-adiposo para reposição de volume em cavidade anoftálmica. Métodos: Estudo retrospectivo baseado em revisão de prontuários incluindo todas as cirurgias de enxerto dermo-adiposo realizadas nos últimos 10 anos no King Khaled Eye Specialist Hospital, Saudi Arabia. O enxerto dermo-adiposo foi realizado em 62 pacientes no periodo do estudo. Os dados analisados incluíram características dos pacientes, as complicações pós- operatórias e os resultados cosméticos e funcionais, tais como a habilidade de usar prótese externa. Resultados: A média de idade dos participantes foi de 34,2 ± 9,7 anos. Segundo a classificação das cavidades, 38,7% possuíam cavidade grau 3; 64,5% possuíam cavidade anoftálmica adquirida e o enxerto dermo-adiposo foi realizado como procedimento secundário em 61,3% dos pacientes. Após o procedimento 22,6% dos pacientes permaneceram com lagoftalmo, 17,7% tiveram necrose do enxerto, 12,9% desenvolveram granuloma piogênico, 12,9% tiveram redução do tamanho do enxerto, 3,2% permaneceram com as alterações no posicionamento palpebral e 3,2% continuaram com déficit de volume na órbita. Quarenta e nove pacientes (79%) eram capazes de usar prótese externa antes da cirurgia e depois do enxerto dermo-adiposo 55 (88,7%) puderam utilizar prótese externa. Conclusão: O enxerto dermo-adiposo é uma ótima opção para tratamento de cavidades anoftálmicas congênitas ou adquiridas, assim como realizado como procedimento primário ou secundário, em cavidades com ou sem contração tecidual. Os resultados são encorajadores e as complicações são pouco frequentes.

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

Introduction and Hypothesis We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. conclusions The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts. .

Aplicación de biomateriales de base biológica, moléculas bioactivas e ingeniería de tejidos en cirugía plástica periodontal: una revisión / Application of biological based biomaterials, bioactive molecules and tissue engineering in periodontal plastic surgery. A review

Objetivo: Describir, clasificar y discutir las indicaciones de los biomateriales de base biológica, moléculas bioactivas e ingeniería de tejidos que se están usando para el manejo de recesiones y aumento de encía en cirugía plástica periodontal. En esta revisión de la literatura, se utilizó una combinación de los términos de búsqueda específicos que consideraran los materiales en revisión, para el aumento de encía adherida, y el recubrimiento radicular. Materiales y Métodos: Se usaron las siguientes fuentes: Medline, Biblioteca Cochrane, y búsqueda manual de revistas específicas como el Journal of Periodontology, International Journal of Periodontics and Restorative Dentistry y Journal of Clinical Periodontology entre años 1985 y 2011. Se revisaron un total de 117 artículos y se seleccionaron 74 entre estudios clínicos controlados, estudios clínicos randomizados, reportes de casos y estudios en animales. Los artículos fueron revisados por los autores y aceptados por consenso para su discusión. Conclusiones: 1) Existe una serie de materiales que presentan gran potencial y podrían ser una alternativa viable a los injertos autógenos, pero se requiere más estudios a largo plazo. 2) Existe necesidad de estudios con la investigación de estos procedimientos en relación a resultados orientados a la estabilidad, seguridad y efectividad de los diferentes materiales existentes.

Objective: To describe, classify and discuss the clinical applications of biologically based biomaterials, bioactive molecules and tissue engineering being utilized in gingival recession therapy and gingival augmentation procedures in plastic periodontal surgery. In this literature review, a combination of specific search key words were used, including materials being reviewed, indicated for gingival augmentation and root coverage procedures. Materials and Methods: The following sources were consulted: Medline, Cochrane Library and manual search of specific scientific journals such as Journal of Periodontology, International Journal of Periodontics and Restorative Dentistry and Journal of Clinical Periodontology between the years 1985 and 2011. A total of 117 articles were reviewed with 74 being selected unanimously by the authors for discussion in the manuscript. These articles included controlled clinical studies, randomized clinical studies, case reports and animal studies. The selected articles were reviewed by the authors and accepted by consensus. Conclusions: 1) There is a cohort of materials that exhibit great potential which could be a viable alternative to autografts but are in need of further long term studies. 2) There is a need of research of these materials in relation to stability, safety and efficacy.

Dermis as an interposing graft for reconstructing Peyronies disease

Peyronies disease is an acquired fibrous plaque induced penile deformity, it has two phases; acute with painful erection and chronic with minimal pain but persistant penile curvature. Many conservative and surgical treatment modalities have been described. Plaque excision and dermal grafting has given promising results. To evaluate the efficacy of plaque excision and dermal grafting in peyronies disease. A prospective study was conducted on ten patients with chronic peyronies disease. All the patient underwent surgical excision of fibrotic plaque and dermal grafting. All the patients were evaluated postoperatively through regular visits for six to eight months to detect any recurrence or erectile dysfunction. The disease was more prevalent between ages of 40-55 years. All the plaques were located dorsally on the penile shaft except one which was dorsolateral. Five patients were complaining of erectile dysfunction preoperatively, two of them improved after surgery. Postoperative recurrence of fibrotic pluque involved only one patient. Fibrotic plaque excision and dermis grafting is an effective method on the long term with minimal associated complications

Uso de Matriderm para cobertura cutânea pós-ressecção de úlcera de Marjolin / Use of Matriderm for skin coverage after Marjolin’s ulcer resection

Introdução: Úlcera de Marjolin é um termo comumente referenciado à degeneração maligna de feridas crônicas não cicatrizadas ou cicatrizadas por segunda intenção e a maioria dos casos descritos refere-se a carcinoma espinocelular. A matriz dérmica Matriderm® consiste numa estrutura tridimensional composta de fibras de colágeno bovino e elastina e não existem ainda relatos na literatura do seu uso após ressecções tumorais. O objetivo deste estudo é relatar um caso de úlcera de Marjolin secundária à queimadura de longa data (com 63 anos de evolução), submetido a ressecção e cobertura cutânea com utilização de matriz dérmica de origem bovina (Matriderm®). Relato de Caso: Paciente do sexo masculino, 73 anos, com lesão ulcerada em coxa direita secundária a queimadura por combustão de álcool há 63 anos, com diagnóstico histopatológico de carcinoma espinocelular bem diferenciado, no qual foi realizada ressecção cirúrgica com margens amplas (2 cm) e cobertura do leito cirúrgico com utilização de matriz dérmica bovina (Matriderm®). Conclusão: A utilização da matriz dérmica a celular se mostrou como uma boa opção para cobertura após a ressecção do tumor, com bom resultado estético imediato; porém, ainda tem seu uso limitado, em decorrência do alto custo.

Introduction: Marjolin’s ulcer is a term commonly referred to malignant degeneration of chronic wounds unhealed or healed by secondaryintention and most of the cases described refers to squamous cell carcinoma. The dermal matrix Matriderm® consists of a three-dimensional structure composed of fibers of bovine collagen and elastin, and there are still no reports in the literature of its use after tumor resection. The objective of this study is to report a case of Marjolin’s ulcer secondary to burn of a long time (with 63 years of evolution), who underwentresection and skin coverage with the use of bovine dermal matrix (Matriderm®). Case Report: Patient, male, 73 years, with an ulcerated lesion on the right thigh secondary to burn of alcohol combustion 63 years ago, with histological diagnosis of well-differentiated squamous cell carcinoma, which we performed surgical resection with wide margins (2 cm) and coverage of the surgical site with use of bovinedermal matrix (Matriderm®). Conclusion: The utilization of acellulardermal matrix proved to be a good option for coverage after tumor resection, with good immediate aesthetic result, but still has limiteduse due to high cost.

Uso de matriz dérmica acelular para el cubrimiento radicular de una recesión gingival en lingual de un incisivo central inferior: reporte de un caso / Use of an acellular dermal matriz for root coverage of a lingual gingival recession of a lower central incisor: a case report

Propósito. El propósito de este artículo es presentar un caso clínico en el que se realiza un cubrimiento radicular en un retracción gingival lingual tipo I por medio de una matriz dérmica acelular (Dermis). Métodos: una paciente de 28 años, después del tratamiento de ortodoncia correctiva, presenta en la región lingual del incisivo central inferior derecho una retracción gingival de 5mm con 2mm de banda de encía queratinizada y 2mm de profundidad del surco gingival, la cual produce una hipersensibilidad al frío. Por la ausencia de un adecuado donante palatino, se decidió utilizar la matriz dérmica acelular (Dermis) como injerto alógeno para cubrir dicha retracción. Resultados: se obtuvo un 80% de cubrimiento radicular, quedando en 1 mm la retracción gingival posquirúrgica; se aumentó el biotipo gingival (grosor) y se aumentó la altura de la encía queratinizada de 2 a 5 mm (ganancia de 3mm de altura), a los 3 meses posquirúrgicos. Dichos cambios se mantuvieron en la evaluación realizada al año de la cirugía. Conclusión. La matriz dérmica acelular es una alternativa quirúrgica en el cubrimiento radicular lingual , la cual evita la incomodidad y las posibles complicaciones posquirúrgicas al tomar injertos de tejido conectivo palatino. Se logra un 80% de cubrimiento radicular y se aumenta la banda de encía queratinizada, manteniendo los resultados constantes al año posquirúrgico.

Uso de la membrana dérmica acelular en estética periodontal: segunda parte / The use of acellular dermal matrix in periodontal esthetics: second part

Este artículo comunica un caso clínico con postoperatorio de 5 años, en el cual se trataron con membrana dérmica acelualr recesiones gingivales múltiples Miller I y II, y escaso ancho de encía insertada. Paciente de 32 años de edad, fue derivada para el tratamiento de estos defectos en el maxilar inferior de ambos lados, que le provocaban hipersensibilidad extrema en todos los elementos dentarios con superficies radiculares expuestas. Luego de la terapia básica, instrucción en una técnica de higiene bucal atraumática y control de los factores oclusales, se realizó un colgajo desplazado coronario y colocación de AlloDerm(R) como material de injerto. El aloinjerto fue posicionado en el sector izquierdo del maxilar inferior por su lado conectivo, según especificaciones del fabricante y en el sector derecho por su lado basal, según Harris(1). A 5 años de la cirugía, en ambos lados se mantuvo no sólo el recubrimiento radicular logrado, sino también un adecuado ancho de encía queratinizada. En este caso clínico, el uso de AlloDerm en recesiones gingivales múltiples, independientemente del lado de la membrana usado, resultó un tratamiento estable a largo plazo.

Uso de la membrana dérmica acelular en estética periodontal: primera parte / The use of acellular dermal matrix in periodontal esthetics: first part

Diversos factores convergen por sí solos o combinados para producir alteraciones de importancia en el equilibrio morfológico de los tejidos periodontales. El tratamiento de la enfermedad periodontal exige no sólo la eliminación de los factores desencadenantes de la misma con sus consecuencias sobre los tejidos, sino que necesita de la excelencia de un resultado estético. La demanda de estética de los tejidos blandos en periodoncia e implantes es cada vez mayor. Entre las alteraciones de armonía de los tejidos gingivales, encontramos con frecuencia el inadecuado ancho de encía insertada y las recesiones gingivales. Distintas técnicas quirúrgicas se han intentado para la solución de estos defectos, con resultados diversos. Los injertos gingivales libres, pediculados, doble papila, combinados, complementarios, de técnicas combinadas, fenestración perióstica, etc, fueron técnicas de elección. Los distintos resultados obtenidos por la aplicación de estas técnicas quirúrgicas, motivan el estudio de soluciones alternativas que satisfagan las exigencias funcionales y estéticas. La aparición en el mercado de la membrana dérmica acelular (Alloderm) y su utilización en odontología, podría ser una alternativa de éxito para el tratamiento de algunos de estos defectos. Se utilizó dicha membrana para el tratamiento de pacientes con escaso ancho de encía insertada y recesiones gingivales generalizadas. Los resultados obtenidos con un postoperatorio inmediato satisfactorio, fueron promisorios, de manera inmediata y su mantenimiento en el tiempo, 6 años, demuestran a este material de injerto muy predecible para el aumento del ancho de encía insertada y tratamiento de las recesiones gingivales generalizadas, ofreciendo de esta manera una alternativa de elección para devolver la estética y función a los tejidos.

Surgical Treatment Using an Allograft Dermal Matrix for Nasal Septal Perforation

PURPOSE: Numerous methods have been utilized to repair nasal septal perforation with varying degrees of success; however, no consensus has been reached on nasoseptal perforation repair. Here, the authors describe a surgical method based on human dermal allograft (Surederm(TM), Hans Biomed Corp. Korea) for the repair of nasal septal perforations. MATERIALS AND METHODS: Eleven patients with a nasal septal perforation were included in this study. The causes of these septal perforations included previous nasal surgery, trauma, foreign body (button battery), and idiopathy. There were several sites of perforation: 9 in the central area, 1 in the posterior-central area, and 1 in the anterior area. An interpositional graft incorporating Surederm(TM) was positioned between bilateral mucoperichondrial flaps using an intranasal approach. A silastic sheet was then left in the nasal septum bilaterally until complete healing had occurred through new nasal mucosa, which took a mean duration of 6 weeks. RESULTS: Outcomes in ten of the eleven patients were successful, with complete septal perforation closure. The remaining perforation, which was caused by a button battery, closed incompletely; however, its initial size of 2cm was reduced to 5mm. CONCLUSION: The described technique has a high success rate and can be performed under local anesthesia without external scarring. In the absence of donor site morbidity, this technique can also be utilized to repair posterior or multiple septal perforations without difficulty.