Outcomes of DIEP Flap and Fluorescent Angiography: A Randomized Controlled Clinical Trial.

BACKGROUND: Breast reconstruction with the deep inferior epigastric perforator (DIEP) flap can be associated with complications such as fat necrosis. The authors' objective was to assess the safety and efficacy of fluorescent angiography with indocyanine green to reduce fat necrosis. METHODS: The authors designed a parallel, randomized, controlled clinical trial for unilateral breast reconstruction. The poorly vascularized tissues of the DIEP flap were removed based on a clinical evaluation in group 1 and based on angiographic criteria in group 2. The authors recorded the flap dimensions, perfusion in terms of fluorescence intensity, complications, reoperations, and BREAST-Q questionnaire scores for both groups. RESULTS: The study included a total of 51 patients. The flaps showed no size differences after the tissue was excised. The flaps of group 2 presented higher perfusion rates (p = 0.001). The incidence of fat necrosis was 59.3 percent in group 1 and 8.3 percent in group 2 (p = 0.001). Four cases of partial necrosis were recorded in group 1 (18.2 percent) compared with none in group 2 (0 percent) (p = 0.131). Four patients underwent reoperation in group 1 (14.8 percent) compared with none in group 2 (0 percent) (p = 0.113). The patients in group 2 reported higher scores in all domains of the BREAST-Q. CONCLUSIONS: Fluorescent angiography with indocyanine green significantly reduced the incidence of fat necrosis without diminishing the flaps' dimensions. The perfusion rates were significantly higher and the patients reported significantly greater satisfaction and quality of life. Fluorescent angiography with indocyanine green may be considered a safe and effective tool to enhance the outcomes of breast reconstruction with the DIEP flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Bisphosphonate-related osteonecrosis. Application of adipose-derived stem cells in an experimental murine model

Background: Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. Material and Methods: 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. Results: The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. Conclusions: In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs

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Beckwith-Wiedemann Syndrome: Open bite evolution after tongue reduction

Background: Macroglossia causes functional deficits such as airway obstruction, drooling, phonation difficulties, and leads to protrusion of dentoalveolar structures resulting in an anterior open bite and a prognathic mandibular appearance. Macroglossia is present in the majority of patients with Beckwith-Wiedemann syndrome (BWS) and surgical treatment may be indicated. Material and Methods: A retrospective review was conducted including BWS patients who underwent surgical tongue reduction between 2000 and 2015 at the Hospital Universitario La Paz, Madrid. Results: Out of 16 patients with BWS, surgery was performed in 11 cases. Tongue protrusion with open bite was the main indication for surgical treatment. Reduction glossectomy was performed using the keyhole technique. We analysed the relationship between age at surgery and evolution of open bite. Complications were minimal and satisfactory outcomes were observed with a decrease in anterior open bite. Conclusions: In this study we have observed that surgical treatment in patients with BWS and open bite accompanied by macroglossia seems to provide positive results with a satisfactory outcome in dentoskeletal alterations (AU)

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Complicaciones en reconstrucción craneal con prótesis de polieteretercetona / Complications in cranial reconstruction using PEEK prosthesis

Introducción. Los defectos craneales tienen una repercusión importante en el paciente desde un punto de vista estético, psicológico y funcional. Actualmente no existe acuerdo sobre el material ideal para la reconstrucción de estos defectos. Material y métodos. Realizamos un estudio retrospectivo incluyendo a los pacientes con reconstrucción craneal con prótesis de polieteretercetona (PEEK) a medida entre los años 2008 y 2014 en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario La Paz, Madrid. Las prótesis son diseñadas de manera específica para cada paciente con el sistema CAD-CAM. Resultados. Se reconstruyó a un total de 7 pacientes con defectos craneales con prótesis de PEEK. Solo en un caso, la resección y reconstrucción fueron realizadas en el mismo acto quirúrgico. En el resto de los casos se realizó una reconstrucción diferida. Las complicaciones que se presentaron fueron: un seroma y una fístula de LCR, que se resolvieron con tratamiento conservador; y una dehiscencia de la herida y un caso con episodios de infecciones repetidas, cuyo defecto estaba próximo al seno frontal, que terminaron con la retirada definitiva de la prótesis. Conclusión. El material ideal para la reconstrucción de defectos craneales no existe. Las prótesis de PEEK están obteniendo buenos resultados estética y funcionalmente. Cuando el hueso autógeno no esté disponible o en determinados casos con defectos grandes, las prótesis de PEEK pueden ser una buena opción. Sin embargo, si el defecto está en comunicación directa con los senos paranasales, debemos valorar bien la indicación (AU)

Introduction. Cranial defects tend to carry functional and aesthetic consequences for the patient. The most suitable material to be used remains controversial. Methods. We report a retrospective review of patients whose cranial defects were reconstructed using a computer designed polyetheretherketone (PEEK)-patient specific implant) between 2008 and 2014 at the Oral and Maxillofacial Surgery Department, in Hospital Universitario La Paz, Madrid. Implants are designed individually to each patient with CAD-CAM system. Results. Seven patients underwent cranial reconstruction using a PEEK-patient specific implant. One case involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Complications were: one seroma and one CSF leak, resolved with conservative treatment, and a wound dehiscence and an infection case whose defect was near the frontal sinus, resolved with removal of the implant. Conclusion. The ideal material for reconstructing cranial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or in selected cases with large defects, PEEK is a good option to reconstruct these defects. However, if the defect is related with paranasal sinuses, indication must be evaluated (AU)

Orthodontically guided bone transport in the treatment of alveolar cleft: A case report.

INTRODUCTION: Conventional treatments are sometimes not possible in certain alveolar cleft cases due to the severity of the gap which separates the fragments. Various management strategies have been proposed, including sequential surgical interventions or delaying treatment until adulthood to then carry out maxillary osteotomies. A further alternative approach has also been proposed, involving the application of bone transport techniques to mobilise the osseous fragments and thereby reduce the gap between lateral fragments and the premaxilla. CASE REPORT: We introduce the case of a 10-year-old patient who presented with a bilateral alveolar cleft and a severe gap. Stable occlusion between the premaxilla and the mandible was achieved following orthodontic treatment, making it inadvisable to perform a retrusive osteotomy of the premaxilla in order to close the alveolar clefts. Faced with this situation, it was decided we would employ a bone transport technique under orthodontic guidance using a dental splint. This would enable an osseous disc to be displaced towards the medial area and reduce the interfragmentary distance. During a second surgical intervention, closure of the soft tissues was performed and the gap was filled in using autogenous bone. CONCLUSIONS: The use of bone transport techniques in selected cases allows closure of the osseous defect, whilst also preserving soft tissues and reducing the amount of bone autograft required. In our case, we were able to respect the position of the premaxilla and, at the same time, generate new tissues at both an alveolar bone and soft tissue level with results which have remained stable over the course of time. KEY WORDS: Alveolar cleft, bone transport, graft.