ABSTRACT
Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered.
ABSTRACT
Inflammation after surgical incisions is related to the degree of tissue damage. Healing with low inflammation is desirable, especially in patients with compromised healing potential. This experimental study was conducted to assess the degree of inflammatory reaction and scar formation from incisions made by an ultra-polished scalpel (UPS). Two paravertebral incisions were made with a conventional scalpel (CS) and a UPS in 18 individual rats with diabetes. The fibrotic tissue (scar) area and expression levels of collagen, transforming growth factor, and matrix metalloproteinases were quantified on postoperative days 3, 7, and 30. The scar widths and areas were significantly lower in the UPS group than in the CS group. The scar widths were 64.3 ± 14.7 µm and 86.8 ± 12.1 µm in the UPS and CS groups, respectively (P = 0.03). The scar areas were 11,398 ± 1595 µm2 in the UPS group and 17,433 ± 3487 µm2 in the CS group (P = 0.014). The UPS group had less inflammation on day 3, less transforming growth factor synthesis on days 3 and 7, lower levels of matrix metalloproteinases, and less collagen synthesis on day 7 than did the CS group. The UPS achieved less local inflammation by reducing the local tissue damage in diabetic rat models, enabling better healing, and resulting in less scar formation. The UPS warrants further clinical study as it may bring beneficial outcomes for patients with impaired healing capability and patients who seek to reduce scarring.
ABSTRACT
This study aimed to compare the bony relapse ratios of standard and accelerated distraction protocols (ADP) in one-piece fronto-orbital distraction osteogenesis (DO). Patients with unilateral or bilateral coronal synostoses who underwent one-piece fronto-orbital DO were included. The accelerated cranial distraction protocol included a 3-day latency period and a distraction rate of 1-2 mm/day, followed by a 4-week consolidation period. Intracranial volume was measured using computed tomography (CT) before the surgery, at the end of the consolidation period, and 1 year after the removal of distractors. The intracranial volume changes and relapse ratios were calculated. This study included 32 patients; of these, 16 were included in each of the ADP and standard protocol (SP) groups. The mean ages were 1.4 years and 1.6 years in the ADP and SP groups, respectively (p = 0.895). In the ADP and SP groups, the expanded volumes were 270.9 ± 90.3 cm3 and 284.6 ± 149.7 cm3 (p = 0.91) and the growth-corrected expanded volumes were 162.1 ± 67.5 cm3 and 177.1 ± 105.2 cm3, respectively (p = 0.867). The relapse and growth-corrected relapse ratios showed no significant differences between the two groups, suggesting similar stability between the two protocols. The relapse ratios were 7.1 ± 4.8% and 7.3 ± 5.0% (p = 0.91) and the growth-corrected relapse ratios were -3.0 ± 3.3% and -2.4 ± 2.7%, respectively (p = 0.498). Within the limitations of the study, it seems that the ADP can shorten the distraction period without compromising stability. This may contribute to resolving the disadvantages and highlighting the advantages of DO.
Subject(s)
Craniosynostoses , Osteogenesis, Distraction , Craniosynostoses/diagnostic imaging , Craniosynostoses/surgery , Humans , Infant , Osteogenesis, Distraction/methods , Recurrence , Skull/surgeryABSTRACT
OBJECTIVE: Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis. METHODS: Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI. RESULTS: A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation. CONCLUSIONS: Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.
