Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults.

OBJECTIVES: Surgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults. METHODS: From March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B). RESULTS: All patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001). CONCLUSIONS: Cannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.

Reconstruction of Maxillary and Orbital Floor Defect With Free Fibula Flap and Whole Individualized Titanium Mesh Assisted by Computer Techniques.

PURPOSE: We sought to investigate the clinical application of free fibula flap and individualized titanium mesh through the use of a virtual planning and guiding template to assist the reconstruction of maxilla and orbital floor defects. PATIENTS AND METHODS: Between 2015 and 2016, a total of 6 adult patients with maxillary and orbital floor defects were enrolled in this study. Preoperative virtual planning, including virtual maxillary resection and fibular reconstruction, was performed in all cases according to 3-dimensional radiographic and clinical findings. A 3-dimensionally printed resin model and prebent templates were used to guide the harvesting and positioning of the fibula flap during surgery. Then, an individualized titanium mesh was used to support the orbital floor and restore the maxillary contour. The results were confirmed by postoperative computed tomography scans and clinical follow-up. RESULTS: Preoperative virtual planning and prebent templates can be used to guide the harvesting and positioning of the fibula flap, as well as the forming and positioning of the individualized titanium mesh, with satisfactory results. All flaps survived, and symmetrical facial contours were achieved with normal lower jaw movement and proper vertical distance for dental implants in all patients. CONCLUSIONS: Computer-aided techniques such as virtual planning, 3-dimensionally printed models, and prebent guide templates can be used to harvest and position a free fibula flap, form personalized titanium mesh, and ultimately improve the clinical efficacy of maxillary and orbital floor reconstruction.

[Prevention of paracolostomic hernia]. / Profilaktika parakolostomicheskoi gryzhi.

AIM: To improve the prevention of paracolostomic hernias. MATERIAL AND METHODS: We studied the prevention of paracolostomic hernia using mesh allograft. The study involved 73 patients with low-ampullary rectal cancer. Open or laparoscopic abdominoperineal extirpation of rectum was performed in all observations. 21 patients underwent prophylactic Sugarbaker's repair of paracolostomic area. We used the modifications of this surgical stage for transabdominal and retroperitoneal stoma. RESULTS: There were no postoperative complications associated with the use of allograft. The hernia occurred in one case (4.8%) of prevention group and in 14 (26.9%) patients of control group. CONCLUSION: The first results of composite allograft application to prevent paracolostomic hernias are encouraging. The absence of specific complications and favorable long-term results allow to continue the investigation.

Engineering a vascularized collagen-ß-tricalcium phosphate graft using an electrochemical approach.

Vascularization of three-dimensional large synthetic grafts for tissue regeneration remains a significant challenge. Here we demonstrate an electrochemical approach, named the cell electrochemical detachment (CED) technique, to form an integral endothelium and use it to prevascularize a collagen-ß-tricalcium phosphate (ß-TCP) graft. The CED technique electrochemically detached an integral endothelium from a gold-coated glass rod to a collagen-infiltrated, channeled, macroporous ß-TCP scaffold, forming an endothelium-lined microchannel containing graft upon removal of the rod. The in vitro results from static and perfusion culture showed that the endothelium robustly emanated microvascular sprouting and prevascularized the entire collagen/ß-TCP integrated graft. The in vivo subcutaneous implantation studies showed that the prevascularized collagen/ß-TCP grafts established blood flow originating from the endothelium-lined microchannel within a week, and the blood flow covered more areas in the graft over time. In addition, many blood vessels invaded the prevascularized collagen/ß-TCP graft and the in vitro preformed microvascular networks anastomosed with the host vasculature, while collagen alone without the support of rigid ceramic scaffold showed less blood vessel invasion and anastomosis. These results suggest a promising strategy for effectively vascularizing large tissue-engineered grafts by integrating multiple hydrogel-based CED-engineered endothelium-lined microchannels into a rigid channeled macroporous scaffold.

A retrospective analysis of the use of cannulated compression screws and a vascularised iliac bone graft in the treatment of displaced fracture of the femoral neck in patients aged < 50 years.

There is a high risk of the development of avascular necrosis of the femoral head and nonunion after the treatment of displaced subcapital fractures of the femoral neck in patients aged < 50 years. We retrospectively analysed the results following fixation with two cannulated compression screws and a vascularised iliac bone graft. We treated 18 women and 16 men with a mean age of 38.5 years (20 to 50) whose treatment included the use of an iliac bone graft based on the ascending branch of lateral femoral circumflex artery. There were 20 Garden grade III and 14 grade IV fractures. Clinical and radiological outcomes were evaluated. The mean follow-up was 5.4 years (2 to 10). In 30 hips (88%) union was achieved at a mean of 4.4 months (4 to 6). Nonunion occurred in four hips (12%) and these patients had a mean age of 46.5 years (42 to 50) and underwent revision to a hip replacement six months after operation. The time to union was dependent on age with younger patients achieving earlier union (p < 0.001). According to the Harris hip score which was available for 27 of the 30 hips with satisfactory union, excellent results were obtained in 15 (score ≥ 90 points), fair in ten (score 80 to 90 points), and poor in two hips (≤ 80 points). One patient aged 48 years developed avascular necrosis of femoral head six years after operation and underwent total hip replacement. The management of displaced subcapital fractures of the femoral neck, in patients aged < 50 years, with two cannulated compression screws and an iliac bone graft based on the ascending branch of lateral femoral circumflex artery, gives satisfactory results with a low rate of complication including avascular necrosis and nonunion.

[AN EXPERIMENTAL STUDY OF THE HISTOLOGICAL FIBRO GENESIS ABILITIES IN THE AREA OF IMPLANTATION OF ALOTRANSPLANTATES APPLYING INTRAABDOMINAL AND PREPERITONEAL PLASTIC SURGERY].

The histological fibro genesis abilities in the area of implantation of allotransplantates applying intraabdominal and preperitoneal plastic surgery were examined during experimental research. The experiment involved 12 Russian chinchilla rabbits. The animals were spitted into two groups: I group--operated using IPOM methodology (intraperitonealonlaymesh, n = 6) with the installation "Proceed" mesh made by "Ethicon", group II--modeling preperitoneal plastics with the installation of "Ethicon's Ultrapro" mesh (n = 6). After removing the animals from the experiment, the implants with adhering musculo-aponeurotic tissue layer were excised and sent for histological examination. At the same time the severity of the inflammatory process were rated, the composition of the inflammatory infiltrate, germination of the connective tissue through the pores of the prosthesis and neovascularization. Analyzing the research data of histological connective abilities complexes formed in the area of the allotransplants implantation using intra-abdominal and pre-peritoneal plastic during the experiment, we can conclude that intra-abdominal installation of mesh prostheses reduces the severity of inflammatory changes surrounding tissues and reduces the probability of seroma formation in comparison with the placement of the pre-peritoneal implant.