Treatment of chylous fistula with fibrin glue and clavicular periosteal flap.
We describe a new treatment for chylous fistula using fibrin glue and clavicular periosteal flap.
Carcinoma, Squamous Cell↗
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Periosteal chondroma of the distal radius.
We report a case of periosteal chondroma in an unusual location at the distal end of the radius.
Adult↗
Periosteal reaction induced by prostaglandins.
Prostaglandin administration is the main therapy for ductal-dependent congenital heart disease prior to definitive therapy. We report a case in which tetralogy of Fallot and Noonan syndrome were diagnosed, complicated by small pulmonary arteries, which occasioned a delay in surgery. Treatment was started with prostaglandins, which were given for a total of 2 months, and a diffuse periosteal reaction occurred secondary to the administration of intravenous prostaglandin E1.
Alprostadil↗
[Sonographic follow-up of secondary fracture healing. Initial experiences with morphologic and semiquantitative assessment of periosteal callus formation].
We report on the contribution of real-time sonography in comparison to plain radiographs to the assessment of fracture healing of 121 patients suffering fractures of the long bones of the lower limbs. Sonographic morphology of periosteal callus metamorphosis shows basically a persistent increase of echogenicity representing the temporal range from fracture haematoma to the "woven bone". Further criteria are the homogeneity of structure and the development of a marginal interface. Nonunion radiologically classified into hypertrophic and atrophic types may also be differentiated by sonographic criteria and may influence proper orthopaedic management. Regarding sonographic methods using an A-mode amplitude signal, the morphologic assessment of callus metamorphosis is more likely to be translated into clinical practice. Although it yields a variety of information, sonography will be unable to replace radiography due to methodical limitations.
Adult↗
Video-endoscope assisted teaching during sub-periosteal orbital surgery.
PURPOSE: The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible. MATERIALS AND METHODS: This technique was used for 16 cases of orbital surgery during a 12-month period. There were 5 orbital fracture repairs, 8 orbital decompressions (4 via a swinging eyelid and 4 via a transcaruncular approach), an infraorbital nerve biopsy, an eosinophilic granuloma and an orbitofrontal cholesterol granuloma. All procedures were performed by the trainee under consultant supervision with the endoscope being used when direct visualisation was not possible for the consultant. A rigid Storz 3-chip video-endoscope with 0, 30 and 70-degree tips was used to enable visual supervision. RESULTS: The endoscope was of particular use in procedures involving the posterior orbital floor, orbital roof and medial orbital wall. It also enabled safe supervision of curettage of an orbital roof lesion which abutted the dura. The technique was easy to use; it provided good local illumination and a magnified view for supervision. CONCLUSION: This technique is a valuable adjunct in allowing the trainee to safely perform selected complex orbital surgery under video-endoscopic supervision.
Endoscopy↗
The long Abbe flap combined with periosteally-vascularised mandibular bone for the simultaneous reconstruction of the upper lip and supportive columella.
We did a simultaneous reconstruction of the upper lip and the supportive columella for a midface deformity caused by the wide resection of a squamous cell carcinoma of the nasal vestibule. It was reconstructed with an Abbe flap combined with a periosteally-vascularised outer layer of mandibular bone, which give an aesthetically and functionally acceptable result.
Aged↗
THE EFFECTS OF EXTRAPERIOSTEAL INJECTIONS OF BLOOD COMPONENTS ON PERIOSTEAL CELL PROLIFERATION.
Following extraperiosteal injections of saline, serum, or whole blood, the synthesis of DNA in the cells of the osteogenic layer of the femora of mice was stimulated to approximately two-thirds of the level obtained by fracture of the femora. Irrespective of the material injected, the proliferative response of the cells in the periosteum was similar. These studies have shown that neither bone fracture nor direct disruption of the periosteum is necessary to induce periosteal cell proliferation since a single extraperiosteal injection of physiological saline induces DNA synthesis.
Animals↗
Basic fibroblast growth factor: effects on matrix remodeling, receptor expression, and transduction pathway in human periosteal fibroblasts with FGFR2 gene mutation.
The Crouzon syndrome, which is associated with fibroblast growth factor receptor (FGFR2) mutations, is characterized by premature fusion of cranial sutures. We used an in vitro model of cultured periosteal fibroblasts from normal subjects and from Crouzon patients with FGFR2 mutation. We analyzed the matrix turnover rate and the effects of adding FGF2 by evaluating fibronectin synthesis and the activity of some proteolytic enzymes. To assess the role of some FGF signaling molecules involved in FGFR2 regulation, we studied Grb2 tyrosine phosphorylation and the phosphotyrosine proteins associated with Grb2. The iodinate FGF binding assay was performed to quantify FGFR expression. Compared with normal fibroblasts, fibronectin synthesis was decreased in Crouzon fibroblasts, and protease activities in cells and medium were enhanced, suggesting that excess fibronectin catabolism is present. Differences were more marked when FGF2 was added. Very few phosphoproteins were visible in anti-Grb2 immunoprecipitations from Crouzon fibroblasts, which showed a significant increase in the number of high-affinity and low-affinity FGF2 receptors. These results suggest that the abnormal genotype and the Crouzon cellular phenotype are related. To compensate the low levels of tyrosine phosphorylation, Crouzon cells might increase the numbers of FGFR2, thus increasing the cell surface binding sites for FGF2.
Adaptor Proteins, Signal Transducing↗
The vascular pattern and viability of microvascularized rib grafts based on periosteal circulation--an experimental study.
Previous reports have stressed the importance of the nutrient blood supply in rib grafts transferred by microvascular anastomoses. In the present experimental study, we have demonstrated that a rib graft transferred by microvascular anastomoses based on periosteal vessels can survive; vascular clearing studies demonstrated that the vascularity of these grafts extends not only into the cortex but the medulla as well. The relative facility of harvesting these grafts (compared with those based on nutrient vessels) should make them the favored choice. Technetium bone scintigraphy proved accurate in the assessment of both vascular pattern and microanastomotic patency. Tetracycline labeling did not correlate well with the patency of a rib graft's pedicle blood supply.
Animals↗
The use of periosteal flaps in scalp and forehead reconstruction.
In certain clinical situations, coverage of scalp and forehead soft-tissue defects is best accomplished by skin graft. When bone is also exposed, however, skin graft coverage may not be possible. Flaps of periosteum can be used in these cases as bony coverage, thus providing the vascularized bed necessary for skin graft "take." Advantages and disadvantages of these periosteal flaps are discussed.
Adult↗
The iliac crest region: donor site for vascularized bone periosteal and soft tissue flaps.
A review is presented of the classic vascularized iliac crest transfer and to show useful variations on this technique. A technical variation to reconstruct mandibular defects, the semisegmented iliac crest graft, is described. Another variation, the half iliac crest graft, is presented for use in the neovascularization of avascular necrosis of the femoral head. When such a flap is raised with a large periosteal flap and overlying muscle or skin, or both, as a composite flap, a primary osteoperiosteal tube can be created to reconstruct segmental defects in long bones. This primary osteoperiosteal tube is secondarily transformed into a completely osseous tube.
Bone Transplantation↗
Blepharoptosis repair by supraorbital rim periosteal rotation flaps.
This article describes a procedure for repair of severe blepharoptosis by means of supraorbital rim periosteal rotation flaps. The results of a group of patients undergoing the procedure are analyzed, and the potential for the successful use of this procedure is discussed.
Adolescent↗
Tibial periosteal hemangioma.
A case report on periosteal hemangioma in the left tibia of an 11-year-old girl demonstrates roentgenographic thickening, sclerosis, and a smooth scalloping cortical depression in the bone. En block exicision of the defect, together with the markedly thickened periosteum, revealed a combination of cavernous and capillary bone hemangiomas.
Bone Neoplasms↗
Periosteal augmentation of a tendon graft improves tendon healing in the bone tunnel.
Secure fixation of tendon or ligament to bone has been a challenging problem. The periosteum is an osteogenic organ that regulates bone growth and remodeling at the outer surface of cortical bone and also is known to play an important role in forming a tendon insertion site to bone. Therefore, we hypothesized that a freshly harvested periosteum can be used as a stimulative scaffold to biologically reinforce the attachment of tendon graft to bone. Using a rabbit hallucis longus tendon and calcaneus process model, we found that a periosteal augmentation of a tendon graft could enhance the structural integrity of the tendon-bone interface, when the periosteum is placed between the tendon and bone interface with the cambium layer facing toward the bone. Clinically, the use of an autogenous periosteum patch would be an optimal choice for biologic augmentation of the tendon graft in the bone tunnel, because the tissue is readily available for harvest from the patient's body.
Analysis of Variance↗
An experimental study of the patterns of periosteal and endosteal damage in tibial shaft fractures using a rabbit trauma model.
After fractures were manually produced in rabbit tibia, soft-tissue damage was assessed both visually and by vascular radiography. Transverse fractures produced circumferential laceration of the periosteum and complete transection of the marrow. Sprial fractures produced longitudinal periosteal laceration and incomplete marrow damage. These results indicate that soft-tissue damage in transverse fractures may be qualitatively different from that in spiral fractures. Perfusion studies revealed that although the nutrient artery may be interrupted by fracture, its main trunks on either side of, and up to, the fracture line may still be filled via available collateral channels.
Angiography↗
Periosteal pennant lateral canthoplasty.
A periosteal pennant method of primary lateral canthoplasty is described, and it effectively maintains surgical correction of the axis of the palpebral fissure and the position of the lateral canthus. In using it more than 50 times, we have not had to do a secondary correction.
Adolescent↗
The viability of rib grafts transplanted with the periosteal blood supply.
We present two additional cases of microvascular rib transplants supplied by the periosteal circulation through the anterior intercostal vessels. We studied the viability of the bone by the uptake of fluorochrome markers. We also examined thin sections of calcified bone to demonstrate the deposition of new osteoid by osteoblasts, and the resorption of bone by osteoclasts. These studies confirm the early viability of the transplanted bone.
Cell Survival↗
Surgical treatment of Stahl's ear using the periosteal string.
Surgical treatment of Stahl's ear is reported. Lifting of the cymba and bending of the helix by the periosteal string are the main points. This method is simple, and it is easy to adjust the extent of correction. Four patients were operated on by this method, and no complications were encountered. The results are quite satisfactory. In the follow-up periods (16 to 29 months, average 22.5 months), the operated ears retain their corrected forms and bear close resemblances to the opposite ears.
Child↗