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PubMed1995

Cranioplasty in the growing canine skull using demineralized perforated bone.

This study was designed to test the hypothesis that demineralized perforated bone matrix implant from canine skull and tibia induces new bone formation within the calvarial defect comparable with the bone induced by autogenous graft. We also were interested in determining whether demineralized perforated bone matrix implants from membranous bone have greater osseoinductive capacity in the calvarial area than demineralized perforated bone matrix implants from endochondral bone. Forty 12-week-old purebred beagles were used. Group I consisted of animals with unrepaired surgically created calvarial defects healed by secondary intention (n = 10). Group II consisted of animals with surgically created calvarial defects in which the bone was removed and replaced with an autograft (n = 10). Group III consisted of animals with surgically created calvarial defects in which the bony defect was closed with a demineralized perforated bone matrix implant obtained from beagle calvaria (n = 10). Group IV consisted of animals with surgically created calvarial defects in which the bony defect was closed with a demineralized perforated bone matrix implant obtained from beagle tibia (n = 10). The two control groups (I and II) allowed us to isolate the inductive capacity of demineralized perforated bone matrix implants and compare it with the healing of the bone defects left unrepaired or repaired with calvarial autografts. Animals were sacrificed after 8 and 12 weeks. In the present study we were able to verify that demineralized perforated bone matrix implants are well accepted in the calvarial defects with little tissue reaction and remarkably little osteoclastic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

A graduated approach to the repair of nasal septal perforations.

Septal perforation is an avoidable complication of septal surgery, but it can also occur because of a variety of traumatic, iatrogenic, caustic, or inflammatory reasons. Symptoms usually are related to disruption of the normally laminar flow of air through the nasal passages. Crusting, bleeding, parosmia, and neuralgia can develop, leading the patient to seek medical care. When local hygiene and conservative care are unsuccessful in relieving symptoms, closure of the perforation is considered. Repair is often difficult because of the limited exposure and limited amounts of friable mucosa with impaired vascular supply. The failure of attempted closure of septal perforations can be as high as 80 percent. The authors have developed a graduated approach to the closure of septal perforations that tailors the surgical approach to the size and location of the defect. Perforations 0.5 to 2.0 cm in size were closed in 92.9 percent (13 of 14) of patients using an extended external rhinoplasty approach and bilateral posteriorly based mucosal flaps. Larger perforations (2.0 to 4.5 cm) were closed in 81.8 percent (18 of 22) of patients by a two-staged technique, using a midfacial degloving approach to medially advance posteriorly based, expanded mucosal flaps. With careful preoperative management and selection of the appropriate surgical technique, even moderate-to-large perforations can be repaired reliably with limited operative morbidity.

Humans↗
PubMed2001

The thin latissimus dorsi perforator-based free flap for resurfacing.

The authors present their experience with "thin" latissimus dorsi perforator-based free flaps for resurfacing defects. Perforator-based free flaps have been used for various kinds of reconstruction by presenting important donor structures. The thin latissimus dorsi perforatorbased free flap included only the skin and superficial adipose layer to reduce its bulkiness by dissection through the superficial fascial plane. This flap was used in 12 clinical cases, without flap necrosis or other serious postoperative complications. All of the patients were examined by preoperative power Doppler ultrasound in the spectral Doppler mode to search for the most reliable perforator. This noninvasive ultrasound technique determines the exact location and course of and ensures the reliable flow of the perforators; therefore, it greatly assists microsurgeons in saving operation time and in selecting the most suitable design for perforator flap reconstruction. We used perforators that were identified several centimeters from the lateral border of the latissimus dorsi muscle. The thin flap dimensions could be safely designed for flaps measuring up to 20 cm in length and 8 cm in width for primary closure of the donor site. Generally, a long pedicle is not required for resurfacing reconstructions, where small recipient arteries in the bed are acceptable for anastomosis with pedicles. However, pedicle dissection to the proximal vessels through the latissimus dorsi muscle was required when it was necessary to match the recipient vein for anastomosis. The authors conclude that this thin latissimus dorsi perforator-based free flap has great potential for resurfacing because of its constant thickness, easy elevation with the help of power Doppler ultrasound information, and proper flap size for moderate defects caused by scar contracture release, superficial tumor ablation, and so on.

Adolescent↗
PubMed2004

Multilayer amniotic membrane transplantation in the treatment of corneal perforations.

PURPOSE: To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size. METHODS: Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5-1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3-4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied. RESULTS: Mean epithelialization time was 3.7 weeks (range 2-6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7-15). In all cases, ocular inflammation subsided within 2-5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully. CONCLUSIONS: These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.

Adult↗
PubMed2006

Clinical criteria for diagnosing perforated appendix in pediatric patients.

OBJECTIVE: To determine predictive variables associated with a perforated appendix in pediatric patients with acute appendicitis. METHODS: This is a retrospective, cross-sectional, observational study from a medical center with more than 2000 beds (230 beds in Department of Pediatrics and Pediatric Surgery), with a mean admission of more than 12000 cases and 2200 surgeries per year. The outcome variable was perforated appendix, and the predictive variables included demographic and clinical factors. RESULTS: During a 6-year period, appendectomies were performed on 274 patients ranging in age from 1 to 18 years. Perforated appendix was found in 100 children (36.5%). Predictive factors significantly associated with perforated appendix were age younger than 9 years, abdominal pain of more than 2 days' duration, temperature of more than 37.9 degrees C, peritoneal signs, and erythrocyte sedimentation rate of more than 25 mm/h. Abdominal ultrasound was performed in 89 patients (32%). For perforated appendix, the ultrasound had a sensitivity of 35%, specificity of 98%, positive predictive value of 95%, and negative predictive value of 55%. Indications for an abdominal ultrasound were determined from a scoring system using the predictive variables significantly associated with perforated appendix. CONCLUSION: The use of our proposed scoring system to determine the indications to perform an abdominal ultrasound may prove to assist in deciding treatment (medical vs surgical) for children with perforated appendix. Initial antibiotic treatment followed by interval appendectomy would become a more likely treatment option if our study results can be validated in a prospective study.

Adolescent↗
PubMed2003

The "Gent" consensus on perforator flap terminology: preliminary definitions.

Due to its increasing popularity, more and more articles on the use of perforator flaps have been reported in the literature during the past few years. Because the area of perforator flaps is new and rapidly evolving, there are no definitions and standard rules on terminology and nomenclature, which creates confusion when surgeons try to communicate and compare surgical techniques. This article attempts to represent the opinion of a group of pioneers in the field of perforator flap surgery. This consensus was reached after a terminology consensus meeting held during the Fifth International Course on Perforator Flaps in Gent, Belgium, on September 29, 2001. It stipulates not only the definitions of perforator vessels and perforator flaps but also the correct nomenclature for different perforator flaps. The authors believe that this consensus is a foundation that will stimulate further discussion and encourage further refinements in the future.

Humans↗
PubMed2004

Perforator flaps from the lateral lower leg for intraoral reconstruction.

Perforator flaps are based on cutaneous, small-diameter vessels that originate from a main pedicle and perforate fascia or muscle to reach the skin. Although these flaps have recently become popular for soft-tissue reconstructions in nearly all regions of the body, the systematic application of perforator flaps with short, small-caliber pedicles for intraoral reconstruction has not been reported. Experience with the use of 10 consecutive perforator flaps from the lateral lower leg for intraoral defect coverage is reported. In 10 cases, a 4- to 6-cm-long septocutaneous or myocutaneous perforating vessel from the peroneal artery, with a diameter of 1 to 2 mm, could be identified in the proximal one-half of the lateral lower leg. The thin, pliable skin paddles, measuring up to 6 x 8 cm, were used for defect coverage after resection of squamous cell carcinomas of the floor of the mouth (five cases), soft palate (one case), tongue (two cases), or buccal mucosa (two cases). Anastomoses were performed to the lingual artery and concomitant vein. Except for one case, all perforator flaps healed without complications and the functional results were satisfying. At the donor site, which was always closed directly, an approximately 15-cm-long scar resulted, without functional impairments. The peroneal artery was regularly preserved. Perforator flaps from the lateral lower leg might have many applications for intraoral soft-tissue reconstruction, especially because of their minimal donor-site morbidity.

Aged↗
PubMed2004

Gluteal perforator flaps for coverage of pressure sores at various locations.

Flap coverage is essential for successful treatment of pressure sores, and musculocutaneous flaps have been preferred universally. Development of perforator flaps supplied by musculocutaneous perforators has allowed reconstructive surgeons to harvest flaps without including muscles. Perforator flaps have enhanced the possibility of donor sites because a flap can be supplied by any musculocutaneous perforator, and donor-site morbidity is also reduced. Between November of 1998 and June of 2002, the authors used 35 gluteal perforator flaps in 32 consecutive patients for coverage of pressure sores located at sacral (n = 22), ischial (n = 7), and trochanteric (n = 6) regions. The mean age of the patients was 53.1 years (range, 5 to 87 years), and there were 16 male and 16 female patients. All flaps in this series were supplied by musculocutaneous arteries arising from gluteal muscles. Patients were followed up for a mean period of 13.6 months. Wound dehiscence was observed in two patients and treated by secondary closure. Three patients died during the follow-up period. All flaps survived except one that had undergone total necrosis, and only one recurrence was noted during the follow-up period. Gluteal perforator flaps are safe and reliable options for coverage of pressure sores located at different locations. Freedom in flap design and low donor-site morbidity make gluteal perforator flaps an excellent choice for pressure sore coverage.

Adolescent↗
PubMed2004

Bilateral autogenous breast reconstruction using perforator free flaps: a single center's experience.

The authors present a single center's experience in bilateral breast reconstruction using perforator free flaps. The aim of this study was to show their indications, surgical technique, and results. A series of 53 patients underwent this procedure between February of 1996 and October of 2002. The surgical procedures were performed on patients with bilateral breast cancer (11 patients), patients with unilateral breast cancer and contralateral prophylactic mastectomy (22 patients), patients who had undergone bilateral prophylactic mastectomy (18 patients), a patient with Poland's syndrome, and a patient whose aesthetic breast augmentation had failed. Primary and secondary bilateral breast reconstructions were done in 18 and four patients, respectively. Eighteen patients who had earlier undergone breast reconstruction with implants had a tertiary breast reconstruction. Combined reconstruction (primary with secondary and primary with tertiary reconstruction) was done in 13 patients. Ninety-eight deep inferior epigastric perforator flaps and eight superior gluteal artery perforator flaps were used. The average operative time was 10 hours (range, 8 to 14.5 hours) for the simultaneous bilateral reconstruction. Total flap necrosis occurred in two cases (one deep inferior epigastric perforator flap and one superior gluteal artery perforator flap). Partial flap necrosis was not encountered, and fat necrosis was found in one deep inferior epigastric perforator flap (1 percent). Two pulmonary infections, one deep vein thrombosis, and one cardiac arrhythmia occurred as postoperative complications. The mean hospital stay was 9 days (range, 6 to 20 days). Abdominal bulging was reported in one patient. There were no recurrent disease or cancer manifestations, with an average follow-up of 3.5 years. This series clearly shows that perforator flaps are reliable and useful tools for bilateral breast reconstruction. This technique decreases the donor-site morbidity and offers an excellent aesthetic and long-term outcome and high patient satisfaction.

Adult↗
PubMed2005

Efficacy of venous supercharging of the deep inferior epigastric perforator flap in a rat model.

BACKGROUND: An insidious risk with the use of muscle perforator flaps is the possibility of venous outflow compromise. Congestion in deep inferior epigastric perforator (DIEP) flaps in particular is not infrequent. On an empiric basis, their salvage has been accomplished by augmenting venous drainage through alternative outflow tracts. The validity of this clinical maneuver can now best be tested in a rat DIEP flap model. METHODS: The rat DIEP flap is a modification of the rat ventral abdomen flap. Flap perfusion can be based on a single rectus abdominis musculocutaneous perforator. No muscle is included with the flap. Three groups of five male Sprague-Dawley rats each were used. The conventional DIEP flap group had only a solitary perforator artery and venae comitantes and served as the control. The contralateral superficial inferior epigastric vein was included with the flap in the other two groups as a distinctly separate venous outflow tract. The latter two groups differed in that the perforator venae comitantes were either retained or deleted. RESULTS: Mean flap survival in the control DIEP flap group was 80.8 +/- 16.3 percent. Retention of the contralateral superficial inferior epigastric vein resulted in a statistically significant enhancement in flap viability (p < 0.027) whether the perforator venae comitantes were left intact (99.8 +/- 0.4 percent) or had been intentionally ablated (99.6 +/- 0.5 percent). CONCLUSIONS: Venous supercharging of the rat DIEP flap ensures greater flap survival. As a corollary, this supports the efficacy of prior anecdotal experiences in which an alternative venous outflow tract, preferably from the superficial system, had been used to overcome venous congestion. It is advisable for any muscle perforator flap to always try to retain a second outflow source to allow the potential for venous supercharging, if later indicated.

Animals↗
PubMed2006

The in-the-crease inferior gluteal artery perforator flap for breast reconstruction.

BACKGROUND: Perforator free flaps harvested from the abdomen or buttock are excellent options for breast reconstruction. They enable the reconstructive surgeon to recreate a breast with skin and fat while leaving muscle at the donor site undisturbed. The gluteal artery perforator free flap using buttock tissue was first introduced by the authors' group in 1993. Of the 279 gluteal artery perforator flaps, the authors have performed for breast reconstruction, 220 have been based on the superior gluteal artery and 59 have been based on the inferior gluteal artery. The authors have found that for some women with excess tissue in the upper buttock and hip area, use of the gluteal artery perforator flap resulted in an improvement at the donor site, whereas for others the aesthetic unit of the buttock was clearly disrupted. Therefore, the authors have recently been placing the scar in the inferior buttock crease to improve donor-site aesthetics. METHODS: The authors have now performed 31 in-the-crease inferior gluteal artery perforator free flaps for breast reconstruction and found that the results are very favorable. RESULTS: The removal of tissue from the inferior buttock results in a tightened, lifted appearance. The resultant scar is well concealed within the infrabuttock crease, and exposure or injury of the sciatic nerve has not occurred. Extended beveling at this site is also possible, with less risk of causing an unsightly depression. The final aesthetic result of the scar lying within the inferior buttock crease is very favorable. All patients report satisfaction with the donor site. Complications included one total flap loss, two reoperations for venous congestion, one hematoma, two cases with delayed wound healing at the recipient site, and one with delayed wound healing at the buttock. CONCLUSION: The in-the-crease inferior gluteal artery perforator flap from the buttock is now the authors' primary alternative to the deep inferior epigastric perforator flap from the abdomen for breast reconstruction.

Adult↗
PubMed2004

The perforator-based conjoint (chimeric) medial Sural(MEDIAL GASTROCNEMIUS) free flap.

The prototypical conjoint or so-called "chimeric" free flap heretofore has been composed of several large independent flaps, each supplied by a separate major branch, that ultimately arise from a common source vessel. The perforator-based type of chimeric flap is a relatively new concept, usually involving multiple muscle perforator flaps each based on a solitary musculocutaneous perforator, but still arising from the same "mother" vessel. This principle of split cutaneous perforator flaps has been now successfully adapted to the medial suralMEDIAL GASTROCNEMIUS perforator free flap on 2 separate occasions. As a chimeric flap, there was greater flexibility in insetting, and overall flap width may be larger but still narrow enough to allow primary donor site closure; and yet, by definition, only a single recipient site was needed for any microanastomoses. This is further proof that the perforator-based chimeric free flap may be an option for any muscle perforator flap donor site, so that potential donor territories for conjoint flaps have become virtually unlimited.

Adult↗
PubMed2005

Rhomboid perforator flap for a large skin defect due to lumbosacral meningocele: a simple and reliable modification.

To date, very few studies have reported the use of perforator flaps in newborn infants with an immature vascular system. Therefore, it is not clear whether perforator flaps can be used in newborns, as in adults. In this study, we applied the perforator flap procedure to a newborn infant, who had a large skin defect due to lumbosacral meningocele. We used the rhomboid perforator flap, which was a combination of using a rhomboid flap reported by Ohtsuka et al and preserving paraspinal perforator vessels according to Thomas. Although perforator vessels were so thin as to necessitate careful dissection and flap design, a good result was obtained by this procedure. We consider that the rhomboid perforator flap is a simple and reliable procedure for the treatment of lumbosacral meningocele.

Humans↗
PubMed2006

Cutaneous perforators of the forearm: anatomic study for clinical application.

We studied the distribution of constant cutaneous perforators of the forearm.A total of 25 amputated forearms of 13 Korean fresh cadavers were used for the study. The specimens were fixed in formaldehyde solution and phenol mixture in low concentration. Red latex was injected into the axillary arteries of 8 specimens, and lead oxide-gelatin mixture (radiopaque material) was given into another 8. And then the cutaneous perforators were isolated by dissection and radiographed. Free fasciocutaneous flaps with the pedicles of cutaneous perforators were exploited in 9 specimens. Two fasciocutaneous perforators were constant on the flexor surface and 3 on the extensor side. Most of the emerging points of 2 flexor perforators were within each circle, with 2.5 cm (87.5%) and 3.0 cm (75%) in diameter, respectively. Most of the emerging points of 3 extensor perforators were within each circle, with 2.0 cm (87.5%), 1.5 cm (75%), and 2.0 cm (87.5%) in diameter, respectively.A knowledge of constant perforators of the forearm is conducive to the free skin cutaneous flaps to be designed safely.

Cadaver↗
PubMed1999

Uterine perforation during surgical abortion: a review of diagnosis, management and prevention.

We analysed results of 13,907 women who underwent termination of pregnancy over a 6-year period in a public day-surgery clinic in South Australia to determine possible risk factors and preventive measures for known perforation of the uterus in surgical abortion. The perforation rate in the first trimester was 6 in 12,040 (0.05%) and in the second trimester (13-20 weeks), 6 in 1,867 (0.32%). Previous gynaecological surgery had been performed in 11 of 12 (92%) women sustaining perforation and was the main risk factor identified. No second trimester perforations occurred in the 2 years following identification of the risk factor and the introduction of precautionary protocols, and there was only 1 first trimester perforation. The overall reduction in perforation rate was from 0.13% to 0.02% (p=0.022). We conclude that previous gynaecological surgery including termination of pregnancy, lower segment Caesarean section and the large loop excision of transformation zone of the cervix (LLETZ) procedure, which may have resulted in scarring of the internal cervical os is a previously unreported risk factor for tearing of the internal os leading to perforation of the uterus during subsequent surgical abortion procedures. Dilatation of the cervix particularly for these 'at risk' procedures should be predominantly passive by the use of oral prostaglandins such as misoprostol and osmotic dilators.

Abortion, Induced↗
PubMed2004

Perforans varicosis: treatment of the incompetent perforating vein is important.

BACKGROUND: Varicose veins that arise from incompetent perforating veins are called perforans-varicosis. OBJECTIVE: This case report illustrates the relationship between incompetent perforating veins and varicosis. METHODS: An incompetent perforating vein, proximal of a varicose vein located at the dorsal side of the thigh, was treated by means of ultrasound-guided sclerotherapy with 1% polidocanol foam. The varicose vein was not treated. RESULTS: After 1 week, the varicose vein and the incompetent perforating vein showed no reflux. The varicose vein was practically invisible. The residual vein was treated with sclerotherapy. After 6 weeks the varicose vein was still invisible. CONCLUSION: This proximal incompetent perforating vein was important for the development and maintenance of the varicose vein. Treatment of this incompetent perforating vein resulted in complete disappearance of the reflux in the varicose vein. In this case ultrasound-guided sclerotherapy was successful in treating the incompetent perforating vein. More studies are needed to investigate the long-term effect of ultrasound-guided sclerotherapy as treatment of perforans-varicosis.

Female↗
PubMed2004

Effects of cortical bone perforation on experimental guided bone regeneration.

This study was designed to evaluate the effects of cortical bone perforation histologically and histomorphometrically on guided bone regeneration (GBR) in rabbits. After elimination of the periosteum, cortical bone defects of two sizes were made in the external cortical plate of the frontal bone (Group A: 1 x 15 mm; Group B: 3 x 15 mm). A non-resorbable membrane filled with autogenous blood was placed in the experimental area and secured with titanium pins. After 1 and 2 weeks, vascularized connective tissue and new bone were generated in the space surrounding the defects in both the groups. The amount of vascularized connective tissue generated in Group B was greater than that in Group A at 1 week. Alkaline phosphatase (ALP) was expressed on the bone surrounding the perforation. The expression of ALP was more extensive in Group B than in Group A and was proportional to the breadth of perforation. At 2 weeks, the perforated region was almost covered with new bone in Group A. ALP was expressed at the periphery of newly formed bone. The expression of ALP was proportional to the breadth and height of perforation. At 6 weeks, semicircular outgrowth of bone towards the periphery of the perforated region was observed in both the groups. Newly formed bone volume and ALP expression in Group B were more extensive than those in Group A. At 12 weeks, the space was filled with bone and connective tissue in both the groups. There was no difference in ALP expression between Groups A and B. Histomorphometric analysis showed significant differences between both the groups (two-way ANOVA, P<0.01). We conclude that a larger perforation is associated with prompter bone formation in the secluded space during GBR.

Alkaline Phosphatase↗
PubMed2002

Impact of cortical perforations of contiguous donor bone in a guided bone augmentation procedure: an experimental study in the rabbit skull.

BACKGROUND: It has been shown that bone can be augmented beyond the original skeletal envelope by using space-making barriers. Further, it has been suggested that perforation of the contiguous donor bone enhances bone formation in guided bone augmentation procedures. PURPOSE: The goal of the present investigation was to evaluate whether perforations into the donor bone marrow through the cortical plate, located contiguous to an extracalvarial experimental space, influence bone generation into this space with regard to augmented bone tissue volume and bone density 3 months postoperatively. MATERIALS AND METHODS: Two titanium cylinders, each with a titanium lid, were subcutaneously placed with their open ends facing the parietal bones of eight rabbits and secured with miniscrews. The cortical bone plate on the test side was perforated with seven evenly distributed holes, each with a diameter of 1.2 mm, using carbon-steel burs. Together, these perforations corresponded to about one-third of the total experimental bone area. The bone on the control side was left intact, and no bleeding occurred during the placement of the titanium lid. The perforation procedure (test side) resulted in various degrees of blood fill. After 3 months, the animals were sacrificed to obtain ground sections for histology and histomorphometry. RESULTS: The cylinders were found to be partly filled with tissue containing slender bone trabeculae and marrow spaces in abundance. The bone consistently reached a higher level at the inner wall compared with the central part of the cylinders (p = .001). Hollow connections between the experimental space and the skull bone marrow were found in the contiguous outer cortical plate in four of the seven control sites. No statistically significant differences could be demonstrated between the perforated test sites and the control sites regarding augmented tissue volume (64.4 +/- 18.9% vs. 64.9 +/- 22.2%) or bone density, although there was a tendency toward denser bone in the test sites (21.5 +/- 11.1%) versus control sites (14.7 +/- 5.4%). There was no statistical difference regarding relative bone-to-titanium wall contact (27.4 +/- 14.7% for test; 38.6 +/- 25.9% for control). Thickness (height) and density of the skull bone vault were measured in the area beneath and lateral to the cylinders. No significant differences could be observed regarding these parameters between the test and control side. There were no correlations between thickness (height) or density of donor bone versus amount or density of augmented bone. The degree of immediate blood fill could not be shown to correlate with augmented tissue volume or augmented bone density. CONCLUSIONS: In the present model, as observed 3 months postoperatively, cortical perforations of contiguous donor bone or degree of immediate blood fill of an extracalvarial experimental space were not found to enhance augmented tissue volume beyond the skeletal envelope. Although there was a much higher mean value for bone density of augmented bone in the test sites, the large variations failed to show significant intergroup differences.

Animals↗