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PubMed2002

A classification system and reconstructive algorithm for acquired vaginal defects.

Although multiple flaps have been used for vaginal reconstruction, a logical approach to reconstruction of these often complex defects has not been described. The objective of this study was to establish a classification system for acquired vaginal defects and to develop a reconstructive algorithm derived from this system. This study is a retrospective review of a 7-year experience with 51 flaps in 37 consecutive vaginal reconstructions. Twenty-two partial defects and 15 circumferential defects were reconstructed in 35 patients. Average patient age was 48 years (range, 19 to 69 years). Of the 22 patients with partial vaginal defects, six involved primarily the anterior and lateral wall and 16 the posterior vaginal wall. Among the 15 patients with circumferential defects, four included only the upper two-thirds of the vagina and 11 encompassed the entire vagina. On the basis of these defects, a classification system was developed. Partial defects involving the anterior or lateral vaginal wall were classified as type IA defects and were reconstructed primarily with pedicled Singapore fasciocutaneous flaps. Partial defects involving the posterior wall were classified as type IB and were reconstructed with pedicled rectus abdominis myocutaneous flaps. Circumferential defects involving the upper two-thirds of the vagina were classified as type IIA defects and were reconstructed with a rolled rectus flap or, less commonly, sigmoid colon (one patient). Total circumferential defects, type IIB, were reconstructed largely with bilateral gracilis flaps. Six patients had major complications, including one perioperative death, one complete flap loss, one partial flap loss, and three pelvic abscesses. Three patients had minor complications that included delayed wound healing and donor-site infection. Vaginal defects can be categorized into one of four types on the basis of the location and extent of resection. Flap selection is determined on the basis of the type of defect. Using this algorithm, immediate vaginal reconstruction with pedicled regional flaps can be performed with minimal patient morbidity and few surgical complications.

Adenocarcinoma↗
PubMed2006

Unusual case of acanthamoeba keratitis in a contact lens wearer.

PURPOSE: To present an atypical case of acanthamoeba keratitis in a soft contact lens wearer. METHODS: A case report of a 28-year-old female soft contact lens wearer with a 6-day history of redness and blurred vision in her right eye. Examination showed stromal keratitis that did not respond to therapy for herpes simplex virus. Four weeks later, the patient had increased stromal infiltration, an endothelial plaque, and a hypopyon. She did not complain of pain apart from mild discomfort. Corneal smears and anterior chamber tap were negative for bacteria, fungi, acanthamoeba, and herpes simplex virus, and the patient was prescribed fortified antibiotics. One week later, a large epithelial defect with a surrounding ring infiltrate was apparent. Corneal biopsy showed acanthamoeba. RESULTS: The acanthamoeba keratitis resolved with successful treatment. One year later, the patient had a residual visual deficit secondary to stromal scarring and her best-corrected visual acuity was 20/29. CONCLUSIONS: This case emphasizes the importance of considering acanthamoeba species in the differential diagnosis of keratitis, even without the classic symptom of severe pain. A high degree of suspicion with rapid and appropriate treatment may result in improved recovery of vision.

Acanthamoeba↗
PubMed2002

A problem-oriented and segmental open approach to alar cartilage losses and alar length discrepancies.

Alar cartilage losses and alar length discrepancies present problems in nasal tip support, contour, and symmetry. The true extent of the cartilage defect is often not apparent until the time of surgery. This article examines a problem-oriented and segmental open approach to such deformities. It is based on the size of the defect, its location within the dome and lateral crus, and the presence or absence of alar collapse. The defects are classified as major when there is a total or near total loss of the lateral crus, moderate when more than 5 mm is involved, and minor when less than 5 mm is affected. In major defects, a segmental reconstruction of the nasal tip cartilages is undertaken. It consists of a septal graft for columellar support and a conchal shield graft and umbrella graft for nasal tip contour. The whole length of the lateral crus is not reconstructed unless alar collapse is present. In moderate cartilage defects, usually seen laterally in secondary rhinoplasties, the remaining central dome segments are remodeled with shaping sutures. Moderate cartilage length discrepancies, as seen in unilateral cleft lip noses, are equalized through reversed alar rotations. The short crus is rotated laterally, taking length from the medial crus, and the long crus is rotated medially, with the excess advanced into the medial crural footplate. Additional shortening of the long crus can be achieved through cartilage division and advancement. The balanced alar units are then raised with tip projection-vector sutures, and onlay grafts are added if required. In minor cartilage losses, symmetry is usually obtained by shortening the opposite uninjured crus. A total of 33 patients are examined in this review. The average follow-up is 14 months. An improvement in nasal tip shape and support was achieved in all patients.

Cartilage↗
PubMed1990

Wave plate osteosynthesis as a salvage procedure.

The load axis of the curved proximal femur lies not inside but outside the bone. Therefore, high bending forces are acting, the medial cortex absorbing pressure and the lateral cortex absorbs tension. In a transverse fracture, a laterally applied plate will absorb the tensile stresses and the medial cortex, the pressure forces. When the medial buttress due to a bony defect is missing, the laterally applied plate is subjected to cyclic bending and will undergo fatigue fracture. This dilemma is compensated by a wave plate with bone graft: the compression forces are redirected to the lateral cortex, and the plate is again subjected to tension. Furthermore, since the plate stands away from the bone, it does not disturb the blood supply at the fracture site and thus bone healing.

Adult↗
PubMed2000

Repair of an intrabony defect from an adenomatoid odontogenic tumor.

This case report describes the occurrence and treatment of an adenomatoid odontogenic tumor (AOT) presenting as a periodontal intrabony defect on a upper lateral incisor. Following incision and flap reflection, a solid, rubbery specimen was enucleated in one piece leaving a wide moat-like intrabony defect. A bioabsorbable membrane of glycolide and lactide copolymer was sutured over the defect to maximize regeneration and the flaps then sutured over the membrane. Microscopic analysis of the biopsied specimen revealed dental hard tissue interspersed in a field of odontogenic epithelium in a glandular configuration, consistent with a diagnosis of AOT. AOT is a rare odontogenic tumor usually associated with unerupted teeth or dentigerous cysts, not periodontal defects. Clinical evaluation 6 months postoperatively revealed restoration of clinical attachment and periodontal health.

Adult↗
PubMedDate not supplied

[Dural bone defects and encephalocele associated with chronic otitis media or its surgery].

OBJECTIVES: We investigated the incidence of dural bone defects and encephalocele following radical mastoidectomy or open cavity tympanoplasty. PATIENTS AND METHODS: We retrospectively evaluated 190 operations of 182 patients (97 males, 85 females; mean age 30.6 years; range 9 to 70 years) who underwent radical mastoidectomy (n=89) or open cavity tympanoplasty (n=101). Follow-up examinations included otomicroscopy. Patients with documented dural bone defects on examination or operation records were further evaluated by axial and coronal computed tomography scans of the temporal bone. Those with suspected encephalocele were studied by magnetic resonance imaging. RESULTS: Dural bone defects were detected in 17 patients perioperatively. Of these, 14 defects were associated with chronic otitis media. Three iatrogenic bone defects were induced during obliteration of lateral sinus thrombosis. The mastoid tegmen was the most common site of defects (41%) and the most common etiologic factor was cholesteatoma (84%). Encephalocele was detected in one patient in whom radical mastoidectomy with lateral sinus obliteration was performed due to lateral sinus thrombophlebitis. Encephalomalasia was found nearby the defect area in two patients. CONCLUSION: Dural bone defects associated with chronic otitis media are not rare, the most common cause being cholesteatoma. Repair of dural lacerations requires watertight closure to prevent the occurrence of encephalocele.

Adolescent↗
PubMed1990

Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee.

This paper describes a flap for covering defects around the knee. Dissections of 20 legs showed that in the majority the lateral sural cutaneous artery branched from the popliteal artery and descended along the posterolateral aspect of the leg together with two venae comitantes and the lateral sural cutaneous nerve. An island flap was designed, pedicled on these vessels and nerve, and was used in 17 patients with defects around the knee, including acute trauma (three cases), soft tissue tumours (three cases), unstable scar or ulcer (seven cases), and chronic osteomyelitis or infected open fractures with tissue loss (four cases). All the flaps survived entirely and possessed normal sensation. Furthermore, it was not necessary to sacrifice the main vessels of the lower leg.

Adolescent↗
PubMed1978

Osteogenic capacity of periosteal grafts. A qualitative and quantitative study of membranous and tubular bone periosteum in young rabbits.

A standardized model, permitting only periosteal bone formation, has been applied for qualitative and quantitative studies on the osteogeneses from periosteal grafts. The periosteum from the tibia was grafted to the skull and vice versa. The investigation also included the study of periosteal bone formation combined with other osteogenic factors. A total of 78 operations were performed on the tibias and skulls of 43 growing rabbits. For qualitative studies ordinary histological methods were used. Tibial periosteal grafts to skull defects started bone formation already after 2 weeks and, via a very small amount of woven bone, compact bone and bone marrow was formed after 8-10 weeks. Combined epidural and subperiosteal bone formation gave a calvarial bone. Skull periosteal grafts to tibial defects started bone formation somewhat later, but, after more woven bone as an intermediate stage, the defect had healed with thick compact bone and bone marrow after about the same period. For quantitative studies the newly formed periosteal bone was removed, dry-weighted and ashed. The ashes were dissolved in HCl for spectrophotometric determination of total Ca content, which was used as a quantitative measure of bone amount. Tibial periosteum grafted to a calvarial defect halved its bone forming capacity but compared to the in situ skull periosteal potential, the capacity was tripled. This meant that the defect was completely healed. Calvarial periosteum was much less potent than was the tibial periosteum, when both were grafted to skull defects. However, when transplanted to a long bone defect the former increased its bone forming capacity 5 times compared to its original one as an in situ flap. Environmental functional demands seem to influence the type of bone formation and the final structure of the new bone. On the other hand, there are differences between long and membranous bone periosteum regarding the amount of bone formed.

Animals↗
PubMed1991

Bilateral, spontaneous and simultaneous rupture of the quadriceps tendon in chronic renal failure and secondary hyperparathyroidism. Report of five cases.

Bilateral and simultaneous rupture of the quadriceps tendon of the knee without significant trauma in five patients, two males and three females, with chronic renal failure and secondary hyperparathyroidism is reported. Ruptures of the extensor mechanism are relatively rare injuries. Unilateral rupture is more common. Bilateral, simultaneous and spontaneous rupture is a very rare condition and only eleven cases have been reported in patients with a number of systemic diseases. Two cases have also been described in healthy subjects. The following points contribute to the diagnosis of quadriceps tendon rupture: 1) sudden pain and inability to extend the knee, 2) a palpable defect above the patella, 3) lateral x-rays with technique for soft tissue, reveal a defect and anterior tilting of the proximal pole of the patella. Operative repair of the ruptured tendon was the treatment in all our cases and gave excellent results.

Adult↗
PubMed2006

A case of rudimentary lateral parietal cephalocele: extracranial meningothelial and glial tissue without intracranial communication or bony defect.

The authors report a case of a 7-month-old infant with a right lateral parietal scalp lesion intermittently leaking fluid similar to cerebrospinal fluid that histologically demonstrated meningothelial and glial cells. At surgical removal, however, no fibrous stalk or bony defect could be identified connecting the lesion with the intracranial compartment. While the embryologic mechanism of this lesion is unclear, the prognosis for normal neurological development appears excellent.

Encephalocele↗
PubMed2005

Reconstruction of the form and function of lateral malleolus and ankle joint.

Soft-tissue reconstruction alone cannot obtain normal ankle function in patients with large defects in the area of the lateral malleolus. The authors report a functional reconstructive method for the lateral malleolus, utilized in a male patient whose osteosarcoma in the fibula was resected with surrounding soft tissue. In order to reconstruct the lateral malleolus, the remaining half of the fibula at the knee was removed, and the fibular head was fixed with the tibia at the ankle joint. Ligaments were reconstructed with tendon grafts. Skin and soft-tissue defects were reconstructed with a combined composite flap comprised of a latissimus dorsi myocutaneous flap and a serratus anterior muscle flap. Dead space around the bone graft was filled with the serratus anterior muscle flap that was divided into two portions. The surface was covered with the latissimus dorsi myocutaneous flap. The patient regained almost normal function of the ankle joint. This technique would be a useful functional reconstructive method for patients with large defects in the area of the lateral malleolus.

Adolescent↗
PubMed1994

Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy.

PURPOSE: The aim of lateral internal anal sphincterotomy when treating anal fissure is to divide the distal one-third to one-half of the internal anal sphincter. This study aimed to evaluate prospectively the extent of disruption to the internal anal sphincter following lateral anal internal sphincterotomy and also to establish the prevalence of symptoms of anal incontinence in these patients. METHODS: Fifteen patients with anal fissure (ten females and five males) had bowel symptoms assessed and anal endosonography performed preoperatively and two months after lateral internal anal sphincterotomy. RESULTS: Anal endosonography was normal preoperatively in all but two females who had anterior external sphincter defects (presumedly from previous obstetric trauma). Postoperatively, apart from one male in whom no defect could be identified, all had an internal anal sphincter defect corresponding to the site of lateral internal anal sphincterotomy. In nine of the ten females, the defect involved the full length of the internal anal sphincter, but in the other four males, the defect involved the distal internal anal sphincter only. All were continent preoperatively, but after lateral internal anal sphincterotomy, three females became incontinent to flatus (two of whom had a preoperative external sphincter defect). CONCLUSION: In contrast to lateral internal anal sphincterotomy in males, division of the internal anal sphincter in most females tends to be more extensive than intended. This is probably related to their shorter anal canal. In some females, lateral internal anal sphincterotomy may compromise sphincter function and precipitate anal incontinence, particularly in the presence of other sphincter defects. Care should be exercised especially in the presence of previous obstetric trauma, as internal anal sphincter division may further compromise sphincter function.

Adult↗
PubMed1989

Para-alar crescentic subcutaneous pedicle flap for repair of skin defects in the philtrum.

Crescentic subcutaneous pedicle flaps prepared on the area lateral to the alar base were designed to cover the skin defects in and around the philtrum. In 1 patient a combination of the lateral lip advancement flap and the crescentic subcutaneous pedicle flap was applied to the skin defect on the lateral lip and philtrum. In another patient, a combination of two crescentic subcutaneous pedicle flaps was applied to the skin defect within the philtrum. Both methods have been successful.

Adult↗
PubMed1999

[Reconstruction of a complex defect of the upper third of the humerus by pedicle transplant of the lateral edge of the scapula. A case report].

Vascularized bone transfer of the lateral border of the scapula is exceptionally used in orthopaedic surgery. The authors report a case of pedicle transfer of the lateral border of the scapula designed to reconstruct a nine centimetre bone defect of the upper third of the humerus following a gunshot wound. A complementary conventional bone graft was performed one month later and consolidation was achieved at the fourth month.

Adult↗
PubMed1978

Bone growth alterations resulting from application of CO2 laser beam to the epiphyseal growth plates. An experimental study in rabbits.

The CO2 laser beam was used to create defects 3 mm in depth in the distal growth plate of one femur in a group of 59 rabbits. In most of the 32 rabbits in which the defect was created on the lateral aspect of the epiphyseal plate the procedure resulted in the subsequent development of valgus deformity and shortening of the femur. In most of the 27 rabbits in which defects were produced both medially and laterally to the epiphyseal plate there was a subsequent marked shortening of the bones. Histological studies revealed that the laser-induced defects of the growth cartilage led to epiphysiodesis and premature disappearance of the epiphyseal growth plates.

Animals↗
PubMed1977

Congenital brain defect masked by subdural fluid collection.

Two rare cases of subdural fluid collection are reported. In these cases, the subdural space was in direct communication with the lateral ventricle through the congenital brain defects. The subdural fluid was formed by the cerebrospinal fluid which passed from the lateral ventricle through the brain defects. The difficulty to diagnose these cases from the usual subdural hygroma is emphasized.

Brain↗
PubMed1996

Mutations affecting development of the zebrafish inner ear and lateral line.

Mutations giving rise to anatomical defects in the inner ear have been isolated in a large scale screen for mutations causing visible abnormalities in the zebrafish embryo (Haffter, P., Granato, M., Brand, M. et al. (1996) Development 123, 1-36). 58 mutants have been classified as having a primary ear phenotype; these fall into several phenotypic classes, affecting presence or size of the otoliths, size and shape of the otic vesicle and formation of the semicircular canals, and define at least 20 complementation groups. Mutations in seven genes cause loss of one or both otoliths, but do not appear to affect development of other structures within the ear. Mutations in seven genes affect morphology and patterning of the inner ear epithelium, including formation of the semicircular canals and, in some, development of sensory patches (maculae and cristae). Within this class, dog-eared mutants show abnormal development of semicircular canals and lack cristae within the ear, while in van gogh, semicircular canals fail to form altogether, resulting in a tiny otic vesicle containing a single sensory patch. Both these mutants show defects in the expression of homeobox genes within the otic vesicle. In a further class of mutants, ear size is affected while patterning appears to be relatively normal; mutations in three genes cause expansion of the otic vesicle, while in little ears and microtic, the ear is abnormally small, but still contains all five sensory patches, as in the wild type. Many of the ear and otolith mutants show an expected behavioural phenotype: embryos fail to balance correctly, and may swim on their sides, upside down, or in circles. Several mutants with similar balance defects have also been isolated that have no obvious structural ear defect, but that may include mutants with vestibular dysfunction of the inner ear (Granato, M., van Eeden, F. J. M., Schach, U. et al. (1996) Development, 123, 399-413,). Mutations in 19 genes causing primary defects in other structures also show an ear defect. In particular, ear phenotypes are often found in conjunction with defects of neural crest derivatives (pigment cells and/or cartilaginous elements of the jaw). At least one mutant, dog-eared, shows defects in both the ear and another placodally derived sensory system, the lateral line, while hypersensitive mutants have additional trunk lateral line organs.

Animals↗