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At least 127 records · Page 7Linked to original sources
PubMed2000

Use of apically based periosteal flaps as globe tethers in severe paretic strabismus.

OBJECTIVE: To evaluate the technique of using an intact autogenous periosteal flap for tethering of the globe in patients with severe paretic strabismus. METHODS: We performed a periosteal flap procedure on 5 patients and followed their postoperative course. The flap was created from the medial, lateral, or superior orbital walls. A description of the harvesting and manipulation of the flap and the initial postoperative findings are presented. RESULTS: All patients showed marked reduction in their postoperative strabismic deviation compared with preoperative measurements. Greater early postoperative swelling was noted after this procedure than with the standard strabismus surgery. No complications were experienced during or after surgery. Two patients required a second operation for adjustment of the periosteal flap for adequate alignment. CONCLUSIONS: The vascularized periosteal flap technique provides an excellent tether for the globe. Early and late stability has been favorable.

Aged↗
PubMed1985

Periosteal osteosarcoma.

An analysis of 6 patients with periosteal osteosarcoma treated by the authors along with a review of 55 patients reported in the literature demonstrates that periosteal osteosarcoma is distinctly different from conventional osteosarcoma or periosteal chondrosarcoma. Periosteal osteosarcoma is a less aggressive tumor than conventional osteosarcoma. It is a relatively well-differentiated chondroblastic osteosarcoma occurring on the surface of the long bones of the extremities. Three patients demonstrated frank medullary invasion of tumor, two grossly and one microsurgically. Patients treated with marginal resection had a 70% local recurrence rate. Patients receiving wide resection or primary amputation have survived longer with less recurrence of disease. Overall, 10 of 61 patients are dead with metastatic disease with a mean reported follow-up of 6 years and 7 months. Adjunctive therapy has been of no demonstrable aid in terms of prolonging survival. Medullary extension of this tumor should not be used to exclude this diagnosis. The authors believe that the treatment of choice is wide resection without adjunctive chemotherapy.

Adolescent↗
PubMed1990

Continuing periosteal apposition. II: The significance of peak bone mass, strain equilibrium, and age-related activity differentials for mechanical compensation in human tubular bones.

It is generally presumed that compensation for the reduction of bone strength by progressive endosteal bone loss in adults is provided by continuing periosteal apposition (CPA) of new lamellar bone. However, the appropriate magnitude of compensatory bone growth, and the parameters that operate to determine that magnitude, are unknown. This paper examines the mechanical compensation hypothesis in a series of right-circular tubular bone analogues. Under this hypothesis, the stated objective of CPA is maintenance of the cross-sectional geometric properties of the element. These include the second and polar moments of area, as well as the cortical area of the section (I, J, and CA, respectively). This study assumes that, as resorption and apposition proceed, geometric change is isometric (shape preserving). The analysis suggests that for a given rate of endosteal bone loss (the stimulus), the magnitude of periosteal growth (the response) required to maintain geometric strength is determined by the maximum ratio (CT0) of the radial distances from the section centroid to the endosteal and periosteal surfaces (i.e., cortical thickness prior to the onset of progressive endosteal bone loss, or peak bone mass). The analysis also indicates that, for any given individual, the amount of compensatory periosteal gain required may be very small. This is particularly true for individuals having a large CT0 and for whom the magnitude of dynamic loading imparted to the skeleton declines with advancing age. This finding is illustrated in a model that relates concepts of bone surface remodeling equilibria and age-related activity differentials.

Aging↗
PubMed1991

The use of polylactic acid matrix and periosteal grafts for the reconstruction of rabbit knee articular defects.

In order to find a material that would improve cartilage repair, we investigated the use of porous polylactic acid matrix (PLA) with and without periosteal grafts in large articular defects in the medial femoral condyles of 18 New Zealand white rabbit knees. The right knee defect was filled with PLA, the left defect was filled with PLA and a periosteal graft. All animals were killed at 12 weeks. PLA allowed for the de novo growth of neocartilage at the articular surface in all specimens and appeared to serve as a scaffolding for cell migration and matrix formation. Histologically, small amounts of PLA remained under the neocartilage with the majority being replaced by bone. PLA was a suitable carrier for periosteal grafts with a high graft survival rate (89%) and proliferation of a neocartilage which was thicker and more closely resembled articular cartilage than PLA alone knees. Biochemically, there was more type II collagen in the grafted knees (83%) than in the PLA alone knees (65%). Biomechanical tests of the neocartilage included equilibrium displacement, aggregate modulus, and apparent permeability. These tests were not statistically different between PLA alone and grafted knees. Comparison to normal cartilage indicated that the neocartilage was less stiff but had similar permeability. A consistent repair of the articular defects was achieved with and without periosteal grafts resulting in a tissue that closely resembled hyaline articular cartilage.

Animals↗
PubMed1990

Failure of isolated rat tibial periosteal cells to 5 alpha reduce testosterone to 5 alpha-dihydrotestosterone.

Periosteal cells were isolated from tibiae of adult male rats after collagenase treatment. Northern blot analysis of total cytoplasmic RNA extracted from the isolated periosteal cells was positive for expression of genes encoding the osteoblast marker proteins osteocalcin (BGP) and pre-pro-alpha 2(I) chain of type 1 precollagen. The isolated periosteal cells were incubated with 1 nM [3H]testosterone [( 3H]T) for up to 240 minutes and the reaction products separated by high-performance liquid chromatography. [3H]5 alpha-dihydrotestosterone [( 3H]DHT) was not detected in extracts of periosteal cell incubations. In contrast, [3H]DHT was produced in a time-dependent manner by cells from seminal vesicles. These results suggest that testosterone 5 alpha-reductase activity is not expressed by osteoblasts in rat tibial periosteum and that the anabolic effects of androgens in this tissue are not mediated by locally produced DHT.

Animals↗
PubMedDate not supplied

Osteogenesis from periosteal autografts in ulnar defects in dogs.

The quantity of new bone formed by revascularized periosteal grafts was compared with that formed by nonvascularized periosteal grafts in ulnar diaphyseal defects in dogs. Although in general the revascularized periosteal grafts produced a greater quantity of bone than their nonvascularized counterparts, this osteogenic behavior was not consistent. The results, however, are sufficiently encouraging to merit further investigation into the free transfer of revascularized periosteal autografts.

Animals↗
PubMed1982

Anterior periosteal dermal suspension with suction curettage for lateral thigh lipectomy.

The standard excisional approach to lipectomy has now been expanded by the use of suction curettage either as an adjunct or a primary procedure. In severe cases of steatomeria (a term used to designate trochanteric obesity and eliminate the misuse of the term lipodystrophy), curettage serves to prepare and shape the flaps, while excision and "periosteal dermal suspension" are sometimes necessary to achieve adequate contour and lift. Periosteal anchoring ensures adequate permanent suspension and a tension-free closure. Achievement of lateral thigh contouring by an anterior approach is facilitated by the use of the suction curette. Undermining of the superior flap and contouring with suction, as well as overlapping the closure with buried dermal-fat suspension flaps, eliminates bulging above or below the incision. Periosteal dermal suspension decreases the possibility of scar widening and eventual ptosis, provides a fixation technique that permits more lift, and eliminates scarring from the lateral thigh. Lateral thigh suction lipectomy with periosteal dermal suspension has been done alone or in conjunction with buttock reduction or with medial thigh or abdominal lipectomy in 14 patients. The operating time was short, and the results were good with minimal morbidity.

Adipose Tissue↗
PubMed1999

Comparison of plain radiographs and magnetic resonance images in the evaluation of periosteal reaction and osteoid matrix in osteosarcomas.

To determine the relationship and the degree of agreement between radiographs and MR images for the existence of osteoid matrix and periosteal reactions in the initial diagnosis of osteosarcomas, the plain radiographs and MR studies of 54 patients with proven osteosarcoma were retrospectively evaluated. In each tumor the visualization and type of osseous matrix, periosteal reaction and Codman angle were recorded independently for both techniques and by consensus between two radiologists. In 37 tumors agreement existed regarding osteoid matrix and in 31 cases regarding periosteal reactions. The Kappa statistic showed a significant relationship between both tests (0.49 and 0.44, respectively). Both techniques were also not statistically different in the proportion of findings with the McNemar test. Therefore, the ability of MR images seems important in reporting the MR features of bone tumors. Identification of osteoid mineralization and periosteal reaction can also be used with MR in the diagnosis of osteosarcoma.

Adolescent↗
PubMed1997

[Ligamentization as an explanation for the stability of periosteal flap repair in the replacement of the fibular ligament system].

The gold standard in the operative treatment of chronic insufficiency of the lateral ligaments of the ankle joint is replacement with a tendon (tenodesis). The disadvantage of this method is limitation of movement. The results of the replacement of ligaments with a periosteal flap are similar to the results after tenodesis, but the rate of complications is significant lower. We investigated the histological changes in periosteal flaps in patients. We saw an alignment of the collagenous fibers in the periosteal flap 8-12 weeks after the operation. The results are statistically significant. The conclusion is that the periosteal flap in the replacement of ligaments changes into a ligament-like structure.

Biopsy↗
PubMed2003

The role of periosteal flap in the prevention of femoral widening in anterior cruciate ligament reconstruction using hamstring tendons.

Tunnel widening in anterior cruciate ligament reconstruction has been reported for many years, whatever the type of plasty (allo- or autograft) or graft (patellar or hamstring tendons). Recently, the hypothesis has been formulated that widening would be responsible for later laxity of the knees. Micromobility of the graft or biological factors are classically responsible for the enlargement. In order to improve the biological conditions around the graft within the tunnel, we have developed a surgical technique using a periosteal flap. The periosteal flap is harvested at the superior and medial metaphysis of the tibia and wrapped around the proximal part of the four strands of gracilis and semitendinosus tendons near the outlet of the femoral tunnel. Forty-one patients with isolated rupture of the ACL were included in a prospective and randomized study: the first group of 20 patients had femoral fixation by Transfix and resorbable screw, the second group of 21 patients had femoral fixation by Transfix and periosteal flap. The diameters of the tunnel were measured between the sclerotic margins at the tunnel entrance and 1 cm above, and compared to the peroperative drill size. The percentage change in diameter was calculated as: (tunnel diameter-drill size)/drill size. The two groups of patients were comparable as to gender, side, age, KT-1000 side to side difference, femoral tunnel diameter and follow-up. At 2.5 months and 11 months postoperatively on average, there was a significant reduction of enlargement at the outlet of the tunnel with the use of a periosteal flap but widening was constant.

Adolescent↗
PubMed2006

Preliminary results after rotator cuff reconstruction augmented with an autologous periosteal flap.

Periosteal augmentation of tendons in the course of refixation to bone has been shown to be a suitable method for early primarily stable osteofibroblastic integration. The aim of this study was to evaluate the clinical and radiological results of open rotator cuff reconstruction using an autologous periosteal flap augmentation technique. The research was performed as a prospective cohort study. Twenty-three prospective patients (average age 59.7 years) with degenerative rotator cuff tears were operated on with an open technique and a subtendinous periosteal flap augmentation using bioabsorbable suture anchors and a modified Mason-Allen technique. Clinical evaluation consisted of the Constant-Score and the Simple Shoulder test. Radiological evaluation included standard radiographs and magnetic resonance imaging (MRI). Twenty patients were evaluated at a mean follow-up of 14.4 months. The average Constant Score increased significantly from 51.7 to 80.9 points (p<0.05) with 12 excellent, seven good and one satisfactory result. The Simple Shoulder test showed a significant increase of an average of 4.8-10.7 questions answered with yes (p<0.05). Four patients (20%) demonstrated a retear of the tendon on postoperative MRI. Ectopic ossifications in the supraspinatus tendon were found in four patients (20%) but these had no impact on the final clinical results. Open rotator cuff repair augmented with an autologous periosteal flap shows high patient satisfaction level with low rerupture rates. Mid- and long-term results remain to be seen. The potential benefits compared with conventional open or arthroscopic rotator cuff surgery must be examined in prospective randomized studies.

Activities of Daily Living↗
PubMed2003

Evidence for bone formation on the external "periosteal" surface of the femoral neck: a comparison of intracapsular hip fracture cases and controls.

Age-related expansion of the external surface of the femoral neck in order to offset generalized bone loss is potentially an important mechanism whereby hip strength and hence resistance to hip fracture is maintained. However, it has been widely assumed that bone formation is precluded from this external interface due to the presence of a synovial membrane associated with the hip joint. In this study we have demonstrated histologically that bone formation does indeed occur on the outer "periosteal" surface of the proximal femoral neck. It was therefore hypothesized that an impairment or reduction in periosteal bone formation might be seen in cases of femoral neck fracture compared with age-matched controls. Qualitative analysis of whole femoral neck samples from female subjects and age- and sex-matched post-mortem controls demonstrated that these groups expressed similar distributions of the bone formation marker, alkaline phosphatase (AP), at the periosteal surface [whole biopsy mean % periosteal AP-positive surface: control=16.0 (range=0.5-43.0), fracture=13.4 (range=1.0-34.6), p=0.44]. In conclusion, despite a wide intersubject variation, bone formation at the femoral neck periosteum is a feature of elderly women even if they have had a hip fracture.

Aged↗
PubMed2002

Periosteal reaction with normal-appearing underlying bone: a child abuse mimicker.

Any irritation or disruption to the underlying bone will cause a periosteal reaction and result in new periosteal bone deposition. Periosteal bone formation may be due to either physiologic or pathologic causes. Pathologic bone formation generally results from an adjacent inflammatory process or a hypoxic or toxic stimulus. Common causes of pathologic periosteal reaction in children include trauma to the underlying bone. However, other causes such as hypervitaminosis A, prostaglandin therapy, cortical hyperostosis (Caffey's disease), hypertrophic osteoarthropathy (primary and secondary), osteomyelitis, leukemia, trauma, and syphilis must also be considered. The last four are usually associated with some degree of bone destruction, while in the first four diseases the underlying bone is left radiologically intact. This paper will concentrate on those diseases that appear to leave the underlying bone intact. The clinical and radiological features that help to differentiate some of these entities are presented.

Journal Article↗
PubMed1994

A comparison of different imaging modalities and direct inspection after periosteal stripping in predicting the invasion of the mandible by oral squamous cell carcinoma.

OBJECTIVE: To compare the predictability of orthopantomograms (OPG), bone scans, computerised tomography (CT), magnetic resonance imaging (MRI) and periosteal stripping with direct inspection in predicting both the presence and extent of tumor invasion of the mandible. DESIGN: Prospective study. SETTING: Queen Elizabeth Hospital, Birmingham; Wordsley Hospital, Stourbridge; North Staffordshire Royal Infirmary, Stroke-on-Trent. SUBJECTS: 35 consecutive patients requiring a mandibular resection as part of their treatment for oral squamous cell carcinoma. MAIN OUTCOME MEASURES: The prediction of the extent of bone invasion for each of the investigations and direct inspection after periosteal stripping. The actual extent of invasion of the mandible from a detailed histological assessment. RESULTS: The OPG underpredicted the width and depth of invasion by on average 13 mm and 2 mm. There were 5 false negative reports. Bone scans overpredicted the width and depth by 14 mm and 15 mm with 1 false negative. CT scans underpredicted the width of invasion by 5 mm and overpredicted depth by 3 mm, but 7 false negatives were returned. MRI scans overpredicted width and depth of invasion by 19 mm and 10 mm with 1 false negative. Direct inspection after periosteal stripping underpredicted the width and depth of invasion by 5 mm and 3 mm with 1 false negative. CONCLUSION: OPG's and bone scans are useful for the initial assessment of all tumours in the region of the mandible. MRI is a more useful investigation than CT in the assessment of mandibular invasion by oral squamous cell carcinomas. Exploratory periosteal stripping at the time of resection can accurately predict the presence of tumour invading the mandible.

Adult↗
PubMed2005

Tensile mechanical strain up-regulates Runx2 and osteogenic factor expression in human periosteal cells: implications for distraction osteogenesis.

PURPOSE: Distraction osteogenesis is now accepted as a standard treatment in oral and maxillofacial reconstructive surgery. In the process of bone regeneration with the application of strain, the periosteum might be very involved in osteogenesis. This study examined the effect of mechanical strain on periosteal cells and the implications for distraction osteogenesis. MATERIALS AND METHODS: Periosteal cells were obtained from mandibular periosteum that was excised while extracting impacted wisdom teeth. Mechanical strain was applied using a specially designed apparatus with flexible silicon bottom chambers. The levels of mRNA of the osteoblast differentiation factor Runx2 (Cbfa1/AML3/Peb alpha A) and osteogenic factors were analyzed at different times using the reverse transcription-polymerase chain reaction method to evaluate the effect of the strain. RESULTS: The periosteal cells expressed the osteogenic phenotype. The strain had a shaping effect on the cells. The application of tensile strain strongly activated the expression of osteogenic and angiogenic growth factors, and up-regulated the expression of Runx2, an osteoblast-specific transcription factor. CONCLUSION: Tensile strain may initiate the differentiation of periosteal cells into osteogenic cells, inducing the expression of Runx2 in the process of bone regeneration. Therefore, the periosteum is profoundly involved in bone formation and regeneration, especially in distraction osteogenesis.

Bone Regeneration↗
PubMed2002

An avian model of limb deviation induced by periosteal surgery.

A model of limb deviation induced by hemi-circumferential periosteal stripping of the distal tibiotarsus of domestic chicks is described. This model has been developed to study the effects of periosteal stripping on the cellular, mechanical, vascular, and biochemical status of the immature bone and growth plate. It is hoped that such studies may further elucidate the mechanisms involved in altered bone growth following periosteal stripping techniques which are used in human and equine orthopaedics for the management of leg length discrepancies and angular limb deformities respectively (Auer and Martens 1980, Warrell and Baker 1987). Hemi-circumferential periosteal stripping of the left distal tibiotarsus of 28-day-old chicks resulted in significant change in metaphyseal-diaphyseal angle with time, compared to both the controls and the untreated right legs (P<0.0001). This model of limb deviation developed rapidly and consistently, and the procedures were well tolerated by the birds over the short survival time (maximum 28 days).

Animals↗
PubMed1981

Transplantation of free tibial periosteal graft on alveolar bone defect in adult rabbit.

The healing of bone defect in eight adult rabbits was studied. The age range of animals was 5-23 months. The bone defects were made symmetrically in the inferior surface of the mandibles. At the defect site the root surface of continuously erupting mandibular incisors was exposed. On the left side, the bone defect was covered with a local periosteal flap (control side) and on the right side the defect was covered with a free periosteal graft from the tibia (test side). The healing of bone defects and the amount of new bone were studied. The quality of the bone formed was investigated histologically. The findings of this investigation led to the following conclusions: (1) The bone defects healed on both sides. The amount of bone on the control side was identical to that in the anatomical region. On the test side the amount of bone formed was in seven cases two to threefold that formed on the control side. (2) The histological study proved that the bone formed was lamellar bone, being identical on both the control and the test side. (3) The ages of the animals or the length of follow-up time did not affect the amount of new bone, the healing of the defect or the quality of new bone. (4) The eruption of the incisors was symmetrical. In this study the free periosteal graft from the tibia led to better bone formation than the local periosteal flap in the induced bone defects of the tooth-bearing region in the mandible of the adult rabbit.

Age Factors↗
PubMed2001

Histomorphological and proliferative characterization of developing periosteal neochondrocytes in vitro.

Periosteal chondrogenesis is relevant to cartilage repair and fracture healing. Cell proliferation is a limiting factor of cartilage production. We used an in vitro organ culture model to test the hypothesis that proliferative activity correlates with cell morphology. One hundred and four periosteal explants from 26 two-month old New Zealand rabbits were cultured for up to 42 days. They were analyzed histomorphologically, and immunohistochemically with proliferative cell nuclear antigen (PCNA). The periosteal neocartilage displayed a consistent zonal pattern of chondrocyte cell shapes. The flat cell zone from day 7 to 21, consisted of uniform-sized small spindle-shaped cells. The round cell zone, which appeared on day 14, consisted of variable-sized round cells averaging 510 +/- 250 microm2 in area. They were subdivided into small round (<510 microm2) and large round cells (>510 microm2). The proliferative index was highest in the small round cell group (32 +/- 6%), intermediate in the flat cell group (27 +/- 6%), and lowest in the large round cell group (20 +/- 7%) (P < 0.001). Furthermore, the proliferative indices in the round cell group were inversely proportional to cell size. Therefore, (1) there is a sequential progression of cell morphology during periosteal chondrogenesis, (2) cell differentiation is arrested prior to terminal differentiation for some cells and not for others, and (3) proliferative activity is strongly related to cell morphology. This organ culture model provides us with opportunities to study the regulation of terminal chondrocyte differentiation and the control of cell proliferation. This will contribute to our understanding of cartilage repair, fracture healing and growth plate physiology.

Animals↗