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At least 1,711 records · Page 95Linked to original sources
PubMed2004

[Recurrent highly-differentiated eccrine carcinoma of the thumb -- a case report].

The eccrine carcinoma is a rare tumour originating from the sweat glands. They are mainly located in the palm of the hand and the sole of the foot, the digits, the head and the trunk. We report on a now 68-year-old male, who underwent partial amputation of the thumb at the level of the proximal phalanx due to an eccrine carcinoma in 1990. In the following years, three local recurrences were excised. After the exclusion of metastases an amputation at the MP I level was performed at our institution. To restore grip function, we performed a distraction of the first metacarpal bone followed by deepening of the first web space. So far, there are no defined treatment recommendations due to the rarity of the tumor. In some cases, metastatic disease has been reported, and in most cases, a high rate of local recurrence. After diagnostic biopsy, we recommend staging to exclude metastatic spread of the tumor followed by aggressive local surgical treatment.

Acrospiroma↗
PubMed2006

[Hip arthroscopy. Technique for positioning and distraction].

Arthroscopy of the hip joint can be performed in the supine or lateral position. The decision whether to use the supine or lateral position appears to be more a matter of individual training or habit. Both positions have specific pros and cons. The operative experience with arthroscopy of the central and peripheral compartment shows that a combined procedure with and without traction is beneficial. Whereas arthroscopy of the central compartment in normal joints of adults is feasible only with traction, the peripheral compartment can be better scoped without traction. The combination of both techniques however is technically demanding. Particularly for arthroscopy of the central compartment with traction, the success of the operative procedure is strongly correlated with a correct technique of positioning and distraction. Precise positioning and thick padding of the counterpost, secure fixation and thick padding of the foot, and the limitation of magnitude and duration of traction are important features in order to avoid soft tissue and nerve damage. Good relaxation, joint position, and distension of the joint to break the joint vacuum significantly improve distraction of the femoral head from the socket. In combination with fluoroscopy, scope trauma to the acetabular labrum and hyaline cartilage can be minimized. For arthroscopy of the peripheral compartment without traction, the counterpost is removed and the foot taken out of the traction module for free range of motion of the leg and hip joint. This allows dynamic testing of the hip and access to different parts of the peripheral labrum, proximal femur, and soft tissues.

Arthroscopes↗
PubMed1999

Stimulation of bone formation by recombinant fibroblast growth factor-2 in callotasis bone lengthening of rabbits.

Bone lengthening by callotasis is one of the most useful methods not only for the treatment of short extremities but also for extensive bone defects; however, the procedure takes a long time especially for the consolidation of the distracted callus. In this study, effects of a single local injection of recombinant human fibroblast growth factor-2 (FGF-2 or basic FGF) on callotasis bone lengthening were examined in rabbits. Ten days after the osteotomy at the middle of the tibia and the installment of an external fixator, the osteotomized site was distracted at a rate of 1.4 mm/day for 7 days, resulting in 9.8 mm lengthening. On the final day of distraction, 200 microg of FGF-2 in 150 microl of saline solution or vehicle alone was injected into the center of the distracted callus. Injection of FGF-2 increased bone formation at the distracted callus radiologically and histologically. A significant effect on bone mineral content (BMC) at the callus was observed as early as 2 weeks, and FGF-2 increased the BMC about twofold at 5 weeks after a normal remodeling process. We conclude that the callotasis method in combination with FGF-2 injection at the consolidation step could be clinically beneficial to shorten the bone lengthening period.

Absorptiometry, Photon↗
PubMed2002

Is early osteodistraction a solution for the ascending ramus compartment in hemifacial microsomia? A literature study.

AIM: In hemifacial microsomia, osteodistraction before skeletal maturation claims to induce both bone- and soft-tissue generation in such a way that conventional bone grafting and soft-tissue grafts are not necessary. Early osteodistraction in facial microsomia would have a positive effect on the 'functional matrix', and allow symmetrical vertical and sagittal expansion of the midface and mandible. The aim of this literature survey was to find evidence for this hypothesis by analysing long-term follow-up reports on distraction histiogenesis in the ascending ramus. MATERIAL: Only eight published studies were found, of which only two had more than ten patients, two were case reports, and three were from the same institution. RESULT: Invariably, the results pointed towards over-correction, repeated osteodistraction procedures, soft-tissue stretching (but no lateral augmentation), and to soft-tissue complications. The studies did not allow a conclusion to be made as whether increased vertical gain in the ascending ramus was unstable because of decreased growth on the affected side, inborn or iatrogenic, or due to resorption of the bone generated by distraction. To date, there is no evidence that osteodistraction produces better results and has lower morbidity than conventional growth centre transplantation and separate soft-tissue augmentation. CONCLUSION: Recommendations for prospective studies are: sharp differentiation between the four Pruzansky-Kaban mandibular types, multi-centre study of a surgical protocol to increase the sample number using a standard three-dimensional evaluation protocol, and differentiation between decreased growth and collapse of the newly generated bone.

Age Factors↗
PubMed2006

Simultaneous hybrid of maxillary Le Fort I halo distraction and mandibular set-back for patients with severe cleft jaw deformity.

One of the surgical tactics and retrospective chart review of clinical cases are described for severe maxillo-mandibular discrepancy. The recently developed Le Fort I Halo distraction combined with mandibular sagittal splitting osteotomy is initially carried out simultaneously. Materials include six adult patients revealing severe jaw deformity with mandibular prognathism somehow ranging from 17-19 years of age. The required adjustment of the maxillo-mandibular discrepancy ranged from 14-23 mm to obtain the preferred occlusion. The simultaneous combination of over 10-mm maxillary Le Fort I Halo distraction with mandibular set-back secured rigidly by sagittal splitting was accomplished. The amount of mandibular set-back ranged from 4-6 mm. The amount of maxillary Le Fort I halo distraction ranged from 10-17 mm (Table I). The retention period of the halo brace was 21-22 days. In addition, the Delair type of face mask was used for 3-4 months as a night splint for consolidation after removal of the halo brace. Satisfactory maxillary distraction and mandibular set-back as planned preoperatively was obtained in all six cases. No particular postoperative complications were noticed. Compared with standard Le Fort I advancement for cleft patients, more advancement can be obtained easily with halo distration, particularly in cases where a large amount of advancement > 10 mm is required. This combination is worthwhile for a severe cleft jaw deformity, and is an alternative for standard double jaw osteotomy.

Adolescent↗
PubMed2001

[Mid-facial distraction without osteotomy with a trans-facial pin. Report of 4 clinical cases].

After the publications of Mulhbaüer, Raposo do Amaral and mainly the one of Toth and Chin, it has been proved that midfacial distraction was an effective procedure for the treatment of cranio-facial dysostosis. First attempts to distract (in human) the midface without osteotomies has given poor results because devices acting on the zygomatic bone had failed to draw forward the maxilla through a thin maxillo-zygomatic suture which had been dislocated. With the help of a transfacial pin and an external device, we have obtained in four patients an important advancement of the maxilla. We report here the surgical procedure and preliminary results.

Child, Preschool↗
PubMed2006

The effect of tibial lengthening on immature articular cartilage of the knee joint.

OBJECTIVE: To investigate the acute response of immature articular cartilage, in the distraction and consolidation phases, to 30% tibial lengthening. DESIGN: Sixteen immature New Zealand white rabbits underwent diaphyseal lengthening of the left tibia by callotasis at a distraction rate of 0.4mm twice daily. A sham control group of 12 rabbits underwent fixation and osteotomy without lengthening. In each group, half of the rabbits were killed at the end of the distraction phase or at an equivalent time period and the rest were killed after an additional 5 weeks (consolidation phase). The tibial condyles and synovial fluid in the knee joint cavity were taken for laboratory examination. Sulfated glycosaminoglycan in synovial fluid was estimated using a colorimetric method. Sections along the mid-coronal plane of the whole of the tibial condyles were examined histologically and by scanning electron microscopy. A grading system was used to make a semiquantitative assessment of the histopathological changes in articular cartilage. RESULTS: Damage to the immature articular cartilage had occurred by the end of the distraction period and the cartilage continued to deteriorate in the consolidation phase of 5 weeks. However, when compared with a similar study in a mature rabbit model, damage to immature cartilage appeared less severe. CONCLUSION: This model of 30% lengthening caused acute cartilage damage which did not recover in the short term. The result may have implications for longer lengthening in children; the effects may be disadvantageous and lead to degenerative diseases later in life.

Animals↗
PubMed2004

[Correlation between ultrasound and radiographic data for assessment of symphyseal bony callus maturation after distraction].

OBJECTIVE: To search for means of reducing ionizing radiation during treatment planning for transmandibular osteodistraction. MATERIAL AND METHODS: Eleven patients (6 female, 5 male) underwent combined bimaxillary osteodistraction at a mean age of 18 Years. The following investigations were performed to determine symphyseal callus maturation: occlusal radiographs (O-RX) preoperatively, after the active phase of distraction (mean 27 days); ultrasound investigations (US) after the active and consolidation phase. RESULTS: US showed calcification foci at the end of the active phase, when O-RX failed to do so. Both US and O-RX detected callus immaturity after 2 Months of consolidation in 1 patient. Both detected bridging ossification one Month later. DISCUSSION: US can replace radiography in the diagnosis of callus maturation related to distractor removal.

Adolescent↗
PubMed2004

[Quadruple internal distraction with early frontal-facial avancement for faciocraniodysostosis].

INTRODUCTION: Frontofacial monobloc advancement (FFMA), known as a high risk procedure, was evaluated in combination with distraction. PATIENTS AND METHOD: Twenty patients with faciocraniosynostosis, were treated with FFMA and quadruple internal distraction. Mean age at surgery was 3.2 Years and mean follow-up was 14 Months (3-32 Months). Four distractors were used per patient in combination with complete osteotomy FFMA. Rate of distraction was classical (0.5 mm to 1mm per day) starting on day 7. The rate of short-term complications was evaluated. Correction of exorbitism and the dental occlusion relationship were assessed to evaluate achievement of advancement. Rate of relapse was evaluated by measuring the orbital bony gap on horizontal CT slices, before and 6 Months after removal of the distractor. Respiratory impairment when present was also evaluated. RESULTS: Distraction was completed in 18/20 patients. Fifteen patients completed their distraction uneventfully during the initial period. In three patients with CSF leaks, distraction was delayed at day 14 and 16, but was resumed and completed normally. Second operations were required for two patients during the early phase: the distractor failed in one requiring immediate reoperation to change the device; distraction was completed successfully. Device infection developed in two patients requiring removal of the device and abortion of distraction. One patient died the day after surgery from acute tonsillar herniation before distraction could be initiated. Exorbitism was clinically corrected in all cases in whom distraction was completed (n=18). Class I occlusion was obtained in 16/18 patients. When present, respiratory impairment was corrected in all cases. Septic frontal necrosis occurred in one patient two Months after distraction was completed and necessitated removal of the forehead flap. Distractors were easily removed through a coronal approach at 6 Months, but reossification was limited. Relapse was observed in three patients whose retaining phase was less than five Months. Rate of relapse was much lower when distraction was maintained more than six Months. DISCUSSION: Internal distraction can provide early correction of respiratory impairment due to faciocraniosynostosis in infancy and can reduce the major risks of frontofacial monobloc advancement. Morbidity is higher in patients with prior surgery before FFMA. Further evaluation is necessary to determine whether the two stage treatment strategy for faciocraniosynostosis (fronto-orbital advancement before one Year of age, and later facial Lefort III type advancement) could be replaced by a routine FFMA procedure.

Adolescent↗
PubMed2004

Late reconstruction of neglected metacarpal shaft defects due to gunshot wound.

We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively.

Adult↗
PubMed2000

Mechanical characterization of regenerated osseous tissue during callotasis and its related biological phenomenon.

The mechanical characteristics of the regenerated osseous tissue and osteoblastic activities during callotasis were studied using Chinese mountain goat as the animal model. Open osteotomy of the left tibiae was done in 24 goats. Distraction started 6 days after the operation with the rate of 1 mm per day for 4 weeks. The bone regeneration was monitored with serial X-ray films. The tension generated during distraction was measured with the strain gauges mounted on the distraction apparatus. The osteoblastic activities were monitored by measuring plasma bone specific alkaline phosphatase activity. The results showed that the average lengthening was 22.9 +/- 2.8 mm in each animal. The newly formed osseous tissue becomes stiffer during the course of distraction lengthening. The continuous evolution of the tensile behaviour of the newly formed osseous tissue correlates with the plasma bone specific alkaline phosphatase activities. The radiological appearance of a physis like structure took place at 12 mm lengthening. Its appearance corresponds to the changes in the tensile behaviour as well as the biological activities of the osteoblasts and may serve as a useful radiological marker in monitoring the process of callotasis in clinical practice.

Alkaline Phosphatase↗
PubMed2001

[Hemifacial microsomia treated with mandibular lengthening using intraoral distractors. On precise indications].

Mandibular hypoplasia in the hemifacial microsomia have largely benefited from distraction techniques especially intraoral. In fact, these techniques are possible in the child, replacing him in a better morphological, psychological and functional configuration. They can redynamise growth and, in any case, diminish secondary distant effects. The authors, from precise criteria, propose a surgical classification to facilitate the therapeutic decision. Intraoral and sometimes bidirectional distraction, whose results are equivalent to external distraction, present numerous advantages that, in the majority of cases, make it preferred now to external distraction. Its three-dimensional (3D) effect on bone and soft tissues and the long term follow-up must be evaluated more objectively, as pre and post-distraction stereolithographic or 3D photogrammetric may get. It must be considered in the child as the first step of skeletic surgery preparing to a facilitated second step orthopedic, orthodontic or orthognathic after puberty. In the young adult, it is in competition with conventional surgery but the slow progressive process, kind with the temporo-mandibular joints, allows in mandibular asymmetries an adaptation having avoided the need for controlateral osteotomy or a bone graft.

Adolescent↗
PubMed2001

Multidimensional osteodistraction for correction of implant malposition in edentulous segments.

This study examined multidimensional osteodistraction as a treatment method for correction of implant malposition and as an alternative to augmentation procedures. The prosthetically unfavourable implant positions were due to growth-related implant malposition (in the context of treatment of young patients with oligodontia) or primary bone-driven implant insertions. The radiographical and clinical findings obtained with this osteodistraction technique are presented and discussed. A tooth-supported osteodistractor for multidimensional distraction with custom-fabricated distraction abutments was used for treatment of 8 patients with a total of 9 maxillary and mandibular edentulous segments including single-tooth gaps. All patients underwent an osteotomy at a minimum distance of 1 mm from the implant surface. Following primary wound healing, distraction was carried out by 1 mm in vertical direction and 0.5 mm in the demanded transverse direction daily until the prosthetically optimized position was achieved. During and after the 12-week retention phase, the patients were evaluated clinically and radiographically. Multidimensional osteodistraction was carried out successfully in all 8 patients. The distraction distances were 3 to 11 mm in vertical direction and a maximum of 5 mm in buccolingual/buccopalatal direction. The malpositioned implants were brought into a prosthetically optimized position in all cases. The results of this study show that this multidimensional osteodistraction technique allows both augmentation of edentulous segments with a clearly compromised implant host site and correction of unfavourable implant positions.

Adolescent↗
PubMed2005

Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results.

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33-0.66 mm per day and the device was retained for 4-6 months for consolidation. Active orthodontic therapy was started after 8-10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

Adult↗
PubMed2003

[Submental intubation: surgical and anesthesiological aspects].

In patients with cranio-maxillofacial trauma and in corrections of cranio-facial anomalies submental intubation may be used during surgery and postoperatively. In the period June 2001-May 2002 submental intubation was performed on five patients with cranio-maxillofacial trauma and on two patients with cranio-facial anomalies (Dubowitz syndrome (LeFort II osteotomy and distraction) in one patient and cheilognathopalatoschisis (Le Fort I osteotomy and distraction) in the other). In accordance with the literature the submental intubation technique was a useful, fast and safe technique which provides a secure airway during surgery. No postoperative intubation-related complications were seen in the group of patients. It provides the surgeon with an excellent view of the operation field and permits optimal intra-operative control of the dental occlusion. Combined procedures by the surgeon and the anaesthetist must be planned beforehand.

Craniofacial Abnormalities↗
PubMed2006

Dynamic periosteal elevation.

The osteoinductive potential of the periosteum can be stimulated by raising the periosteum using a type of distraction. This was tested and confirmed in an animal experiment in 6 Goettingen minipigs. A titanium mesh was implanted beneath the periosteum and then raised. Bone formed underneath the mesh, with rows of micro-pillars similar to those found after osteodistraction. The main advantages of dynamic periosteal elevation are that invasion and morbidity are minimal. Clinically it might be applicable in craniomaxillofacial surgery, in augmentation before implantation, and in reconstruction of the skull.

Animals↗
PubMed2002

Influence of cage design on interbody fusion in a sheep cervical spine model.

OBJECT: The purpose of this study was to compare the characteristics of interbody fusion achieved using an autologous tricortical iliac crest bone graft with those of a cylinder- and a box-design cage in a sheep cervical spine model. This study was designed to determine whether there are differences between three interbody fusion procedures in: 1) ability to preserve postoperative distraction; 2) biomechanical stability; and 3) histological characteristics of intervertebral bone matrix formation. METHODS: Twenty-four sheep underwent C3-4 discectomy and fusion in which the following were used: Group 1, autologous tricortical iliac crest bone graft (eight sheep); Group 2, titanium cylinder-design cage filled with autologous iliac crest bone graft (eight sheep); and Group 3, titanium box-design cage filled with autologous iliac crest graft (eight sheep). Radiography was performed pre- and postoperatively and after 1, 2, 4, 8, and 12 weeks. At the same time points, disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the sheep were killed, and fusion sites were evaluated by obtaining functional radiographs in flexion and extension. Quantitative computerized tomography scans were acquired to assess bone mineral density, bone mineral content, and bone callus volume. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending. Stiffness, range of motion, neutral zone, and elastic zone were determined. Histomorphological and histomorphometric analyses were performed, and polychrome sequential labeling was used to determine the time frame of new bone formation. Over a 12-week period significantly higher values for disc space height and intervertebral angle were shown in cage-treated sheep than in those that received bone graft. Functional radiographic assessment revealed significantly lower residual flexion-extension movement in sheep with the cylinder cage-fixed spines than in those that received bone graft group. The cylinder-design cages showed significantly higher values for bone mineral content, bone callus content, and stiffness in axial rotation and lateral bending than the other cages or grafts. Histomorphometric evaluation and polychrome sequential labeling showed a more progressed bone matrix formation in the cylindrical cage group than in both other groups. CONCLUSIONS: Compared with the tricortical bone graft, both cages showed significantly better distractive properties. The cylindrical cage demonstrated a significantly higher biomechanical stiffness and an accelerated interbody fusion compared with the box-design cage and the tricortical bone graft. The differences in bone matrix formation within both cages were the result of the significantly lower stress shielding on the bone graft by the cylinder-design cage.

Animals↗
PubMed2002

Osteolysis of structural autograft after calcaneocuboid distraction arthrodesis for stage II posterior tibial tendon dysfunction.

Surgical treatment of stage II posterior tibial tendon dysfunction that fails nonoperative treatment is amenable to operative treatment. This commonly consists of a medial soft-tissue reconstruction and lateral column lengthening. We report on 32 patients undergoing distraction calcaneocuboid arthrodesis using an autogenous tricortical iliac crest graft. Almost 50% of patients did not go on to complete and uneventful incorporation of the graft at the arthrodesis site. Two different types of failure were noted. The first was classic nonunion which maintained structural integrity of the graft. The second was osteolysis and collapse of the graft accompanying the nonunion. Risk factors included smoking, K-wire fixation and possibly larger deformities requiring Achilles tendon lengthening. Complications of nonunion were salvageable with reoperation.

Adult↗