OtorhinolaryngologySfakianakis: Ιανουαρίου 2019

Πέμπτη, 31 Ιανουαρίου 2019

The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

This is a retrospective review of 90 patients with a posterior fossa meningioma (PFM) treated between 1996 and 2017 in our two tertiary skull base centers. Patients underwent surgical resection via different approaches. We aimed to show how different surgical approaches may help to reach gross total resection (GTR) and low morbidity, especially on facial nerve function.

Recent Findings

PFM is a real surgical challenge with high morbidity and mortality due to the surrounding structures, their common large size at diagnosis, and their potentially invasive behavior. Total resection is the only way to cure people affected. We successfully treated 90 cases of PFM and evaluated different surgical approaches.

Summary

GTR is the aim of the surgery as the extent of resection influences the rate of recurrence, which in turn influences the prognosis. Seventy percent (p < 0.001) of surgical patients achieved a GRT with low morbidity and no mortality.

http://bit.ly/2Bc6yFm

The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

Recent Findings

Summary

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The Transpetrosal Approaches System in Posterior Fossa Meningiomas Surgery: Rationale and Results

Abstract

Purpose of Review

Recent Findings

Summary

http://bit.ly/2Bc6yFm

Bolus Airway Invasion Observed During Videofluoroscopy in Healthy, Non-dysphagic Community-Dwelling Adults

Annals of Otology, Rhinology &Laryngology, Ahead of Print.

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Prevalence of Fatigue in Head and Neck Cancer Survivors

Annals of Otology, Rhinology &Laryngology, Ahead of Print.

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Mouse Model of Tracheal Replacement With Electrospun Nanofiber Scaffolds

Annals of Otology, Rhinology &Laryngology, Ahead of Print.

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Transgenic versus conventional corn: fate of fumonisins during industrial dry milling

Abstract

The aim of this study was to compare the fate of fumonisins in transgenic and non-transgenic corn during industrial dry milling. For this purpose, whole corn samples and their fractions (germ, pericarp, endosperm, corn meal, and grits) were collected from one of the major Brazilian milling plants, totaling 480 samples. There was no significant difference (p > 0.05) between mean fumonisin (FB₁ + FB₂) levels in transgenic (1130 μg/kg) and non-transgenic (920 μg/kg) whole corn. However, in non-transgenic germ, endosperm and corn meal fraction fumonisin levels were higher (2940 μg/kg, 250 μg/kg and 190 μg/kg, respectively) than in transgenic fractions (2180 μg/kg, 130 μg/kg and 85.0 μg/kg, respectively). Furthermore, the highest percentages of fumonisins were distributed in the germ, corresponding to about 87 and 76% of the total fumonisins present in the whole corn from non-transgenic and transgenic hybrids, respectively. Concerning the endosperm from non-transgenic and transgenic corn, approximately, 23% and 13% of the total fumonisins were retained after the dry milling. Further processing in corn meal (300 to 420 μm particle size) and grits (590 to 1190 μm) decreased the percentages of remaining fumonisins to 4% and 2% (transgenic) and 10% and 3% (non-transgenic corn), respectively. These results suggested that fumonisin concentration was higher in outer and inner non-transgenic fractions when compared to transgenic ones and that the fate of fumonisins during the industrial dry milling could be affected by the transgenic status. However, it was not possible to conclude that the difference was exclusively due to this variable.

http://bit.ly/2SgBT3s

First report of Fusarium foetens as a mycotoxin producer

Abstract

Fusarium foetens, a pathogen of Begonia plants, has been recently described as a new fungal species. This Fusarium species causes a destructive vascular wilt disease which leads to the death of the plant. Moreover, Fusarium species are known to produce a huge variety of secondary metabolites such as mycotoxins and phytotoxins. Here, we studied the toxicogenic profile of one F. foetens strain, isolated from maize, employing two methods based on the use of ultra-performance liquid chromatography coupled to mass spectrometry-ion trap-time of flight detection. The mycotoxins beauvericin and fusaric acid were detected in a pure culture of F. foetens. In addition, four fusaric acid analogs (10,11-dihidroxyfusaric acid, hydroxyfusaric acid, dehydrofusaric acid, and a hydroxylated unsaturated fusaric acid analog) were tentatively identified on the basis of their accurate mass and fragmentation patterns. Therefore, these preliminary data indicate that F. foetens isolated from maize is able to produce Fusarium mycotoxins including beauvericin and fusaric acid.

http://bit.ly/2GeP2U6

Dental implants: immediate placement in infected sockets and survival rates

9 observational studies were included in this review comparing the immediate placement of implants in an infected site compared to a health site. The findings suggest no difference although the quality of the evidence is low to very low.

The post Dental implants: immediate placement in infected sockets and survival rates appeared first on National Elf Service.

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Transgenic versus conventional corn: fate of fumonisins during industrial dry milling

Abstract

http://bit.ly/2SgBT3s

First report of Fusarium foetens as a mycotoxin producer

Abstract

http://bit.ly/2GeP2U6

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention

Summary

This review is part of a series of annual updates summarizing the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2016 with a focus on treatment and prevention of AE. There is reasonable evidence of benefit for topical corticosteroids, calcineurin inhibitors, a glycyrrhetinic acid‐containing preparation (Atopiclair^®), oral ciclosporin, oral azathioprine, narrowband ultraviolet B radiation and education programmes. Overall, there is evidence that topical corticosteroids and calcineurin inhibitors have similar efficacy and that both can prevent AE flares when used twice weekly as maintenance therapy. However, topical calcineurin inhibitors are costlier and have more adverse reactions, thus topical corticosteroids should remain the standard of care for patients with AE. There is no evidence that multiple applications are better than once‐daily application of topical corticosteroid. There is inconsistent evidence to support omalizumab and specific allergen immunotherapy use in AE. There is some evidence that vitamin D supplementation and synbiotics reduce AE severity, although the margin of improvement may not be clinically meaningful. There is little evidence to support the use of wet wraps or of complementary/alternative medicine (including Chinese herbal medicine). There is some evidence to suggest that a diet high in fish in infancy may be preventative for AE, but other dietary interventions for the prevention of AE show little promise. This review provides a succinct guide for clinicians and patients wishing to remain up to date with the latest evidence for the treatment and prevention of AE.

http://bit.ly/2UBunO9

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 2: Epidemiology, aetiology and risk factors

Summary

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It presents the key findings from 14 systematic reviews published in 2016, focusing on AE epidemiology, aetiology and risk factors. For systematic reviews on the treatment and prevention of AE and for nomenclature and outcome assessments, see Parts 1 and 3 of this update, respectively. The annual self‐reported prevalence of AE is a range of 11.4–24.2%, compared with a general practioner‐diagnosed prevalence of 1.8–9.5%. The mean age of AE diagnosis is 1.6 years. Persistent AE is associated with more severe disease at the time of diagnosis, onset after the age of 2 years and female sex. There is a significant association between having AE and subsequent development of food allergy. Food allergy is also associated with more severe and persistent AE. No consistent association was found between the timing of allergenic food introduction and the risk of developing AE. Evidence from heterogeneous studies indicates that skin absorption is increased in patients with AE, and that there is increased colonization with Staphylococcus aureus in lesional and nonlesional skin and the nasal mucosa of patients with AE compared with controls. There is uncertain evidence indicating an association between AE and smoking exposure, antenatal infection and low maternal vitamin D levels during pregnancy. Weak evidence suggests an increased risk of basal cell carcinoma, but not of melanoma or squamous cell carcinoma, while the risk of glioma is reduced.

http://bit.ly/2RZXg9z

Convergent end‐to‐end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats

Introduction

Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for long term facial palsy. An experimental model was designed to compare single and dual innervation of the gastrocnemius muscle (GM) in rats.

Methods

Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups (n = 10): control (C), tibial nerve section (TS), tibial nerve primary end‐to‐end neurorrhaphy (PEE), tibial nerve primary repair associated with end‐to‐side peroneal‐to‐tibial nerve transfer (PRES), and tibial nerve repair by convergent end‐to‐end (CEE) neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve. The outcomes were assessed 12 weeks after the experiment by walking track, electromyography, GM mass index, and histomorphometric analysis of the distal tibial nerve.

Results

The functional recovery of the PRES (−33.77 ± 24.13) and CEE (−42.15 ± 31.14) groups was greater (P < 0.003) than the PEE group (−80.26 ± 17.20). The CEE group (18.35 ± 7.84) showed greater amplitude (P = 0.006) than the PEE group (8.2 ± 4.64). There was no difference in the muscle mass index among the reinnervation groups (P > 0.705). Histologic analysis revealed greater (P < 0.002) axonal density in the CEE group (126.70 ± 15.01) compared to PEE (99.70 ± 12.82) and PRES (92.00 ± 19.17) groups.

Conclusions

The dual innervation techniques showed earlier and greater functional recovery of the GM than did the single innervation technique. The CEE group showed a 40% higher number of regenerated axons in the distal tibial nerve stump.

http://bit.ly/2SoPjdO

Microvascular lining options for subtotal and total nasal reconstruction: A scoping review

Background

Restoration of nasal lining is essential in reconstruction of subtotal/total nasal defects. When local flaps are inadequate, a microvascular flap should be used. The purpose of this scoping review is to map the literature and identify the described flap options for subtotal/total nasal reconstruction. Further to that, we will summarize the stated advantages and disadvantages, evaluate functional and esthetic outcomes, and appraise the current body of literature.

Methods

An electronic literature search was completed. Studies required adult patients with subtotal/total nasal defects and lining reconstruction with microvascular free flap. Two independent reviewers completed screening and data extraction. Flap characteristics, advantages, disadvantages, functional and esthetic outcomes were reviewed. Two independent reviewers evaluated study quality.

Results

Of 305 initial articles, 22 studies were included (13 case reports, 9 case series) accounting for 65 flaps. Microvascular flaps varied by composition and anatomical location. For functional outcome, 13 studies used clinical exam by surgeon, 5 reported patient being satisfied, 3 studies used endoscopy, and 1 study used nasometry. Assessing esthetic outcome, 13 studies used clinical exam by surgeon, 5 studies reported patient being satisfied, 1 study used patient‐reported outcome measures, and 16 studies included photos. Study quality (modified CARE and PROCESS checklists) was deemed poor. Quality of available evidence was level IV.

Conclusions

Microvascular free flaps for nasal reconstruction, confer an overall satisfactory functional and esthetic outcome. All studies lack a systematic and comprehensive approach to assessing and reporting these outcomes. Future research should provide objective assessment and utilize patient reported outcome measures.

http://bit.ly/2GgyOtB

Convergent end‐to‐end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats

Introduction

Methods

Results

Conclusions

http://bit.ly/2SoPjdO

Microvascular lining options for subtotal and total nasal reconstruction: A scoping review

Background

Methods

Results

Conclusions

http://bit.ly/2GgyOtB

The Effect of Stimulus Polarity on the Relation Between Pitch Ranking and ECAP Spread of Excitation in Cochlear Implant Users

AbstractAlthough modern cochlear implants (CIs) use cathodic-leading symmetrical biphasic pulses to stimulate the auditory nerve, a growing body of evidence suggests that anodic-leading pulses may be more effective. The positive polarity has been shown to produce larger electrically evoked compound action potential (ECAP) amplitudes, steeper slope of the amplitude growth function, and broader spread of excitation (SOE) patterns. Polarity has also been shown to influence pitch perception. It remains unclear how polarity affects the relation between physiological SOE and psychophysical pitch perception. Using a within-subject design, we examined the correlation between performance on a pitch-ranking task and spatial separation between SOE patterns for anodic and cathodic-leading symmetric bi...

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Occurrence, speciation, and risks of trace metals in soils of greenhouse vegetable production from the vicinity of industrial areas in the Yangtze River Delta, China

Abstract

The effect of industrial activities on trace metals in farmland of rapidly industrializing regions in developing countries has increasingly been a concern to the public. Here, soils were collected from 13 greenhouse vegetable production (GVP) farms or bases near industrial areas in the Yangtze River Delta of China to investigate the occurrence, speciation, and risks of Cr, Cu, Zn, Cd, Ni, and Pb in GVP soil. The results revealed that the main metal elements causing GVP soil pollution were Cd, Zn, Ni, and Cu, of which contamination levels were generally unpolluted to moderately polluted. Zinc pollution was mainly attributed to heavy fertilization, while Cd, Ni, and Cu pollution may be greatly ascribed to industrial effluents and coal combustion. Metal speciation studies showed that most of Cr, Ni, Cu, and Zn was present in residual fraction while more than half of Cd and Pb was present in non-residual fractions. Additionally, pollution of Cd, Cu, Ni, and Zn in GVP soil increased their corresponding mobile fractions. Risk assessment using potential ecological risk index and risk assessment code showed that Cd was the major risk contributor. Specifically, Cd generally posed moderate or considerable ecological risk as well as displayed medium or high mobility risk in GVP soil. Thus, great attention should be paid to the contribution of both industrial discharges and intensive farming to soil pollution by trace metals, especially Cd, because of its high mobility risk.

http://bit.ly/2HJyh5Z

Techno-economic assessment of coconut biodiesel as a potential alternative fuel for compression ignition engines

Abstract

Over the past years, there were dramatic improvements in identifying and assessing various feedstocks for the production of biodiesel fuels. To promote a particular feedstock as a renewable source of energy, it is important to analyze their energy, economic, and engine performance characteristics. The current work attempts to evaluate the net energy and economic indices for both fossil diesel and coconut-blended diesel (B20) considering the diesel consumption by the Indian railways. Further, we present the experimental results of a multi-cylinder diesel engine operated with neat coconut biodiesel (B100) and fossil diesel at various load and speed conditions. The engine experiments reveal that the coconut biodiesel exhibits leaner combustion and shorter ignition delay than fossil diesel. Lower amount of carbon monoxide, hydrocarbon, and smoke emission is observed in the case of coconut biodiesel, with higher levels of nitric oxide (14%) and fuel consumption than diesel. The coefficient of variation in indicated mean effective pressure is within the range of better driveability zone for both the fuels at all test conditions. Overall the engine performance, emission and combustion results with neat coconut biodiesel are favorable with a penalty in NO emission at high load conditions. The techno-economical study highlights higher production cost per liter of B20 than the cost of fossil diesel. However, the net energy ratio (NER) for B20 is 1.021, favoring higher output than diesel and thus lowers the dependency on crude oil.

http://bit.ly/2sYbTLF

Biodegradation of anthracene and different PAHs by a yellow laccase from Leucoagaricus gongylophorus

Abstract

Laccases produced by Leucoagaricus gongylophorus act in lignocellulose degradation and detoxification processes. Therefore, the use of L. gongylophorus laccase (Lac1Lg) was proposed in this work for degradation of anthracene and others polycyclic aromatic hydrocarbons without the use of mediators. Degradation reactions were performed in buffer aqueous solution with 10 ppm of anthracene and other PAHs, Tween-20 in 0.25% v/v and a laccase preparation of 50 U. The optimum condition (pH 6.0 and 30 °C) was determined by response surface methodology with an excellent coefficient of determination (R²) of 0.97 and an adjusted coefficient of determination (R²_adj) of 0.93. In addition, the employment of the mediator ABTS decreased the anthracene biodegradation from 44 ± 1% to 30 ± 1%. This optimum pH of 6.0 suggests that the reaction occurs by a hydrogen atom transfer mechanism. Additionally, in 24 h Lac1Lg biodegraded 72 ± 1% anthracene, 40 ± 3% fluorene and 25 ± 3% phenanthrene. The yellow laccase from L. gongylophorus biodegraded anthracene and produced anthrone and anthraquinone, which are interesting compounds for industrial applications. Moreover, this enzyme also biodegraded the PAHs phenanthrene and fluorene justifying the study of Lac1Lg for bioremediation of these compounds in the environment.

http://bit.ly/2HJyczd

Implant treatment of two failing or missing central incisors in the aesthetic region: a treatment protocol and 1-year prospective study

Implant treatment for two central incisors in the maxillary aesthetic region is complex due to concerns regarding inter-implant hard and soft tissue stability. A treatment protocol was therefore developed and implemented in a 1-year prospective case series study involving 16 patients with two failing or missing central incisors in the maxillary aesthetic region. The protocol consists of five options depending on whether teeth are still present (options 1 –3) or not (options 4 and 5) and on the amount of bone available at the start of treatment: (1) extraction followed by immediate implant placement and provisionalization, (2) extraction followed by immediate implant placement and delayed provisionalization, (3) extraction followed by ridge preserv ation, delayed implant placement and imm...

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Quality and potency profile of eight recombinant isoallergens, largely mimicking total Bet v 1‐specific IgE binding of birch pollen

Abstract

Background

To date only limited information on structure, expression levels and IgE binding of Bet v 1 variants, which are simultaneously expressed in birch pollen, is available.

Objective

To analyze and compare structure and serum IgE/IgG binding of rBet v 1 variants to Bet v 1.0101.

Methods

Recombinant Bet v 1 variants were studied with sera of 20 subjects allergic to birch pollen. Folding, aggregation and solubility of the rBet v 1 variants was analyzed to attribute diverging IgE binding to either allergen structure or methodological features. IgE/IgG binding was studied with rBet v 1 in solution or adsorbed to solid phases. Allergen‐mediated crosslinking of FcεRI receptors was determined by mediator release of sensitized humanized rat basophil leukemia cells.

Results

All variants, except for rBet v 1.0113, were monomeric and had Bet v 1‐type conformation. Serum IgE binding to variants adsorbed to solid phase was reduced to 6.6% ‐ 36.5% compared with Bet v 1.0101. In contrast, inhibition of IgE binding to Bet v 1.0101 by rBet v 1 variants ranged from 62% ‐ 83%. Similarly, mediator release ranged from 30.7% ‐ 55.2% for all variants and was only clearly reduced for rBet v 1.0301 (10.4%). The IgE binding potency of rBet v 1 variants representing their native quantities in birch pollen was only slightly lower compared to extract. IgG binding to variants was between 50.9% ‐ 134.5% compared with rBet v 1.0101 (100%).

Conclusion and clinical relevance

Bet v 1 variants previously classified as hypoallergenic can exhibit similar functional IgE binding as Bet v 1.0101. Eight rBet v 1 variants largely reproduce total Bet v 1‐specific IgE binding of birch pollen extracts. Assay format dependent variation of IgE binding properties needs to be considered in the development of diagnostic or therapeutic products.

http://bit.ly/2G1Utqk

Quality and potency profile of eight recombinant isoallergens, largely mimicking total Bet v 1‐specific IgE binding of birch pollen

Abstract

Background

To date only limited information on structure, expression levels and IgE binding of Bet v 1 variants, which are simultaneously expressed in birch pollen, is available.

Objective

To analyze and compare structure and serum IgE/IgG binding of rBet v 1 variants to Bet v 1.0101.

Methods

Results

Conclusion and clinical relevance

http://bit.ly/2G1Utqk

Photodynamic inactivation of planktonic cultures and Streptococcus mutans biofilms for prevention of white spot lesions during orthodontic treatment: An in vitro investigation

This study evaluated the efficacy of photodynamic inactivation (PDI) with hematoporphyrin IX (H) and modified hematoporphyrin IX (MH) at 10 μmol/L, using a blue light-emitting diode (LED), fluence of 75 J/cm,2 over planktonic cultures and biofilm of Streptococcus mutans (UA 159).

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Directory: AAO Officers and Organizations

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Information for readers

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Residents' journal review

Proper control of the occlusal plane (OP) is an important criteria for success in surgical treatment of patients with double-jaw surgery. Alteration of the OP or rotation of the maxillomandibular complex around a predetermined point is a surgical technique that involves intentional manipulation of the OP by clockwise (CWR) or counterclockwise (CCWR) rotation. The purpose of this study was to evaluate the stability of CCWR double-jaw orthognathic surgery of hyperdivergent Class III patients. Patients were evaluated by means of lateral cephalometric analysis, and counterclockwise rotation was assessed according to the change in the angle of the OP to the Frankfort horizontal plane.

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Editorial Board

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Short-term cone-beam computed tomography evaluation of maxillary third molar changes after total arch distalization in adolescents

Our objectives were to evaluate changes in the position of maxillary third molars with cone-beam computed tomography images in adolescents after total arch distalization using a modified C-palatal plate (MCPP) and to compare them with the changes in a matched control group.

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What I say versus what I do

So, you're an expert in a malpractice case; for which side is irrelevant. The legal issue is a simple one. Can you say that the doctor's care fell within the prevailing standard of care if you would have done it differently? Some courts allow an expert to be cross-examined on this point, and some don't. Let's take a look at how Indiana handles this matter and why.

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Evaluation of facial soft tissue thickness in symmetric and asymmetric subjects with the use of cone-beam computed tomography

The aims of this study were to evaluate facial bilateral soft tissue thickness in symmetric and asymmetric subjects and to investigate whether soft tissue compensates for skeletal asymmetry.

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What the world needs now …

Your newly minted diploma is ample representation of the culmination of your decades of hard work and sacrifice. You are excited to meet new colleagues in your city, to learn the faces behind their names, and to avail yourself for future patient referrals. So you begin calling each of their offices with the intention of making an appointment to introduce yourself and to bring a modest gift that represents your new office brand. All told, there are almost 4 dozen practitioners whose patients might benefit from your service.

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Comparison of root resorption after bone-borne and tooth-borne rapid maxillary expansion evaluated with the use of microtomography

Root resorption was compared between bone-borne and tooth tissue–borne rapid maxillary expansion patients with the use of microtomography.

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February 2019

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Mandibular molar intrusion with mini-implants and the multiloop edgewise archwire technique

We sincerely compliment the authors on the publication of their case report, "Nonsurgical correction of a severe anterior open bite with mandibular molar intrusion using mini-implants and the multiloop edgewise archwire technique" in the April 2018 issue (Freitas BV, Abas Frazão MC, Dias L, Fernandes Dos Santos PC, Freitas HV, Bosio JA. Am J Orthod Dentofacial Orthop. 2018; 153:577-87). It was a pleasure reading the article, which mentioned a novel technique for the closure of open bite when the patient is unwilling to have surgery.

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Influence of facial pattern in smile attractiveness regarding gingival exposure assessed by dentists and laypersons

The present study aimed to assess the influence of facial pattern in smile attractiveness on different levels of gingival exposure evaluated by dental specialists and laypersons.

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Searching the literature for studies for a systematic review. Part 1: Identifying search concepts in a question

Searching the literature for studies that meet the inclusion criteria is one of the first stages of a systematic review.1 A quality literature search is a systematic survey of the literature on a specific topic or clinical question. It goes beyond a cursory search of the literature to a series of steps that are well organized and planned before the search itself: selecting relevant databases, formulating a structured question, applying specific criteria before executing the search to reduce selection bias, creating a series of search queries using relevant keywords, and reviewing each result for suitability.

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Autotransplantation of premolars and space closure in a patient with inflamed sinuses

Congenital absence of permanent teeth can be treated by means of dental implants and prosthetics. Tooth autotransplantation is an alternative in growing patients because continued eruption of the transplanted tooth and associated alveolar bone growth can be expected. This clinical report presents tooth autotransplantation in a 10-year-old boy with chronic maxillary rhinosinusitis, diagnosed by the department of otorhinolaryngology. The patient's mandibular second premolars were transplanted to a congenitally edentulous maxillary premolar region.

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Lifetime Achievement Award for Orthodontic Research, 2019

In 2015, the American Association of Orthodontists (AAO) established a new award, the Lifetime Achievement Award for Orthodontic Research. The first recipient of this award was Dr William R. Proffit, who received his award at the AAO in 2017. In 2018, Dr Lysle E. Johnston Jr received the second award and nominations were solicited for the 2019 award. Nominees are intended to be those who have made significant contributions to the science related to the specialty of orthodontics. Their research should be considered original, outstanding, and innovative.

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Removing plaque and tartar from teeth

The buildup of plaque and tartar on the teeth can cause bad breath, tooth decay, and gum disease. However, several simple home remedies can help treat and prevent plaque and tartar. Learn more here.

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Anatomical Study of a Chimeric Fascio-Osteomyocutaneous Fibula Flap for Free Microvascular Tissue Transfer

J reconstr Microsurg
DOI: 10.1055/s-0039-1677769

Background Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. Methods Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle. With regards to clinical specifications a maximum-size flap containing cutaneous, osseous, and muscular elements was raised. During dissection, the distribution pattern, number and size of stained septofasciomyocutaneous vessels at the lateral border of the proximal, middle, and distal thirds of the fibula length, as well as the flap dimensions were evaluated. Results In all specimens, vessels originating from the fibular artery and supplying the resected fibular bone, the fasciocutaneous flap and dorsally located muscles were found. The mean number of vessels to the skin was 4.2 per leg with a mean diameter of 1.1 ± 0.5 mm (range: 0.4–2.5 mm) and to the HS muscle 3.4 vessels with a mean diameter of 1.2 ± 0.7 mm (range: 0.3–3.0 mm). A total of 88.4% vessels occurred in the proximal and middle thirds of the legs. The resected fibula graft had a mean length of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) and the skin paddle had a mean size of 23.8 ± 3.9 cm (range: 19.9–31.0 cm) × 7.0 cm. The flexor hallucis longus (FHL) muscle had a mean volume of 37.2 ± 15.8 cm3 (range: 18–58 cm3) and the lateral HS muscle 77.1 ± 23.3 cm3 (range: 48–105 cm3). Conclusion Our results and anatomical descriptions indicate that chimeric fibula flaps can meet the specific reconstructional requirements of complex and large sized defects representing a promising basis for further studies.
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