Comparison Between Micro- and Macrosurgical Techniques for the Treatment of Localized Gingival Recessions Using Coronally Positioned Flaps and Enamel Matrix Derivative

Background: The aim of this study is to compare the macro- and microsurgery techniques for root coverage using a coronally positioned flap (CPF) associated with enamel matrix derivative (EMD). Methods: Thirty patients were selected for the treatment of localized gingival recessions (GRs) using CPF associated to EMD. Fifteen patients were randomly assigned to the test group (TG), and 15 patients were randomly assigned to the control group (CG). The microsurgical approach was performed in the TG, and the conventional macrosurgical technique was performed in the CG. The clinical parameters evaluated before surgery and after 6 months were GR, probing depth, relative clinical attachment level, width of keratinized tissue (WKT), and thickness of keratinized tissue (TKT). The discomfort evaluation was performed 1 week postoperative. Results: There were no statistically significant differences between groups for all parameters at baseline. At 6 months, there was no statistically significant difference between the techniques in achieving root coverage. The percentage of root coverage was 92% and 83% for TG and CG, respectively. After 6 months, there was a statistically significant increase of WKT and TKT in TG only. Both procedures were well tolerated by all patients. Conclusions: The macro- and microsurgery techniques provided a statistically significant reduction in GR height. After 6 months, there was no statistically significant difference between the techniques regarding root coverage, and the microsurgical technique demonstrated a statistically significant increase in WKT and TKT. J Periodontol 2010;81:1572-1579.

The pterional craniotomy: tips and tricks

This review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.

Detecção de trombose venosa em retalhos livres por medidas de glicemia capilar

INTRODUÇÃO: A monitorização do retalho livre após a cirurgia é de vital importância, especialmente nas primeiras horas de pós-operatório, pois o momento de reabordagem pode ser o definidor entre o salvamento ou a perda do retalho. Até o momento, não existe trabalho na literatura estudando a decisão de abordagem do retalho baseada em medidas objetivas ou a comparação da glicemia entre retalhos que evoluíram bem com os que sofreram sofrimento vascular. O objetivo deste estudo é avaliar a validade da medida da glicemia capilar do retalho como método de monitorização de retalhos microcirúrgicos comparando com a avaliação clínica. MÉTODO: Foram estudados prospectivamente 16 pacientes portadores de retalhos livres, realizados de maio de 2012 a julho de 2012. A glicemia capilar foi avaliada por equipe formada por profissionais não envolvidos com a cirurgia realizada. A avaliação clínica do retalho foi realizada no pós-operatório imediato, na chegada à UTI, a cada 3 horas e sempre que necessário. RESULTADOS: Dos 16 pacientes, 5 (31,3%) apresentaram complicações nas primeiras 24 horas. Todas as complicações observadas foram trombose venosa. Foi observada diferença estatisticamente significante na glicemia capilar de portadores de retalhos que apresentaram trombose venosa em comparação àqueles que não tiveram a complicação, nas medidas realizadas 6 horas, 9 horas e 12 horas após a operação (P < 0,05). CONCLUSÕES: A medida da glicemia capilar não foi superior à avaliação clínica por profissional experiente na detecção de trombose venosa de retalhos livres.

Costruzione di uno scaffold vascolarizzato per la chirurgia ortopedica

Specific aims The aim is to improve the treatment of the bone losses at the metacarpal bones level (both diaphysis and epiphysis) combining microsurgery, tissue engineering and biomaterials, so to minimize the donor side morbidity and optimize healing and outcomes. Methods Pre-operative controlateral X-ray or 3-D CT to allow custom-made HA scaffolds. Cement as temporary spacer in acute lesion and monitoring of infective risks. Treatment of the bone loss recurring to pre-fabricated or custom-made HA scaffolds, adding platelet gel or growth factor OP1. Stable synthesis. Control group with auto/omografts. Outcome indices: % of bone-union; finger TAM, Kapandji, DASH score; NMR and Scintigraphy at 180 days for revascularisation and bio-substitution of the scaffold. Preliminary results The authors just treated 6 patients, 4 males and 2 females, with an average age of 38.5 yrs, affected by segmental bone losses at the hand and wrist, recurring to pre-fabricated not vascularised scaffolds. In all cases the synthesis was performed with angular stability plates and a stable synthesis achieved. All patients have been controlled at a mean follow-up of 10.5 months (from 2 to 16 ). In all case but one the bone-scaffold osteo-integration was achieved at an average of 38 days at the hand, and 46 days at the wrist. The outcome studies, according to the DASH score, finger TAM, and Kapandji, were good and excellent in 5 cases, poor in one.

Fistola Artero-venosa Radio-Cefalica Distale per Emodialisi nel paziente anziano: Valutazione dei risultati ottenuti con l'utilizzo della Tecnica Microchirurgica

PREMESSA: Le linee guida raccomandano la fistola AV radio-cefalica autogena (RCAVF)come prima scelta per l'emodialisi. Preoccupazione è stata sollevata che questo potrebbe non essere appropriato nei pazienti anziani. METODO: Noi abbiamo seguito in modo prospettico 126 pazienti per tre anni. Dopo sistematica valutazione clinica ed ecografica, la RCAVF è stata creata utilizzando un microscopio operatore. La pervietà è stata valutata subito, a 1 settimana, a 1 mese e a 1 anno. I risultati sono stati registrati e stratificati in 2 gruppi: <70a e > 70a. RISULTATI: La RCAVF è stata creata nel 75% dei <70a e nel 70% dei >70a. L'incidenza di insuccesso immediato è stata 11% (<70a) e 13% (>70a). La pervietà primaria e secondaria ad 1 anno è stata 67% e 84% (<70a), 63% e 80% (>70a). CONCLUSIONI: La microchirurgia ha permesso la creazione di RCVAF in >70a con un rischio accettabile di fallimento e lievi differenze rispetto a <70a. L'età non deve precludere una creazione di RCAVF.

Long-term results after muscle-rib flap transfer for reconstruction of composite limb defects

The authors present the long-term results in a series of 44 cases with post-traumatic bone defects solved with muscle-rib flaps, between March 1997 and December 2007. In these cases, we performed 21 serratus anterior-rib flaps (SA-R), 10 latissimus dorsi-rib flaps (LD-R), and 13 LD-SA-R. The flaps were used in upper limb in 18 cases and in lower limb in 26 cases. With an overall immediate success rate of 95.4% (42 of 44 cases) and a primary bone union rate of 97.7% (43 of 44 cases), and despite the few partisans of this method, we consider that this procedure still remains very usefully for small and medium bone defects accompanied by large soft tissue defects.

Improved microsurgical creation of venous pouch arterial bifurcation aneurysms in rabbits

The choice of the experimental aneurysm model is essential for valid embolization-device evaluations. So far, the use of the rabbit venous pouch arterial bifurcation aneurysm model has been limited by demanding microsurgery, low aneurysm patency rates, and high mortality. This study aimed to facilitate microsurgery and to reduce mortality by optimized peri-/postoperative management.

Presentation, microsurgical therapy, and clinical outcomes in three cases of expanding melanonychia of the nail unit in children

The management of expanding melanonychia in childhood is controversial. Here, we present three cases and discuss their operating indications and reconstruction. Between January 1, 1995 and December 31, 2007, one boy and two girls, were operated for expanding melanonychia, involving the thumb, index finger or the middle finger. They were 2, 4, and 7 years at the time of surgery. A complete resection of the nail plate was performed followed by a direct finger reconstruction using a free short-pedicle vascularized nail flap of the toe. Histology showed a junctional nevus in all cases. The follow-ups were after 2, 3, and 5 years and without any complications or recurrence. Regarding reconstruction, the mean Foucher and Leclère score were, respectively, 17 and 16 points. It is concluded that for expanding melanonychia, in case of doubt, an examination of the entire lesion is necessary. Reconstruction of the nail unit after wide excision with nail plate ablation can be performed using microsurgery as discussed below. However, new guidelines on shave biopsy can make this microsurgical procedure obsolete.

1.9 µm diode laser assisted vascular microanastomoses: Experience in 40 clinical procedures

Since the initial work of Jacobson and Suarez in 1960, microsurgery has evolved greatly. In 2009, we reported our clinical experience with 1.9 µm diode laser-assisted vascular microanastomoses (LAMA) for free flap reconstruction. In this report, the ongoing study is now expanded to include 11 additional procedures which were analyzed prospectively with a focus on the duration of the LAMA technique.

Low-threshold monopolar motor mapping for resection of primary motor cortex tumors

Microsurgery within eloquent cortex is a controversial approach because of the high risk of permanent neurological deficit. Few data exist showing the relationship between the mapping stimulation intensity required for eliciting a muscle motor evoked potential and the distance to the motor neurons; furthermore, the motor threshold at which no deficit occurs remains to be defined.

The extended diep flap: extending the possibilities for breast reconstruction with tissue from the lower abdomen

The classical DIEP-flap is considered state-of-the-art in microsurgical autologous breast reconstruction. Some patients may require additional volume to match the contralateral breast. This quality control study prospectively evaluates the feasibility and outcome of a surgical technique, which pursues the volumetric augmentation of the DIEP-flap by harvesting of additional subscarpal fat tissue cranial to the classical flap border.

The role of androgens on hypoxia-inducible factor (HIF)-1α-induced angiogenesis and on the survival of ischemically challenged skin flaps in a rat model

Effects of androgens on angiogenesis are controversial. Hypoxia-inducible factor (HIF)-1α promotes expression of vascular endothelial growth factor (VEGF) that stimulates angiogenesis.

Evaluation of a porcine whole-limb heterotopic autotransplantation model

Recently performed vascularized composite tissue allotransplantations (CTAs) stimulate the ongoing research in the area of whole-limb transplantation. A reliable in vivo animal model is required for investigations in vascularized whole-limb CTA. The model should allow in vivo assessment in whole-limb preservation, allograft and xenograft response, and host immunomodulation. The goal of this study is to describe and evaluate the in vivo feasibility and reproducibility of a whole-limb porcine model as a basis for future research in this field.

Leiomyomatoid angiomatous neuroendocrine tumor (LANT) of the pituitary: a distinctive biphasic neoplasm with primitive secretory phenotype and smooth muscle-rich stroma

We describe a hitherto undocumented variant of dimorphic pituitary neoplasm composed of an admixture of neurosecretory cells and profuse leiomyomatous stroma around intratumoral vessels. Radiologically perceived as a macroadenoma of 3.8 cm in diameter, this pituitary mass developed in an otherwise healthy 43-year-old female. At the term of a yearlong history of amenorrhea and progressive bitemporal visual loss, subtotal resection was performed via transsphenoidal microsurgery. Discounting mild hyperprolactinemia, there was no evidence of excess hormone production. Histologically, solid sheets, nests and cords of epithelial-looking, yet cytokeratin-negative cells were seen growing in a richly vascularized stroma of spindle cells. While strong immunoreactivity for NCAM, Synaptophysin and Chromogranin-A was detected in the former, the latter showed both morphological and immunophenotypic hallmarks of smooth muscle, being positive for vimentin, muscle actin and smooth muscle actin. Architectural patterns varied from monomorphous stroma-dominant zones through biphasic neuroendocrine-leiomyomatous areas, to pseudopapillary fronds along vascular cores. Only endothelia were labeled with CD34. Staining for S100 protein and GFAP, characteristics of sustentacular cells, as well as bcl-2 and c-kit was absent. Except for alpha-subunit, anterior pituitary hormones tested negative in tumor cells, as did a panel of peripheral endocrine markers, including serotonin, somatostatin, calcitonin, parathormone and vasoactive intestinal polypeptide. Mitotic activity was absent and the MIB-1 labeling index low (1-2%). While assignment of this lesion to any established neoplastic entity is not forthcoming, we propose it is being considered as a low-grade neuroendocrine tumor possibly related to null cell adenoma.