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Background: We have demonstrated the effectiveness of 3D resection specimen scanning for communicating margin results. We now address the corresponding surgical defect by debuting 3D defect models, which allow for accurate annotations of harvested supplemental margins. Methods: Surgical defects were rendered into 3D models, which were annotated to document the precise location of harvested supplemental margins. 3D defect scans were also compared with routine 2D photography and were analyzed for quality, clarity, and the time required to complete the scan. Results: Forty defects were scanned from procedures including segmental mandibulectomy, maxillectomy, and laryngopharyngectomy. Average duration of defect scan was 6 min, 45 s. In six of ten 2D photographs, the surgeon was unable to precisely annotate the extent of at least one supplemental margin. Conclusion: 3D defect scanning offers advantages in that this technique enables documentation of the precise location and breadth of supplemental margins harvested to address margins at‐risk. [ABSTRACT FROM AUTHOR]

Introduction: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported. Objective: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors. Methods: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speech- and taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result. Results: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient’s own mucosa. No adverse features were observed in the cohort. Conclusion: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient’s own mucosa to be restored with a more physiological result.

Gelfoam, an absorbable gelatin material that can carry thrombin and provide a matrix for the clotting cascade, is commonly used in dermatologic surgery to obtain hemostasis. Gelfoam application is often well tolerated, with minimal surgical site reaction. Gelfoam may be an incidental histopathologic finding following cutaneous surgery, typically without any clinical sequelae. Both dermatologic surgeons and pathologists should be familiar with this histopathologic finding to eliminate confusion and to avoid additional intervention. We present a case of a 76-year-old man with an interesting histopathologic finding of basophilic material predominantly overlying and among keratinocytes in an epithelializing surgical defect that was covered with Gelfoam.

Gelfoam, an absorbable gelatin material that can carry thrombin and provide a matrix for the clotting cascade, is commonly used in dermatologic surgery to obtain hemostasis. Gelfoam application is often well tolerated, with minimal surgical site reaction. Gelfoam may be an incidental histopathologic finding following cutaneous surgery, typically without any clinical sequelae. Both dermatologic surgeons and pathologists should be familiar with this histopathologic finding to eliminate confusion and to avoid additional intervention. We present a case of a 76-year-old man with an interesting histopathologic finding of basophilic material predominantly overlying and among keratinocytes in an epithelializing surgical defect that was covered with Gelfoam. [ABSTRACT FROM AUTHOR]

Primitive neuroectodermal tumor in the zygomaticoorbital region is a rare neoplasm of the head and neck. Due to the necessity for wide radical excision of a primary tumor, there may be serious functional and cosmetic disorders that substantially affect quality of life in patients. Restoration of this region is one of the challenges of reconstructive surgery because of the specific features of the relief of bone structures. The paper describes a clinical case of the site of primitive neuroectodermal tumor in the zygomaticoorbital complex and a method for repairing postresectional defect and completely recovering the function of the organ of vision and aesthetic parameters of the face.

The article discusses feasibility of buccal fat pad flap in oral reconstruction based on clinical experience in a governmental hospital, in Alexandria, Egypt. It states that patients were followed up over a mean period to check flap viability, competent repair, and donor site function and aesthetics, and mentions that buccal fat pad flap was found to be feasible for the reconstruction of surgically induced proximal small to medium-sized defects.

Dural defect closure after resection of cranioorbital meningiomas has its own specifics. Extended malignant lesions and common large bone defects involving various anatomical regions require multiple implants or implants with complex geometry. The features of this stage of reconstruction were described in the previous issue of the Burdenko Journal of Neurosurgery. At the same time, contact of implant with nasal cavity and paranasal sinuses dictates additional requirements for tightness of soft tissue reconstruction and inertness of material. In this review, we describe modern and historically interesting methods of reconstruction of soft tissue defects following resection of cranioorbital meningioma., Objective: To summarize and analyze available literature data on reconstruction of soft tissue defects following resection of cranioorbital meningioma., Material and Methods: The authors reviewed available data on reconstruction of soft tissue defects after resection of cranioorbital meningiomas. Effectiveness of reconstruction techniques and safety of materials were analyzed., Results: The authors analyzed 42 available full-text articles. Features of growth and natural course of cranioorbital meningioma, methods of soft tissue defects closure, modern materials and sealing compositions are described. Considering these data, the authors proposed the algorithms for selecting materials for dural reconstruction after resection of cranioorbital meningioma., Conclusion: Improvement of surgical technique, development of new materials and technologies increase the efficiency and safety of dural defect closure. Nevertheless, high incidence of complications associated with dura mater repair necessitates further research in this area.

Sphenoorbital meningiomas (SOM) are a subgroup of skull base tumors with soft tissue component in the orbit and anterior and/or middle cranial fossa. According to different authors, SOMs account for 2-12% of all intracranial meningiomas. Reconstruction of bone defects after resection of SOM has own nuances. Along with cranial vault repair, patients encounter with cosmetic defects following facial skull lesion, ophthalmic symptoms due to orbital defects, dental and functional problems associated with opening of the mouth in case of damage to maxilla and mandible. Predominant infiltrative growth of tumor and common large bone defects involving various anatomical regions require multiple implants or implants with complex shape. Moreover, contact of implantation area with nasal cavity and paranasal sinuses requires additional impermeability of soft tissue reconstruction and inertness of materials., Objective: To summarize available modern data on bone defect closure after resection of SOM., Material and Methods: The authors reviewed available data on bone defect closure after resection of SOM. Effectiveness of modern methods of reconstruction and safety of materials were assessed., Results: We analyzed 96 available references. Technical features of tumor resection, materials used for bone defect closure and modern possibilities of 3D technologies in reconstructive surgery were described. The authors proposed the algorithms for selecting the materials for bone defect closure after resection of SOM., Conclusion: Improvement of surgical technique and development of new materials and technologies significantly improve cosmetic and functional results. A large percentage of negative ophthalmologic outcomes and high risk of complications in SOM surgery require further studies and elaboration of modern techniques.

Abstract: This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15mm×12mm to 30mm×40mm; size of the buccal fat pad ranged from 15mm×12mm to 43mm×38mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region. [Copyright &y& Elsevier]

In the present study, we investigate the capability of low concentrations of Papain to stimulate cartilage mesenchymal cells proliferation and transformation to chondrocytes and evaluate the healing capability of partial thickness defects in medial condyle cartilage of 30 rabbits’ knee joints. Papain 0.1 mg/ml and Ringer saline l ml each were injected intra-articularly to rabbits of experimental and control groups (15 animals each). Healthy cartilage from lateral condyle and cartilage from medial condyle where the surgical defect was created were studied histologically and by TEM. The study revealed that 0.1 mg/ml Papain activates proliferation and spreading of mesenchymal stem cells to young forms of chondrocyte from perichondrium to the upper layers of healthy cartilage. In only 22.27% cases of the experimental group, surgical defects filled with cartilaginous tissue on the background of distinct destruction of collagenous matrix in the native cartilage. However, in 55.5% of the control group the defect was spontaneously healed by hyaline cartilaginous tissue completely or partially on the basis of slight destruction of collagenous matrix. The defect site was filled with activated chondrocyte-like cells from the subchondral plate (not perichondrium) in both groups, which acquired some cisterns of rough endoplasmic reticulum (RER) and produced matrix proteins. The results suggest that Papain did not ameliorate the recovery of cartilage defects acquired through surgically-induced injury of collagenous matrix in native cartilage. We observed that articular cartilage is the source of mesenchymal stem cells which have the ability to transform into young forms of chondrocytes. This transformation process depends on the level of destruction of native cartilage collagen matrix induced by the defect or by Papain. [ABSTRACT FROM AUTHOR]

In head and neck surgery, sealant films represent a useful adjunct to ensure a reinforcement preventing leakages, dehiscence or oozing. The aim of this pilot study is to present the potential applications of a new sealant sheet in head and neck surgery, reporting outcomes, advantages and limitations. The sample included 32 patients, that underwent oncologic or elective surgery between January 2019 and January 2021 at the Cattinara Hospital in Trieste, Italy. Data regarding the patient, the surgical procedure and the postoperative course over hospitalization in terms of surgical complications were retrospectively collected. In this study, nor complication during the regular follow-up period occurred neither difficulties emerged in TP use in any head and neck subsites. In our experience, TP represented a valid aid in suture strengthening, easy to apply and suitable also for oncologic surgery in which the closure of some surgical defects may need a greater sealing effect., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported., Objective: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors., Methods: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speech- and taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result., Results: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient's own mucosa. No adverse features were observed in the cohort., Conclusion: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient's own mucosa to be restored with a more physiological result., (Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: The purpose of this study was to evaluate the pedicled buccal fat pad flap for its applicability in the reconstruction of surgically created oral defects. We highlighted the technique of flap harvesting, its different applications, and limitations., Design: Prospective analysis of patients with intraoral defects repaired by the buccal fat pad flap., Setting: Institutional center., Patients/participants: Twenty-nine patients with surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, retromolar region, oral floor, and temporomandibular joint., Interventions: Pedicled buccal fat pad flap for treatment of small to medium-sized intraoral defects., Outcome Measures: Patients had repair using a pedicled buccal fat pad flap between 2012 and 2014. Patients' photographs and clinical records were collected. The technique of flap harvesting, its advantages, and its drawbacks are described in this study., Results: Patients were followed up over a mean period of 13.7 months to check flap viability, competent repair, and donor site function and aesthetics. Complete epithelialization was observed within 4 to 6 weeks postoperatively according to the extent of the defect. All patients showed uneventful healing without complications., Conclusions: Buccal fat pad flap proved to be feasible for the reconstruction of surgically induced proximal small to medium-sized defects and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region. Further research using preoperative computed tomography or magnetic resonance imaging for evaluation of the size of the buccal fat pad is needed when reconstructing large distal defects.

Background Vismodegib is an oral hedgehog-pathway inhibitor approved for advanced basal cell carcinoma (BCC). Although most BCCs are amenable to surgery, excision of large tumors in aesthetically sensitive sites may compromise function or cosmesis. Objective We sought to evaluate the reduction in BCC surgical defect area after 3 to 6 months of neoadjuvant vismodegib. Methods This was an open-label, single-arm intervention trial with a primary outcome of change in target-tumor surgical defect area pre- and post-vismodegib (150 mg/d). Secondary outcomes were change in tumor area and tolerability. Results Eleven of 15 enrolled patients, aged 39 to 100 years, completed the trial. Thirteen target tumors were excised after a mean of 4 ± 2 months of vismodegib. In all, 29% (4 of 14 patients) could not complete more than 3 months because of vismodegib-related side effects. The mean baseline target-tumor diameter was 3.2 cm, and 10 of 13 tumors occurred on the face. Overall, vismodegib reduced the surgical defect area by 27% (95% confidence interval –45.7% to –7.9%; P = .006) from baseline. Vismodegib was not effective in patients who received less than 3 months. Over a mean follow-up of 11.5 (range 4-21) months for all tumors, only 1 tumor recurred at 17 months post-Mohs micrographic surgery. Limitations Short follow-up time and no placebo control are limitations. Conclusion Neoadjuvant vismodegib appears to reduce surgical defect area when taken for 3 months or longer for nonrecurrent BCCs in functionally sensitive locations. Further studies with larger sample sizes and long-term follow-up are warranted. [ABSTRACT FROM AUTHOR]