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Mucogingival deformities around implants are frequent findings in clinical practice and often present as inadequate keratinized tissue and insufficient mucosal thickness. Phenotype modification therapy can increase peri-implant mucosal thickness and the amount of keratinized mucosa, improving the long-term clinical outcomes of implants. The free gingival graft (FGG) is considered the gold standard to increase keratinized mucosa; however, FGGs on the lingual aspects of implants are less predictable due to technique sensitivity and often present with insufficient gains in tissue thickness due to a limited blood supply. The semilunar lingualized apically positioned flap (SLAP) with subperiosteal tunnel connective tissue graft (CTG) can increase both peri-implant mucosal thickness and keratinized mucosal width circumferentially. SLAP consists of one full-thickness, semilunar incision within the keratinized mucosa and buccal to the implant, as well as two vertical releasing incisions mesial and distal to the implant, extending lingually into the alveolar mucosa. The tissue is apically positioned lingual to the implant and sutured in place, creating buccal space for a CTG via buccal subperiosteal tunneling. SLAP is a minimally invasive and predictable approach for improving the peri-implant mucosal phenotype. This case report demonstrates gains in peri-implant mucosal thickness and the amount of keratinized mucosa over a 10-month period utilizing SLAP with subepithelial CTG. [ABSTRACT FROM AUTHOR]

The introduction of a new collagen substitute, which will potentially reduce the invasiveness of techniques by avoiding the need for a second surgical site (ie, the donor site), needs to be evaluated in relation to the surgical procedure that could benefit the most by utilizing such a matrix. This study compared the clinical outcomes following treatment of RT1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel (MCAT) technique or the multiple coronally advanced flap (MCAF) in conjunction with a new volume-stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference between the two surgical techniques in terms of discomfort. A total of 20 patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups: MCAF+VCMX (Group A) or MCAT+VCMX (Group B). The following measurements were recorded at baseline (before surgery) and at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PD), keratinized tissue width (KTW), and gingival thickness (GT). Postoperative pain and discomfort were recorded using a visual analog scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), and secondary outcomes were complete root coverage (CRC), changes in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements in REC and GT compared to baseline (P < .05). The mRC was 79.95% ± 29.92% in the MCAF group and 64.74% ± 40.5% in the MCAT group (P = .124). CRC was seen in 65.6% of MCAF-treated sites and 52% of MCAT-treated sites (P = .181). Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe a new sling suturing method with papillary anchorage that is clinically applicable within the available conventional root-coverage tunneling procedures. Although caution is advised to not increase excessive tension on the fragile papilla tips, as they provide coronal and palatal suspension, the tension used with this method ascertains a firm and stable connection for the entire buccogingival graft complex into the horizontal and vertical dimensions of both single and multiple recession defects. This technical note describes the "trapezoidal sling suture" technique, which allows fixation and stabilization for the graft and flap around both natural teeth and implants. [ABSTRACT FROM AUTHOR]

Multiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and postsurgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials to treat these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Ten patients with 33 type 1 recession defects (RT1s) were treated with PADM + TCAF. The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites (assessed with digital intraoral scanning), and patient-reported outcome measures. All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14% ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 mm3, and the mean distance between the surface/mean thickness of the reconstructed volume (DD) was 0.63 ± 0.28 mm. The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the midroot aspect (range: 0.72 to 0.78 mm, assessed 1 to 4 mm apical to the cementoenamel junction) compared to the other regions. The present study presents the clinical and volumetric outcomes of PADM + TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed at 6 months as a result of the treatment, along with satisfactory esthetic and patient-reported outcomes. [ABSTRACT FROM AUTHOR]

This study assessed the effects of buccal contour augmentation for periodontally compromised teeth with horizontal bone loss. A total of 30 subjects were divided into Group A or Group B (n = 15 subjects per group). Group A received open-flap debridement (OFD) with buccal contour augmentation using deproteinized bovine bone mineral (DBBM), jointly referred to as contour augmentation for periodontal defects (CAPD; test group). Group B received only OFD (control group). Bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD), gingival recession (GR), keratinized mucosa width (WKM), keratinized mucosa thickness (TKM), and labial cortical plate thickness were compared at baseline and 1 year. BOP, CAL, PD, and GR did not show significant differences. TKM increased by 1.76 mm for Group A but decreased by 1 mm for Group B. WKM increased from 2.86 ± 0.4 mm to 3.6 ± 0.71 mm (P < .001) and from 2.93 ± 0.32 mm to 3 ± 0.7 mm (P = 0.5) for Groups A and B, respectively, which showed statistical significance. Labial cortical plate thickness increased from 0.94 ± 0.3 mm to 1.95 ± 0.54 mm (P < .001) for Group A but decreased from 0.87 ± 0.45 mm to 0.68 ± 0.31 mm for Group B. Visual analog scale scores for pain perception showed no difference between the two groups. CAPD for periodontally compromised teeth improves WKM and TKM. Long-term analyses are needed to determine its benefits in daily clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. Method and materials: A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. Results: The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. Conclusions: This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects. [ABSTRACT FROM AUTHOR]

Guided bone regeneration (GBR) requires a tension-free flap without damaging the collateral circulation in order to secure better surgical outcomes. Topographic knowledge regarding the neurovascular bundles in the posterior aspect of the mandible can prevent complications during lingual flap design. The lingual branch (LB) of the inferior alveolar or maxillary arteries is not sufficiently illustrated or described in the literature. Nevertheless, it has an intimate relationship with the lingual nerve (LN) during ridge augmentation and implant-related posterior mandible surgery. Therefore, this study aimed to clarify the morphology and topography of the LB related to GBR surgeries. In the present human cadaveric study, the LB was analyzed in 12 hemimandibles using latex injection and corrosion casting. Two types of LB were identified based on their origin and course. The LB was found in a common connective tissue sheath close to the LN. The LB assembled several anastomoses on the posterior lingual aspect of the mandible and retromolar area. The LB acted as an anatomical landmark in identifying LN at the posterior lingual aspect of the mandible. [ABSTRACT FROM AUTHOR]

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla. [ABSTRACT FROM AUTHOR]

Purpose: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. Materials and Methods: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (= 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. Results: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. Conclusions: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Vertical ridge augmentation in the anterior mandible is a technically delicate procedure that requires knowledge of some anatomical structures to reduce intra- and postoperative complications. Proper soft tissue management is one of the primary aspects to the success of these techniques, enabling tension-free primary wound closure and preventing membrane exposure. This cadaveric and clinical study provides an anatomical overview of the lingual portion of the anterior mandible. Moreover, there is a description of a novel surgical approach for release of the lingual flap that will help clinicians achieve primary closure without incurring intrasurgical complications. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible. [ABSTRACT FROM AUTHOR]

Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. OBJECTIVE: To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes. METHODS & MATERIALS: Previous literature was searched for the last 20 years to provide an updated guide. RESULTS: Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review. CONCLUSION: While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations.

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of experience level on the clinical and esthetic results of coronally advanced flap (CAF) surgery. A postgraduate student's first 40 CAF operations in the periodontology residency program were followed. The Miller Class I gingival recessions were divided into four chronologic groups (n = 10 in each). Clinical and esthetic evaluations were performed at baseline and after 6 months. The results of chronologic intervals were statistically compared. While the overall mean root coverage (RC) percentage was 73.6% and the complete RC was 60%, the mean RC percentages of the groups, respectively, were 45%, 55%, 86%, and 95%, showing that the mean and complete RC percentage increased as the experience level increased (P < .05). Similarly, as the experience level increased, closure of the gingival recession depth and width and esthetic scores increased, while the surgical time decreased significantly (P < .05). Complications were observed in three patients during the first interval and in two patients during the second interval, while no complications were observed in the other groups. This study showed that experience level can significantly affect the clinical and esthetic outcomes, operative time, and complication rates of CAF surgery. All education programs should determine how many of each surgical procedure residents must perform before they are considered experienced or expert surgeons who can work independently and predictably achie vesafe, acceptable outcomes. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any sod tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally. [ABSTRACT FROM AUTHOR]

Purpose: To assess the peri-implant and flap parameters of the prefabricated microvascular fibula flap and determine the dental implant survival rate. Materials and Methods: This retrospective study investigated a cohort of subjects who received prefabricated microvascular fibula flaps at two highly specialized tumor reconstruction centers. The subjects had all suffered atrophy or a large segmental defect of the jaws due to tumor resection or injury. Two independent surgeons determined the dental implant survival rate and assessed the peri-implant parameters and flap parameters during clinical follow-up. Results: In total, 41 subjects were treated with a prefabricated fibula flap between 1999 and 2012. Of these, 17 subjects (10 male, 7 female) with a total of 62 dental implants were examined. The other 24 subjects were unavailable for assessment and had to be excluded. Ten of the 62 dental implants (16.1%) had to be removed due to peri-implantitis before the follow-up assessment. Follow-up assessments were performed at intervals ranging from 2 to 12 years (mean: 7.2 years) after fibula flap transplantation. The dental implant survival rate was found to be 83.9%. A total of 208 dental surfaces were assessed. Overall, 96% of all surfaces had a pocket depth (PD) of ≤ 4 mm and 4% had a pocket depth of > 5 mm. An attachment level (AL) of 3 mm was measured in 48.5% of implants and ≥ 5 mm was measured in 15.9% of implants. Dental implants with a PD > 4 mm showed a significantly higher plaque index (PI) (75%; P = .0057), papillary bleeding index (PBI) (62.5%; P = .0094), and radiologic bone loss (P = .0014) compared to dental implants with a PD ≤ 4 mm. Conclusions: Reconstructive surgery using microvascular fibula flaps represents an alternative tool for oral rehabilitation in subjects suffering from a large segmental defect in the maxillary or mandibular bone compared to the conventional method. However, it appears that the different ossification processes that develop the fibula and the jawbones affect dental implant survival. [ABSTRACT FROM AUTHOR]

Gingival recession is an apical shift of the gingival margin with exposure of the root surface to the oral cavity, which creates an esthetic problem. The present study was attempted to compare vestibular incision subperiosteal tunnel access (VISTA) with and without advanced platelet-rich fibrin (A-PRF) in the treatment of Miller Class I gingival recessions. A total of 24 patients were assigned randomly to either the test group (VISTA with A-PRF) or the control group (VISTA alone). Clinical parameters like recession depth, recession width, clinical attachment loss, width of keratinized gingiva, gingival thickness, and probing depth were recorded at baseline and at 3 and 6 months postoperatively. Intergroup comparison of mean root coverage (RC) in mm, %RC, change in width of keratinized gingiva and clinical attachment gain revealed no statistically significant difference (P > .05). Change in gingival thickness showed statistically significant improvement in test group. Within the limitations of this study, both treatment options (VISTA with A-PRF and VISTA alone) have resulted in predictable and comparable RC, with increased gingival thickness in the test group. [ABSTRACT FROM AUTHOR]

Currently, the incision design for periodontal and implant surgeries is mainly based on the surgeon's personal preference. The primary aim of this study is to review the intricate periodontal microvascular system and to illustrate the potential impact of commonly applied flap designs on the integrity of this system. A complete literature electronic search resulted in 37 relevant articles. The maxillary, facial, and lingual arteries supply the microvasculature system, including the supraperiosteal, intraligamental, and intraosseous arterioles. These arterioles have their own territories yet are extensively interconnected. The impact of common papilla management techniques are discussed, including tunneling; papilla base, incision, and preservation; and flap-releasing incisions. Flap design can impact reperfusion and blood inflow in the early healing phase, which eventually influences wound closure probability, healing speed, surgical predictability, tissue volume change, and postoperative morbidity. Future studies on the three-dimensional distribution of microvasculature and clinical impact of various flap designs on tissue reperfusion can lead to evidence-based incision selection and improved wound-healing outcomes. [ABSTRACT FROM AUTHOR]

This study assessed the effectiveness and predictability of a readily available protocol to treat peri-implantitis utilizing mechanical debridement, chemical antiseptic surface detoxification, and osseous grafting. Nine patients (7 women, 2 men; mean age: 56.5 years) with 15 implants with peri-implantitis were included. Pocket probing depth (PPD), bleeding on probing (BOP), and standardized digital periapical radiographic measurements were taken. Surgical flaps were elevated, and the implant threads were cleaned with a plastic curette. Chemical decontamination was performed by scrubbing solutions of 0.25% sodium hypochlorite (NaClO) and 1.5% hydrogen peroxide (H2O2) around the exposed implant using cotton pellets. Bony defects were filled with a 50/50 mixture of bovine hydroxyapatite and nanocrystalline calcium sulfate (CaSO4). A porcine collagen membrane was placed over the grafted bony defect. Follow-up appointments were scheduled 1 week, 2 weeks, 3 months, 6 months, 9 months, and 1 year posttreatment. Clinical and radiographic parameters were assessed and compared. At baseline, PPD ranged from 5 to 7.5 mm (mean: 6 ± 0.7 mm). At 12 months, PPD ranged from 1.5 to 4.2 mm (mean: 2.5 ± 0.8 mm). The mean PPD reduction of 3.6 mm (59.2%) was statistically significant (P < .001). The number of bleeding sites around each test implant decreased significantly from 4 to 0.4 sites between baseline and 12 months (P < .001). Mean radiographic bone loss decreased from 4.8 ± 1.3 mm to 2.7 ± 1.2 mm (P < .001). The proposed method of mechanical decontamination, chemical detoxification, and bone regeneration is clinically effective and reproducible. Clinical peri-implant parameters and radiographic bone levels were improved and maintained their stability for 1 year using this peri-implantitis treatment protocol. [ABSTRACT FROM AUTHOR]

The aim of this case series was to evaluate the clinical performance of a new volume-stable collagen matrix (VCMX) in combination with the modified coronally advanced tunnel technique (MCAT) for the treatment of gingival recessions. Thirteen patients with a total of 33 maxillary RT1 single and multiple gingival recessions were included in the study. Probing pocket depth (PPD), recession width (RECW), recession depth (REC), height of keratinized tissue (HKT), and gingival thickness (GT) were assessed at baseline and at the 12-month follow-up. Postoperative healing was uneventful in all cases without any complications. At 12 months, mean root coverage (MRC) was 92.88%, with complete root coverage (CRC) in 87.88% of treated sites. The present findings suggest that VCMX in combination with MCAT results in predictable coverage of maxillary RT1 gingival recessions. Further studies with larger sample sizes and control groups are needed to support these preliminary outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the effectiveness of submucosal 8 mg (2 mL) dexamethasone (DEX) on postoperative pain, swelling, chewing efficiency, trismus, healing, and discomfort after periodontal flap surgery (PFS). Methods: In this randomized controlled split-mouth study, 25 patients underwent PFS in the mandible, whereby postoperative, submucosal DEX was injected to the surgical field to the test group and submucosal normal saline was applied to the control group. Pain was evaluated using the Visual Analogue Scale (VAS) and the 101-point numeric rate scale in the first 8 h after PFS and on the 2nd, 3rd, 4th, and 7th days, whereas swelling, chewing efficiency, trismus, healing, discomfort and analgesic consumption were evaluated preoperatively on the 1st, 2nd and 7th days. Results: In the intergroup evaluation, the VAS-7th hour value of the test group was lower than the control group(p < 0.05). On the 1st day, it was observed that there was less swelling and more chewing efficiency in the test group than in the control group(p < 0.05). When time-dependent changes were examined, the decrease in mouth opening due to trismus in the control group was greater than that in the test group on the 1st and the 2nd days compared to the preoperative period(p < 0.05). Finally, postoperative healing, discomfort, and analgesic consumption were similar between groups. Conclusion: Within the limits of this study, the submucosal DEX may be an effective protocol in the management of pain, swelling, and trismus after PFS. Clinical relevance: Our findings shed light on the possible effects of DEX after PFS. Trial registration: This study was registered on ClinicalTrials.gov (NCT06119893). [ABSTRACT FROM AUTHOR]

Objectives: To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty. Methods: A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented. Results: Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P <.001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P <.001), and both (57.9 ± 35.0-26.1 ± 20.2, P =.03). Conclusion: The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Skin flaps are among the most important means of wound repair in clinical settings. However, partial or even total distal necrosis may occur after a flap operation, with severe consequences for both patients and doctors. This study investigated whether tert‐butylhydroquinone (TBHQ), a known agonist of the transcription factor nuclear factor erythroid 2‐related factor 2 (Nrf2), and an antioxidant, could promote skin flap survival. Experimental Approach: McFarlane skin flap models were established in male Sprague–Dawley rats and then randomly divided into control, low‐dose TBHQ, and high‐dose TBHQ treatment groups. On postoperative day 7, the survival and blood flow of the skin flaps were assessed. Using flap tissue samples, angiogenesis, inflammation, apoptosis, autophagy, and Nrf2/haem oxygenase 1 (HO‐1) signalling pathway activity were measured with immunohistochemical techniques and western blotting. Key Results: TBHQ dose‐dependently stimulated the Nrf2/HO‐1 signalling pathway, inducing autophagy through the up‐regulation of LC3B and beclin 1 and concurrently suppressing p62 expression. Additionally, TBHQ hindered apoptosis by enhancing Bcl‐2 expression while inhibiting the expression of Bax. It suppressed inflammation by inhibiting the expression of interleukin 1β, interleukin 6, and tumour necrosis factor‐α and enhanced angiogenesis by promoting the expression of vascular endothelial growth factor. Conclusion and Implications: In summary, TBHQ promoted flap survival in rats by up‐regulating the Nrf2/HO‐1 signalling pathway. As TBHQ is already widely used as a food additive, it could offer an acceptable means of improving clinical outcomes following skin flap surgery in patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Forequarter and hindquarter amputations have traditionally been closed with local tissues, but the technique is plagued by a high rate of complication such as marginal necrosis, seroma, infection, and dehiscence. Filet of limb flaps have been used when local tissues are insufficient for closure, and despite their use in more extensive and complex wounds, outcomes seem to be better in these cases. Recognizing that filet of limb flaps not only serve to cover the wound, but also eliminate dead space, supplement at-risk and/or radiated tissue, pad underlying hard structures, and facilitate neuroma prevention with target muscle reinnervation, we have change our practice to utilize buried filet of limb flaps even when local tissues are technically "sufficient" to close the wound. The purpose of this article to organize and describe the ways in which buried filet-of-limb flaps can be used to achieve important and discrete surgical objectives in forequarter and hindquarter amputation, and to facilitate increased recognition of collaborative interdisciplinary opportunities for spare-part reconstruction. Methods: Retrospective data from the medical records of seven patients, collected between 2010 to 2023 at our single tertiary referral center, were reviewed. This included all patients for whom a buried (or partially buried) filet of limb flap was attempted for forequarter or hindquarter amputation reconstruction. Results: Five males and two females ranging 55 to 75 years of age, met the inclusion criteria. Three cases of forequarter amputation and four cases of hindquarter amputation were included. Six flaps were successfully transferred without major flap-related complications. The mean follow-up period was eight and a half months. Conclusion: Even when local tissues are technically "sufficient" to close forequarter and hindquarter amputation wounds, we have found buried filet of limb flaps to be useful in several ways. These include occupying dead space, providing double-layer coverage, padding hard structures, preventing neuromas, and reconstructing sacro- and spino-pelvic continuity. Our approach emphasizes interdisciplinary collaboration and highlights the potential advantages of buried filet of limb flaps in optimizing patient outcomes for complex limb amputations. [ABSTRACT FROM AUTHOR]

Introduction: Vomer flap is a technique to close cleft lip and palate. This technique is a simple procedure that has many benefits. However, the vomer flap's application together with primary lip closure is still questionable. Objective: To find out whether the vomer flap's application in primary cleft lip repair can provide significant benefits Design: A systematic review was conducted using the PRISMA methodology has been licensed in PROSPERO databases (CRD42023399487). Setting: A comprehensive search was set out, utilizing eight data sources up to March 2023. Participants: Both cohort studies and randomized control trials regarding the use of vomer flaps performed concurrently with cleft lip repair in children up to six months old. Results: This article involved 8 studies involving 542 patients who met the inclusion criteria, consisting of 6 retrospective cohort studies, 1 RCT study, and 1 prospective cohort study. Vomer flaps provide a reduction in palatal cleft distance of 3–5 mm, a relatively small number of fistulas (0–4%), improvement of velopharyngeal function (nasal tone and nasal emission), maximal development of the maxilla although it is still controversial. Conclusion: The vomer flap's application in primary cleft lip repair provides many advantages, such as reduced palatal and alveolar clefts, decreased risk of oronasal fistula, increased velopharyngeal function, and increased maxillary growth. It is reliable for the management of cleft lip and palate. [ABSTRACT FROM AUTHOR]

Objective: The failure rate of foot and ankle soft tissue defect reconstruction with flap is relatively high, often posing a significant burden on patients. The aim of this study is to explore the effectiveness of repeated stretch sutures in repairing skin and soft tissue defects of the ankle and foot. Methods: Twenty‐three patients with ankle and foot skin and soft tissue defects were retrospectively analyzed between February 2016 and February 2019. Sutures were repeatedly stretched every 3–5 days. Local skin grafting was performed if necessary after wound surfaces disappeared or exposed tendons and bones were covered by soft tissue. Wound healing time, postoperative healing area, Vancouver Scar Assessment Scale, sensation, and function of the new skin were evaluated. Results: Healing time was 17–35 (24.43 ± 5.29) days. Ten patients wholly healed, and 13 healed by approximately 70.08% ± 6.59%. The Vancouver Scar Assessment Scale average score was 2.83 ± 1.19 points, of which 15 cases were excellent (0–3 points) and 8 cases were good (4–7 points). The sensation and function of the new skin after repair were equivalent to those of normal skin after the last follow‐up. Conclusions: Applying repeated tension sutures on the skin and soft defects of the ankle and foot reduced the skin graft area and decreased complex high‐risk surgical flaps' use and transplantation area. [ABSTRACT FROM AUTHOR]

Objective: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3–6 months. Hard-to-heal DFUs are a major source of morbidity and mortality. Improving wound healing via soft tissue reconstruction may be the key to improving clinical outcomes. Thus, the Diabetic Limb Salvage (DLS) service in Sengkang General Hospital, Singapore, was established to provide patients with a streamlined, one-stop, comprehensive service dedicated to DFU soft tissue reconstruction. The reconstruction was carried out using secondary closure, skin grafting, local flaps or free flaps, depending on the severity of the wound and patient suitability. This study aims to audit the early outcomes of the DLS service. Method: Patients with DFUs treated by the DLS service were compared with patients with DFUs treated prior to the launch of the DLS service (control). Outcomes including major and minor amputation rates, wound healing rate, mortality and DFU recurrence rates were analysed statistically. Results: A total of 103 patients took part in the study (50 in the DLS service cohort and 50 in the control cohort). There was no significant difference in demographics, comorbidities and wound profiles between the two cohorts. All (100%) patients in the DLS service cohort received soft tissue reconstruction versus only 13% in the control group. The DLS service cohort had a significantly higher healing rate (96% versus 68%, respectively), shorter healing duration (77±30 days versus 111±43 days, respectively), reduced major amputation rate (0% versus 9%, respectively), and reduced recurrence rate (6% versus 25%, respectively) compared with the control cohort within the one-year follow-up. Conclusion: The findings of this study showed that an orthoplastic multidisciplinary approach focused on DFU soft tissue reconstruction improved wound healing rates, shortened healing duration and, as a result, lowered amputation rates and reduced recurrence. [ABSTRACT FROM AUTHOR]

Background: Neurofibromatosis is considered a rare genetic disorder primarily affecting neural tissues. The most common type is neurofibromatosis type 1, which is characterized by plexiform neurofibromas. Case presentation: We report a case of a 30-year-old Rag-lay ethnic woman with facial plexiform neurofibroma, which not only infiltrated the left eye socket but also caused destruction of temporal bone and facial deformity. The disease started in her childhood, and she had numerous neurofibromas on her trunk and limb at the time of the hospital admission. The patient was diagnosed with neurofibromatosis 1 based on clinical symptoms, computed tomography images, and histopathologic result. For safety, we divided treatment into two phases. For the first phase, we dealt with the blood supply and meningeal suture, and then we performed surgical resection and skin flap reconstruction surgery. Conclusion: The main therapy for plexiform neurofibroma is surgery, which aims at tumor removal and management of complications. However, the treatment plan is different in each case based on the nature and extent of tumor, which requires more verification and clinical practice. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Key points Plain language summary Several methods have been described for treating deep Cairo Class RT1 recessions. Most involve relieving incisions, which cause scar tissue formation or use a tunneled approach. This report introduces a modified technique for treating a single deep recession beyond the mucogingival margin. The approach uses a laterally closed coronally advanced flap (LCAF) without relieving incisions, combined with a subepithelial connective tissue graft and enamel matrix derivative.A 28‐year‐old woman was referred to our periodontal practice for the treatment of a progressive deep Cairo Class I recession with hypersensitivity and limited access to hygiene measures. The root coverage procedure was performed using a modified LCAF, combined with a connective tissue graft from the palate and enamel matrix derivative. The case was followed for 6 months.The healing process was uneventful. Six months after surgery, the root surfaces remained completely covered. Hypersensitivity resolved entirely, and there was only a slight formation of visible scar tissue.This modified technique of an LCAF is a feasible and effective method for treating single deep RT1 recessions. By avoiding visible relieving incisions, scar tissue formation is minimized. The preparation of an LCAF allows for adequate coronal advancement. As far as our knowledge, this is the first description of a laterally closed coronally advanced flap (LCAF) combining the advantage of a minimalized scarring root coverage with a simplified coronally advancement for recessions exceeding the mucogingival junction. This modified technique combines the advantages of a lateral closing with a CAF for covering deep class RT1 recessions. Meticulous handling of the delicate pedicles combined with a coronal advancement of at least 2 mm beyond the cemento‐enamel junction is the key factor for the successful adaption of this technique. As far as our knowledge, this is the first description of a laterally closed coronally advanced flap (LCAF) combining the advantage of a minimalized scarring root coverage with a simplified coronally advancement for recessions exceeding the mucogingival junction.This modified technique combines the advantages of a lateral closing with a CAF for covering deep class RT1 recessions.Meticulous handling of the delicate pedicles combined with a coronal advancement of at least 2 mm beyond the cemento‐enamel junction is the key factor for the successful adaption of this technique.Deep gum recessions originating from traumatic hygiene measures can cause hypersensitivity and limit patients´ access to oral hygiene. Especially in deep recessions, the common surgical techniques have shortcomings due to a post‐surgical lack of keratinized gingiva or visible scar tissue formation. This case study shows the treatment of a 28‐year‐old woman´s deep recession on a mandibular front tooth introducing a modified surgical technique for covering deep gum recessions exceeding the area of the keratinized gingiva (so‐called deep Cairo RT1 recessions). This new technique uses a “laterally closed coronally advanced flap” (LCAF), which combines a curtain‐similar lateral closing of the flap pedicles with a coronal advancement to cover the recession without making cuts that can lead to scars. It is combined with a tissue graft from the patient's palate and a special protein to regenerate the periodontium. Six months after surgery, complete root coverage was achieved without remaining hypersensitivity and with restored access for oral hygiene measures. Minimal visible scar tissue formed. This case study demonstrates that the LCAF is a feasible technique for covering single deep gum recessions exceeding the keratinized area of the gingiva. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate patient‐reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm‐free flaps (UFFF) reconstruction. Materials and Methods: Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW‐QOL) and Oral Health Impact Profile (OHIP‐14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post‐reconstruction. Results: In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor‐site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW‐QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. Conclusion: Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients. [ABSTRACT FROM AUTHOR]

Selecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management. Patients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes–Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results. The median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively. To minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12–15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20–25 mm defects on the fingers and thumb, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mandibular reconstruction has historically been challenging due to the complex, highly functional, and esthetic nature of the anatomy. The most common etiologies of these defects requiring resection include trauma, benign tumors, and malignant pathology. Mandibular defects have been treated with little consideration for neural reconstruction, leaving patient's orally incompetent with associated social stigma. Although recent advances in reconstructive techniques improve oral rehabilitation, immediate inferior alveolar nerve (IAN) reconstruction has not been widely adapted. OBJECTIVE: Here-in we seek to discuss the innovations of neural reconstruction of large segment mandibular defects and associated IAN defects and present an example case performed at Naval Medical Center San Diego (NMCSD). METHODS: Pertinent literature discussing maxillofacial reconstruction and nerve repair using autogenous nerve harvest and allograft was queried from available online resources. RESULTS: Six patients have received immediate reconstruction of the IAN using processed nerve allograft over the past three years. All obtained sensation to S3 within six months of surgery. CONCLUSION: IAN repair using nerve allografts in conjunction with free flap reconstruction for large mandibular defects is a viable treatment and should be the new paradigm in maxillofacial reconstruction as it provides substantial quantifiable and qualitative improvements in social, functional, and esthetic outcomes of care. [ABSTRACT FROM AUTHOR]

The reported donor site morbidity of the fibula free flap (FFF) is low; however, several uncommon complications have been reported with tibia fracture rarely being reported. We present a case of a pathological tibial fracture in the setting of chronic osteomyelitis after FFF. A 54-year-old female presented with a benign fibro-osseous lesion of the right mandible and was treated with mandibulectomy and reconstructed with a left FFF. Approximately 1 year following surgery, the patient presented to the emergency department. Imaging showed a pathological fracture of the distal third of the tibial shaft with persistent erythema and cellulitis of the lateral prior graft harvest site without signs of systemic infection. She was taken to the operating room for irrigation and debridement with culture and biopsy as well as external fixation of the tibial fracture. Intraoperative biopsy and culture demonstrated fracture site change with callus formation and negative culture. The patient was discharged on 6 weeks of IV vancomycin and ceftriaxone. In conclusion, tibial fracture following FFF is an uncommon complication, yet it can be exacerbated by chronic osteomyelitis. This report highlights the importance of close observation and comprehensive wound care of donor sites after free flap harvest for head and neck reconstruction. [ABSTRACT FROM AUTHOR]

Background: The effectiveness and safety of matrix-associated autologous chondrocyte implantation with an autologous periosteal flap (pMACI) remain unclear. The Japanese Ministry of Health, Labor, and Welfare requires postmarketing surveillance of all patients undergoing pMACI using the tissue-engineered product JACC. Purpose: To evaluate the effectiveness and safety of pMACI for large articular cartilage defects (≥4 cm2) in the knee joint using real-world data analysis. Study Design: Case series; Level of evidence, 4. Methods: Data were collected from patients who underwent pMACI between 2012 and 2019, with 2 years of follow-up. The primary outcomes were the Lysholm knee score and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months. Adverse events were assessed by physical examination, magnetic resonance imaging, and/or arthroscopy. Results: Overall, 232 knees in 225 patients who presented with trauma (198 knees) or osteochondritis dissecans (34 knees) in the medial (132 knees) and lateral (44 knees) femoral condyle, patella (25 knees), trochlea (86 knees), and tibial plateau (4 knees) were included. The mean age of the patients was 40.9 ± 15.0 years, with mean cartilage defects of 5.6 ± 2.4 cm2 in size. Concomitant surgeries, such as osteotomy (50 knees), ligament reconstruction (27 knees), meniscal procedures (28 knees), osteochondral autograft transplantation (24 knees), and microfracture (14 knees), were performed in 113 (48.7%) knees. The minimal clinically important difference in the Lysholm knee score and KOOS Symptoms subscale was achieved in 79.7% and 63.5% of patients, respectively, and the Patient Acceptable Symptom State was achieved in 90.1% and 73.7%, respectively. Substantial clinical benefit was achieved in the KOOS Sports/Recreation and Quality of Life subscales at 39.6% and 37.8%, respectively. Knees that underwent concomitant microfracture had significantly worse KOOS values than the remainder of the cohort. Complications, including effusion (16.8%), graft delamination (14.7%), knee contracture (9.1%), graft hypertrophy (8.2%), and ossification (3.4%), were observed in 86 (37.1%) knees. Osteochondritis dissecans was significantly associated with graft hypertrophy and ossification, whereas concomitant surgery was significantly associated with delamination and contracture. Treatment failure required additional cartilage procedures in 11 (4.7%) knees. Conclusion: Treatment of large cartilage defects (≥4 cm2) with pMACI resulted in improved outcome scores in approximately 75% of patients. However, complications occurred in one-third of patients, and 4.7% required reoperation. [ABSTRACT FROM AUTHOR]

Aim: To assess the possibility of vertical alveolar ridge augmentation by means of activation of the periosteum. Materials and Methods: Six adult male Beagle dogs were used for the study. All premolars and first molars were extracted, and one vertical saucer‐shaped bony defect was created on each side of the mandible. After 3 months of healing, full‐thickness muco‐periosteal flaps were elevated, and one distraction device was placed on each side of the mandible. The distraction plate was left submerged, and the activation mechanism connected to the distraction rod was exposed intra‐orally. The protocol of periosteal activation (PP: periosteal 'pumping') was initiated after a latency of 7 days. The alternation of activation and relaxation at the rate of 0.35 mm/12 h during 5 days was followed by the sole activation of 0.35 mm/12 h for 5 days (PP group). Devices were left inactivated on the contralateral control side of the mandible (C group). All animals were euthanized after 8 weeks of consolidation. Samples were analysed histologically and by means of micro‐CT. Results: New mature lamellar bone was formed over the pristine bone in all groups. More intensive signs of bone modelling and remodelling were observed in the PP group compared to the C group. Mean new bone, bone marrow, connective tissue and total volumetric densities were greater in the PP group (p < 0.001, p = 0.001, p = 0.003 and p < 0.001, respectively). No differences were observed in the relative area parameters. Total tissue volume and bone volume were higher in the PP group (p = 0.031 and p = 0.076, respectively), while the bone mineral densities were higher in the C group (p = 0.041 and p = 0.003, respectively). Trabecular number, trabecular thickness and trabecular separation values were similar between the two groups. Conclusions: Regeneration of vertical alveolar bone ridge defects may be enhanced by activation of the periosteum, without the application of bone grafting materials. [ABSTRACT FROM AUTHOR]

Background In appropriately selected patients, it may be possible to fully bury breast free flaps deep to the mastectomy skin flaps. Because this practice forgoes the incorporation of a monitoring skin paddle for the flap, and thus limits the ability for physical exam, it may be associated with an increased risk of flap loss or other perfusion-related complications, such as fat necrosis. We hypothesized that fully de-epithelialized breast free flaps were not associated with an increased complication rate and reduced the need for future revision surgery. Methods A single-institution retrospective review of 206 deep inferior epigastric artery (DIEP) flaps in 142 patients was performed between June 2016 and September 2021. Flaps were grouped into buried or nonburied categories based on the absence or presence of a monitoring paddle. Patient-reported outcomes were assessed postoperatively using the BREAST-Q breast reconstruction module. Electronic medical record data included demographics, comorbidities, flap characteristics, complications, and revision surgery. Results The buried flap patients (N = 46) had a lower median body mass index (26.9 vs 30.3, p = 0.04) and a lower rate of hypertension (19.5 vs. 37.5%, p = 0.04) compared with nonburied flap patients (N = 160). Burying flaps was more likely to be adopted in skin-sparing mastectomy or nipple-sparing mastectomy (p = 0.001) and in an immediate or a delayed–immediate fashion (p = 0.009). There was one flap loss in the nonburied group; complication rates were similar. There was a significantly greater revision rate in the nonburied flap patients (92 vs. 70%; p = 0.002). Buried flap patients exhibited a greater satisfaction with breasts (84.5 ± 13.4 vs. 73.9 ± 21.4; p = 0.04) and sexual satisfaction (73.1 ± 22.4 vs. 53.7 ± 29.7; p = 0.01) compared with nonburied flap patients. Conclusion Burying breast free flaps in appropriately selected patients does not appear to have a higher complication rate when compared with flaps with an externalized monitoring paddle. Furthermore, this modification may be associated with a better immediate aesthetic outcome and improved patient satisfaction, as evidenced by a lower rate of revision surgery and superior BREAST-Q scores among buried DIEP flaps. [ABSTRACT FROM AUTHOR]

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables. [ABSTRACT FROM AUTHOR]

Aortic vascular graft/endograft infection (VGEI) has historically been managed through graft removal and re-replacement, but new approaches suggest vascularized tissue transfer is an effective adjunctive treatment. We describe our experience with treating thoracic aortic vascular graft infection with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. Data from all patients undergoing combined flap closure by the senior author at a high-acuity cardiac surgery center from 1995–2023 were reviewed. Patients with clinical and radiographic signs of thoracic aortic vascular graft infection were included. Complete data were available for 598 patients with sternal and mediastinal wounds. Combined PMM and omental flaps were mobilized in 11 thoracic aortic vascular graft infection patients. Indications for flap management included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy due to hemodynamic instability (5/11; 45.5%). During chest exploration, 6/11 (54.5%) underwent complete removal of the infected graft, compared to 5/11 (45.5%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 6/11 (54.5%). Postoperative complications included dehiscence (2/11; 18.2%), seroma (1/11; 9.1%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One patient (9.1%) died within 30 days of sternal reconstruction from mitral valve failure tachyarrhythmia. None of the patients underwent reoperation for flap-related complications. Despite significant comorbidities, low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective adjunctive treatment to the antimicrobial and surgical management of select thoracic aortic vascular graft infections. [ABSTRACT FROM AUTHOR]

As seroma formation is a common donor site complication following autologous breast reconstruction, we adapted the surgical protocol by introducing progressive tension sutures (PTS). This study aimed to evaluate the influence of PTS at the donor site in autologous breast reconstruction on seroma formation. Additionally, an exploratory analysis on patient satisfaction and aesthetic outcome was performed. This retrospective cohort study analyzed data of 400 patients who received autologous breast reconstruction between 2018 and 2022. Among them, 204 patients received traditional donor site closure, and 188 patients received PTS with or without drain placement. Proportional incidence of seroma was described and multivariable logistic regression was used to assess the risk factors for seroma formation. At the deep inferior epigastric artery perforator donor site, patient satisfaction was further explored by administering the BREAST-Q and the aesthetic outcome was graded by three blinded participants. Overall, 514 breast reconstructions were performed on 400 patients. The incidence of seroma formation was lower in the PTS group compared with that in the traditional closure group. Multivariable analysis showed that patients who received PTS were 40% less likely to develop seroma. Aesthetic outcome was considered more pleasing objectively and subjectively if PTS were performed. Regarding patient satisfaction, no difference was found in the post-operative physical well-being between the two groups. In this large cohort, we found reduced incidence of seroma when PTS were performed. PTS were also associated with reduced odds of seroma formation and were described to be aesthetically more pleasing. PTS should be considered in autologous breast reconstruction. [Display omitted] [ABSTRACT FROM AUTHOR]

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Background: Pressure injuries (PIs) are among the most common skin and soft tissue wounds occurring in patients who are bedbound and/or immobile. PI management hinges on their prevention; however, reoccurrence poses a challenge to their management and requires a multidisciplinary approach. Here, the authors describe a lumbosacral rotation flap (LSRF) for the coverage of sacral PIs. Method: A single-centre, retrospective analysis of prospectively collected data was carried out. All patients undergoing LSRF for sacral PIs were included. Patients with active systemic sepsis, immune compromise, hepatic or renal dysfunction were excluded. All patients underwent preoperative optimisation and wound cultures to direct antibiotic therapy after surgery. Results: A total of nine patients underwent the procedure (seven male and two female). Mean age was 47.6 years with a mean ulcer size of 92.9 cm2. Bone biopsy indicated the presence of osteomyelitis in three patients. Of the LSRFs, two flaps showed minimal local complications in the form of marginal flap necrosis which was managed conservatively. All flaps healed well with no cases of flap loss or the need for secondary procedures. Conclusion: The results of this analysis showed that LSRF can be considered a first line of treatment of sacral PIs. They can be used to cover large defects. Due to their large base and flap size, readvancement in cases of recurrence is also possible. [ABSTRACT FROM AUTHOR]

Objective: Unusual setting of medical care. Background: Neuropathic pain symptoms caused by neuromas impose physical burdens and affect patients mentally and socioeconomically. Surgical intervention offers more promising outcomes than do conservative approaches. An accessible and cost-effective surgical treatments is neuroma excision, coupled with nerve wrapping flaps. However, few reports have detailed the outcomes of this approach. In this study, we report 4 patients who underwent neuroma excision and nerve wrapping with vein autographs. Case Report: We present 4 patients who experienced persistent neuropathic pain and did not respond to conservative treatment for more than 6 months. Three patients had upper limb neuromas in continuity and 1 patient had a stump femoral neuroma. Surgical intervention involved neuroma excision, nerve grafting, and the application of nerve wrapping flaps at the site of anastomosis. Evaluation of our patients included neuroma pain scores and the Weber 2-point discrimination test. Follow-up assessments demonstrated significant clinical improvement, with all patients showing up to 60% reduction in pain and an average improvement of 5 mm in 2-point discrimination. No recurrence or need for further surgery was observed. Conclusions: Surgical intervention was superior to conservative treatment in patients with painful neuromas. Nerve wrapping flaps, one of the surgical procedures for neuroma management, represents an effective surgical option for neuromas in continuity and stump neuromas. This is related to the more physiological nerve regeneration process when nerve ends are closed. The use of autograft veins as one of the materials for closing nerve ends is advantageous owing to its affordability and versatility in accommodating nerves of varying sizes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aim Methods Results Conclusions Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla‐preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm‐contaminated root surfaces. Endoscopic‐assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non‐surgical alternative.This was a single‐blind, controlled, randomized, parallel‐group, non‐inferiority 12‐month trial comparing EASD with PPFS. Male and female adults with generalized stage III periodontitis and persistent periodontal pockets associated with an intrabony defect after steps 1 and 2 of periodontal therapy were recruited at Prince Philip Dental Hospital. Inter‐group differences in clinical attachment level (CAL) changes at 12 months were the primary outcome. Secondary outcomes included pocket resolution (no pocket > 5 mm and no pocket > 4 with bleeding on probing), radiographic bone changes, treatment time, early wound healing and quality‐of‐life measurements.Sixty‐two subjects (30 EASD and 32 PPFS) were included in the intention‐to‐treat analysis. CAL gains were 2.0 ± 1.0 and 1.8 ± 1.0 mm for test and controls, respectively. The 95% CI of the inter‐group difference was −0.3 to 0.8 mm and within the stipulated 1‐mm non‐inferiority margin. No inter‐group differences were observed (i) in pocket resolution, which was achieved in more than 87% of cases for all groups/time points, and (ii) in radiographic bone healing. The treatment time was significantly shorter for EASD than for PPFS. Better early wound healing index scores were observed for EASD. No inter‐group differences in pain, quality of life or safety were detected.EASD was not inferior to PPFS for managing residual pockets associated with intrabony defects. The observed outcome profile supports additional developments and studies to validate EASD as an alternative to surgery for isolated persistent pockets (ChiCTR‐INR‐16008407). [ABSTRACT FROM AUTHOR]

Taste, a pivotal sense modality, plays a fundamental role in discerning flavors and evaluating the potential harm of food, thereby contributing to human survival, physical and mental health. Patients with tongue cancer may experience a loss of taste following extensive surgical resection with flap reconstruction. Here, we designed a gustatory interface that enables the non-invasive detection of tongue electrical activities for a comprehensive operative assessment. Moreover, it decodes gustatory information from the reconstructed tongue without taste buds. Our gustatory interface facilitates the recording and analysis of electrical activities on the tongue, yielding an electrical mapping across the entire tongue surface, which delineates the safe margin for surgical management and assesses flap viability for postoperative structure monitoring and prompt intervention. Furthermore, the gustatory interface helps patients discern tastes with an accuracy of 97.8%. Our invention offers a promising approach to clinical assessment and management and holds potential for improving the quality of life for individuals with tongue cancer. Cancer patients suffer from dysgeusia. Here, the authors propose a gustatory interface for operative assessment and taste decoding, offering potential to improve the quality of life of individuals suffering from tongue cancer. [ABSTRACT FROM AUTHOR]

Background: Esophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches. Case presentation: A 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient's position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery. Conclusions: Enucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture. [ABSTRACT FROM AUTHOR]

Introduction: The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. Materials and methods: We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. Results: We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. Conclusions: In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition. [ABSTRACT FROM AUTHOR]

Background: The repair of diabetic foot defects (DFD) is a major challenge in clinical practice. The purpose of this study was to investigate the difference in clinical efficacy of different flap techniques in repairing DFD wounds, and to compare the difference in clinical efficacy of anterolateral thigh perforator flap (ALTP) in repairing DFD and non-DFD. Methods: This study is a retrospective clinical study of different types of flap reconstruction in patients with DFD admitted to our hospital from January 2010 to December 2021. A total of 40 patients with DFD and 43 patients with non-DFD were included in this study. Detailed preoperative basic information, intraoperative details, postoperative complications and long-term follow-up results were collected. Result: The comorbidities, wound infection and wound duration of DFD group were more serious than those of non-DFD group. In addition, the incidence of complications was higher in DFD group, the wound healing time was longer, the aesthetic evaluation, the functional recovery rate of ankle joint and the sensory recovery effect of flaps were worse. Conclusion: In this study, it is concluded that different flap techniques can obtain better clinical efficacy in repairing DFD wounds. Compared with non-DFD wounds, the postoperative risk of DFD wounds using free ALTP flaps is higher, but the risk can be reduced by reasonable preoperative vascular examination. Free flap can deal with various irregular wounds and provide more options for clinical repair. Level of evidence: III, Case–control study. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Despite favourable outcomes in recurrence after off‐midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed‐incision negative‐pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing.Patients were randomized to either NPWT for 4–7 days or loop‐vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining.Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI −0.12 to 0.11), p = 1.00]. After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = −0.03 (95% CI 0.19 to 0.13), p = 0.82]. There was no significant difference in pain experienced postsurgery. In a symptom‐based questionnaire, the control group reported self‐esteem to be less affected (p = 0.015).Closed‐incision negative‐pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease. [ABSTRACT FROM AUTHOR]

Objective: For over a century, circumferential pharyngoesophageal junction reconstruction posed significant surgical challenges. This review aims to provide a narrative history of pharyngoesophageal junction reconstruction from early surgical innovations to the advent of modern free-flap procedures. Methods: The review encompasses three segments: (1) local and/or locoregional flaps, (2) visceral transposition flaps, and (3) free-tissue transfer, focusing on the interplay between pharyngoesophageal junction reconstruction and prevalent surgical trends. Results: Before 1960, Mikulicz-Radecki's flaps and the Wookey technique prevailed for circumferential pharyngoesophageal junction reconstruction. Gastric pull-up and colonic interposition were favoured visceral techniques in the 1960s–1990s. Concurrently, deltopectoral and pectoralis major flaps were the preferred cutaneous methods. Free flaps (radial forearm, anterolateral thigh) revolutionised reconstructions in the late 1980s, yet gastric pull-up and free jejunal transfer remain in selective use. Conclusions: Numerous pharyngoesophageal junction reconstructive methods have been trialled in the last century. Despite significant advancements in free-flap reconstruction, some older methods are still in use for challenging clinical situations. [ABSTRACT FROM AUTHOR]