Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps

Abstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible

The impact of endodontic anatomy on clinical practice: a micro-CT study and tribute to Prof. Francesco Riitano

Aim: To evaluate the quality of root canal preparation using two different mechanical NiTi systems. Methodology: 40 maxillary and mandibular molars were selected. Specimens were randomly assigned to two groups and were scanned using a micro-computed tomography scanner before and after root canal preparation that was performed using ProFile instrument sequence and Reciproc single file technique. Each system was used to obtain an optimal apical size for each specimen, following common clinical guidelines. 3D models were reconstructed and evaluated for volume, areas and root canal axis. The total volume of dentine removed and the volume of the coronal, middle and apical thirds of each root canal were calculated, as well as the average deviation of the root canal axis at different levels and the values compared. Student t-test was used to determine the difference between the two experimental groups (P < 0.05). A qualitative evaluation of root canal preparation was also performed. Results: No statistically significant differences were noted between the groups in the volume of dentine removed after root canal preparation, except for the volume of the coronal third (P < 0.05) and the volume of the apical third (P < 0.05) of the disto-buccal canal of maxillary molars and in the mesial canals of mandibular molars, where ProFile instruments produced significantly less enlarged canal volume in the apical third and more enlarged canal volume in the coronal third (P < 0.05). No statistically significant differences were found in the root canal axis deviation. Conclusions: Under the conditions of this study, both the systems analyzed were able to prepare molar teeth with similar amount of dentine removal and a relatively low risk of procedural errors

A new approach to antiglaucoma drugs: carbonic anhydrase inhibitors with or without NO donating moieties. Mechanism of action and preliminary pharmacology.

The clinically used sulfonamide carbonic anhydrase (CA, EC 4.2.1.1) inhibitor dorzolamide (DRZ), a new sulfonamide CA inhibitor also incorporating NO-donating moieties, NCX250, and isosorbide mononitrate (ISMN) (an NO-donating compound with no CA inhibitory properties) were investigated for their intraocular pressure (IOP) lowering effects in rabbits with carbomer-induced glaucoma. NCX250 was more effective than DRZ or ISMN on lowering IOP, increasing ocular hemodynamics, decreasing the inflammatory processes and ocular apoptosis in this animal model of glaucoma. NO participate to the regulation of IOP in glaucoma, having also antiapoptotic and anti-inflammatory effects. The ophthalmic artery, both systolic and diastolic velocities, were significantly reduced in NCX250-treated eyes in comparison to DRZ treated ones, suggesting thus a beneficial effect of NCX250 on the blood supply to the optic nerve. Combining CA inhibition with NO-donating moieties in the same compound offers an excellent approach for the management of glaucoma

Conditioning of root canal anatomy on static and dynamics of nickel-titanium rotary instruments

Abstract Aim Aim of this study is to analyze the real movement, influenced by anatomical difficulties, of nickel-titanium rotary instruments within root canal systems; then the objective is to point out the physical and geometrical characteristics of an ideal instrument, able to overcome the most complex anatomies. Methodology At first, observation of the behavior of nickel-titanium rotary instruments within root canal systems and of the influence on them of root canal anatomy. Then, attempt to avoid the anatomical obstructions exploiting, with manual rotation, the advantages of a zero/low torque. Results Given that, in some root canals the severity of the curves prevents instruments to advance in rotation, we obtained significant results by manually advancing and rotating NiTi rotary instruments. Conclusions Therefore, in some cases, we would need an instrument that can reconcile efficiency with a reduction of mass and torque; the ideal instrument should have a very contained working part, combining efficiency with the decrease of mass and, consequently, of torsional stresses too

Endocrine Aspects of Environmental "Obesogen" Pollutants

Growing evidence suggests the causal link between the endocrine-disrupting chemicals (EDCs) and the global obesity epidemics, in the context in the so-called "obesogenic environment". Dietary intake of contaminated foods and water, especially in association with unhealthy eating pattern, and inhalation of airborne pollutants represent the major sources of human exposure to EDCs. This is of particular concern in view of the potential impact of obesity on chronic non-transmissible diseases, such as type 2 diabetes, cardiovascular disease, and hormone-sensitive cancers. The key concept is the identification of adipose tissue not only as a preferential site of storage of EDCs, but also as an endocrine organ and, as such, susceptible to endocrine disruption. The timing of exposure to EDCs is critical to the outcome of that exposure, with early lifetime exposures (e.g., fetal or early postnatal) particularly detrimental because of their permanent effects on obesity later in life. Despite that the mechanisms operating in EDCs effects might vary enormously, this minireview is aimed to provide a general overview on the possible association between the pandemics of obesity and EDCs, briefly describing the endocrine mechanisms linking EDCs exposure and latent onset of obesity

Periapical healing after simplified endodontic treatments: A digital subtraction radiography study

Abstract Aim To evaluate the 6-month outcome of endodontic treatment of periapical lesions with integrated systems by clinical examination and digital subtraction radiography (DSR). Methodology Eighty-four patients with chronic periapical pathosis were randomly allocated to two groups and received endodontic treatment with Revo-S/One Step Obturator (G1, n = 41) or GTX/GTX Obturator (G2, n = 43). Six months later, clinical examination and DSR analysis were performed. Non-parametric statistical methods were used (p Results Total healing, partial healing and failure occurred in 48.4%, 48.4% and 3.2% of cases in G1, in 50.0%, 43.8% and 6.2% of cases in G2, respectively. No significant difference was detected. Conclusions The integrated endodontic techniques allowed for a high 6-month success rate in both groups in accordance with literature data

Quality of canal obturation assessed by micro-computed tomography: Influence of filling technique and post placement in canals shaped with Reciproc

Abstract Aim To assess by micro-computed tomography (μCT) the quality of fillings in canals shaped with Reciproc considering the effects of filling technique and post insertion. Methodology The canals of 60 single-rooted teeth were instrumented with Reciproc R40 and randomly assigned to four groups (n = 15): G1, single point; G2, as G1 + DT Light Post; G3, continuous wave of condensation; G4, as G3 + DT Light Post. The filling voids were quantified by μCT. Data were statistically analysed by non-parametric test (p Results Filling greater than 96% of the entire canal volume was observed in all groups. The volume of internal voids was greater in G3 than in G4 (p Conclusions Our findings support the use of simplified techniques of canal shaping, filling with matching taper points and post cementation