The effect of CD-HA application on autograft and allograft flexor tendon graft reconstruction in canine model in vivo

Bu çalışmanın amacı karbodiimid'den derive edilmiş hyaluronik asit (cd-HA) jelatinin ekstrasinovyal otogreft ve intrasinovyal allogreft tendonlara olan histolojik etkisini in-vivo modelde araştırmaktır.Çalışmada14 köpeğin bir ön ekstremiteleri 2. ve 5. parmak 28 FDP tendonları kullanıldı. 6 köpeğin 12 tendonuna otogreft ile greftleme yapıldı. 8 köpeğin de 16 tendonuna allogreft ile greftleme yapıldı. Her köpeğin bir tendonuna cd-HA jelatinli diğerine kontrol tendonu ile greftleme yapıldı. Otogreft donörü için aynı hayvanların arka ayak perenous longus (PL) tendonları kullanılırken allogreft donörü için ayrı donör köpekler kullanıldı. Greftlemeden 6 hafta sonra köpekler sakrifiye edilerek greftler incelendi ve histolojik örnekler alındı. Örneklerden hazırlanan HE boyalı kesitlerde tenositler randomize olarak sayılarak ortalamalar gruplar arasında karşılaştırıldı.Allojen cd-HA uygulanan grup tenosit sayısı ortalamaları kontrol grubuna göre fazlaydı ancak fark anlamlı değildi (p=0,2). Otojen cd-HA uygulanan grup kontrol grubuna göre daha fazla tenosit ortalamasına sahipti ancak fark anlamlı değildi (p=0,1). Buna karşın gerek kontrol gruplarında (p=0,02), gerek cd-HA uygulanan gruplarda (p=0,03), gerekse tüm grup karşılaştırıldığında (p=0,003) otojen gruplar allojen gruplara göre daha fazla tenosit ortalamasına sahipti ve farklar istatistiksel olarak anlamlıydı.Ekstrasinovyal otogreftler greftlemenin 6. haftasında intrasinovyal allogreftlere göre birim alanda daha fazla tenosit içermektedir. Cd-HA uygulanan tendonlarda birim alana düşen tenosit sayısı daha fazla olsa da fark anlamlı değildir. Cd-HA jelatin yüzey modifikasyonunun tendon greftlerinin histolojik yapısına ve tenosit sayısına bir etkisi yoktur.The aim of the study is investigating the histological effect of karbodiimid derivate hyaluronic acid (cd-HA) gelatin on extra synovial autograph and intra synovial allograft tendonsin in-vivo model. We hypothesized that the application of cd-HA gelatin to allogenous and autogenous tendon grafts doesn?t disturb the histological structure of the grafts while improving the gliding resistance.2nd and 5th digits of 14 canines? FDP tendons were used in the study. Grafting with aoutograft was applied to 12 digits of 6 canines and allograft to 16 digits of 8 Kanin es. Each dogs?s one digit was chosen for cd-HA gelatin and the other was chosen for control. While same Kanin e?s hind limbs were used as PL tendon donor area for autograft group, different donors were used for allograft group. Six weeks later Kanines were sacrified and the grafts were examined and histological samples were obtained. Tenocytes were counted randomly in HE stained slices prepared from the samples and the mean values were compared between the groups.The number of mean tenocytes in allogenous cd-HA applied groups was higher than the control group but the difference wasn?t significant (p=0.2). The autogenous group which cd-HA applied also has higher average tenocyte than the control group but it wasn?t significant (p=0.1). On the other hand autogenous groups in control group (p=0.02), cd-HA group (p=0.03) and in all group (p=0.003) had higher average of the number of the tenocytes than the allogenous groups.The extra synovial autografts has much more tenocytes in unit area at 6th weeks of grafting. Even though the number of the tenocytes in the unit area is higher in cd-HA applied tendons, it wasn?t significant. Cd-HA gelatin surface modification has no effect on the histological structure of the tendon grafts

Dimensions of Velopharyngeal Space following Maxillary Advancement with Le Fort I Osteotomy Compared to Zisser Segmental Osteotomy: A Cephalometric Study

The objectives of this study are to assess the velopharyngeal dimensions using cephalometric variables of the nasopharynx and oropharynx as well as to compare the Le Fort I osteotomy technique to Zisser’s anterior maxillary osteotomy technique based on patients’ outcomes within early and late postoperative follow-ups. 15 patients with severe maxillary deficiency treated with Le Fort I osteotomy and maxillary segmental osteotomy were assessed. Preoperative, early postoperative, and late postoperative follow-up lateral cephalograms, patient histories, and operative reports are reviewed with a focus on defined cephalometric landmarks for assessing velopharyngeal space dimension and maxillary movement (measured for three different tracing points). A significant change was found between preoperative and postoperative lateral cephalometric measurements regarding the distance between the posterior nasal spine and the posterior pharyngeal wall in Le Fort I osteotomy cases. However, no significant difference was found between preoperative and postoperative measurements in maxillary segmental osteotomy cases regarding the same measurements. The velopharyngeal area calculated for the Le Fort I osteotomy group showed a significant difference between the preoperative and postoperative measurements. Le Fort I osteotomy for advancement of upper jaw increases velopharyngeal space. On the other hand, Zisser’s anterior maxillary segmental osteotomy does not alter the dimension of the velopharyngeal space significantly

Using pedicled rectus abdominis musculocutaneous flaps in thigh and lumber defects

AMAÇ: Daha önce tanımlanmış, fakat az kullanılan “ekstended” veya vertical rektus abdominis muskulokutan (“Ekstended” RAM, VRAM) fleplerinin çok nadir endikasyonlardaki kullanımları incelendi. GEREÇ VE YÖNTEM: Beş hastada, 28x8 ile 35x10 cm ebatlarında cilt adası içeren flepler kullanıldı. Dört flep uyluk ve diz proksimal bölgedeki defekt onarımları için inguinal ligamentin altından, bir flep lomber gölgedeki defekt onarımı için transabdominal olarak defekt alanlara taşındı. BULGULAR: Hiçbir olguda flep kaybı görülmedi. Bir olguda yara yeri enfeksiyonu gelişti ve cerrahi ile tedavi edildi. Uyluk ve lomber bölge defektleri onarımlarında düşük komplikasyon oranlarıyla “ekstended” RAM ve VRAM fleple başarılı transfer gerçekleştirildi ve çok güvenli ve uygun bir seçenek olduğu sunuldu. SONUÇ: Avantajları bol miktarda ve iyi kanlanan doku taşımasını sağlar, flep kolay ve hızlı hazırlanır ve mikrocerrahi deneyimi gerektirmez.BACKGROUND: A series of previously described but rarely used variations of the pedicled, extended or vertical rectus abdominis musculocutaneous flap ( Extended RAM, VRAM) were reviewed. METHODS: Skin paddle dimensions, ranged 8 to 28 cm in width and 10 to 35 cm in length, were used in five consecutive patients. Four flaps were placed deep to the inguinal ligament to repair the thigh as proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. RESULTS: No flaps necrosis were seen and in one case wound healing problems required minimal operative intervention. Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects were demonstrated to be safe and reasonable options of flap reconstruction. DISCUSSION: The flaps had the advantages of being robust and well- vascularized, easy and fast to harvest, and not requiring microsurgery experience

Contribution of the Use of a Pen-Type Endoscope to Evaluate and Treat Ears Simultaneously During Cleft Palate Surgery in Late Presented Cases

Background: The prevalence of secretory otitis media is very high among the nonoperated cleft palate patients