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1.
Introduction
Since the nature of complications following the harvesting of bone from the tibia in children is not well documented in the literature, we undertook this study in order to determine the frequency and nature of donor site complications following the harvesting of large cortical strut grafts from the tibial diaphysis in children. 相似文献2.
Background
Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation. Although an autologous bone transplant does improve the local bone healing potency, significant donor site morbidity must be considered.Methods
In this study we elucidate special bone harvesting techniques from the iliac crest and review the literature related to clinical significance of donor site morbidity. Furthermore, our own experiences are compared and discussed critically with relevant data of other investigators.Results
The increasing number of scientific publications which focus on bone harvesting techniques and related complications in recent years indicate the high interest and relevance of this issue. There is a tendency to alternatives such as biomaterials as bone substitutes, whereas the role of growth factors and cell therapeutics in the treatment of bony defects are still being evaluated in clinical studies.Conclusion
Although autologous, heterotopic bone transplantation is still the gold standard in the treatment of bony defects, there is a tendency towards the application of biomaterials, stem cells, and growth factors. Conscientious observation of relevant anatomic considerations during bone harvesting procedures may help to avoid complications. 相似文献3.
Mohammed A. Rifaat Ayman A. Amin Mahmoud Bassiouny Ayman Nabawi Sherif Monib 《Indian Journal of Plastic Surgery》2008,41(1):24-33
Background:
Autologous breast reconstruction using the extended latissimus dorsi flap has been infrequently reported. In the current study, the authors are reporting their own clinical experience with this method. A review of the literature is also discussed.Materials and Methods:
Over a three year period, 14 patients underwent breast reconstruction using the extended latissimus dorsi (LD) flap. Patients with small to medium sized breasts were selected. The age of the patients ranged from 29 to 42 years with a follow-up period ranging from six to 18 months. The indications, flap-related complications and donor site morbidity and aesthetic results were evaluated.Results:
The main indication to use the flap was dorsal donor site preference by patients. The remaining patients were either not suitable for a flap from the abdomen or wished to get pregnant and were offered the dorsal donor site. Neither total nor partial flap loss was recorded but donor site morbidity was mainly due to seroma, which was treated conservatively in all patients, except for one who required surgery. Another two patients suffered from wound breakdown and distal necrosis of the back flaps. Mild contour deformity was also noted on the back of all patients but caused no major concern. Indeed, the overall patient satisfaction was very high.Conclusion:
The extended LD flap proved to be a good option for autologous breast reconstruction in selected patients. Patients should be warned of the potential for seroma and mild contour back deformity. 相似文献4.
Syed Kamran Ahmed Boris Kwok Keung Fung Wing Yuk Ip Margaret Fok Shew Ping Chow 《Journal of orthopaedic surgery and research》2008,3(1):15
Background
Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. 相似文献5.
Background
Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL. 相似文献6.
Johnson MR Boerckel JD Dupont KM Guldberg RE 《Clinical orthopaedics and related research》2011,469(11):3111-3117
Background
Bone defects and fracture nonunions remain a substantial challenge for clinicians. Grafting procedures are limited by insufficient volume and donor site morbidity. As an alternative, biomaterial scaffolds functionalized through incorporation of growth factors such as bone morphogenetic proteins (BMPs) have been developed and appear to regenerate the structure and function of damaged or degenerated skeletal tissue. 相似文献7.
Naomi Walsh Annemarie Larkin Susan Kennedy Lisa Connolly Jo Ballot Wei Ooi Giuseppe Gullo John Crown Martin Clynes Lorraine O'Driscoll 《BMC urology》2009,9(1):1-7
Background
The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.Methods
Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.Results
Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.Conclusion
Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty. 相似文献8.
Jessica Collins Olubimpe Ayeni Achilleas Thoma 《CANADIAN JOURNAL OF PLASTIC SURGERY》2012,20(1):17-23
PURPOSE:
The anterolateral thigh (ALT) flap is widely used in reconstruction. Its advantage over other flaps is its purported minimal donor site morbidity. The present systematic review summarizes the types of complications and their incidence with this flap. A secondary objective is to delineate factors that influence these complications and make recommendations to avoid them.METHOD:
Two independent assessors undertook a systematic review of the literature using multiple databases. All patients with ALT flap reconstruction for any defect were included. Donor site complications including lateral thigh paresthesia, musculoskeletal dysfunction, hypertrophic scarring, wound breakdown, infection, donor site pain, seroma, hematoma, compartment syndrome and muscle necrosis were extracted from identified articles and tabulated. Based on the number of pooled events and the number of cases performed, an incidence rate was calculated.RESULTS:
Forty-two relevant articles were identified that included 2324 flaps. Of the 2324 flaps, the majority were fasciocutaneous (n=737), and 1303 of the flaps were used in head and neck reconstruction. The incidence of complications were: lateral thigh paresthesia (24.0%); musculoskeletal dysfunction (4.8%); hypertrophic scarring or wound dehiscence (4.8%); donor site pain (3.3%); seroma (2.4%); infection (2.2%); hematoma (0.7%); compartment syndrome (0.09%); and partial muscle necrosis (0.09%).CONCLUSION:
Lateral thigh paresthesia is the most common complication. Severe complications such as compartment syndrome and muscle necrosis can occur, but are rare. Preservation of the lateral cutaneous nerve of the thigh, femoral motor nerve branches and deep fascia decreases the risk of complications. The degree of vastus lateralis disruption did not show a significant impact on musculoskeletal dysfunction. 相似文献9.
Reppenhagen S Reichert JC Rackwitz L Rudert M Raab P Daculsi G Nöth U 《International orthopaedics》2012,36(1):139-148
Purpose
Bone defects resulting from tumour resection or curettage are most commonly reconstructed with autologous bone graft which is associated with limited availability and donor site morbidity. Recent research has focussed on synthetic biomaterials as bone graft substitutes. The aim of this study was to assess the safety and efficiency of a bone substitute as an alternative for autologous bone in the treatment of benign bone tumours and tumour-like lesions. 相似文献10.
Prof. Dr. M. Sauerbier G.A. Giessler G. Germann M. Sedigh Salakdeh M. Döll 《Der Unfallchirurg》2010,113(10):821-831
Background
The purpose of this retrospective study was to verify the advantages and disadvantages of the free lateral arm flap for defect reconstruction of the forearm and hand.Patients and methods
The data of 21 patients who underwent defect coverage of the forearm and hand with the free lateral arm flap between 2002 and 2010 were analyzed. The mean patient age was 48 years (range 17–78 years). The results concerning defect origin, flap size, pedicle length, operative time, revision of the anastomosis or other complications, donor site morbidity and length of hospital stay were evaluated.Results
In 6 cases the defect was on the forearm and in 15 on the hand. The majority of defects were infections or chronic wounds. The overage flap width ranged from 3 to 8 cm and the length from 5 to 20 cm. Revision of the anastomosis was only necessary in one case and flap survival rate was 100%. In all patients primary closure of the donor site was possible without complications during the healing procedure.Conclusion
The results underline the good reliability of the free lateral arm flap with a satisfactory aesthetic appearance excellent tissue quality and frequent primary donor site closure. 相似文献11.
Purpose
A step-by-step harvesting technique for buccal mucosa is described that maximizes graft yield while minimizing potential donor site morbidity in urethral reconstruction.Materials and Methods
A specialized oral retractor was used to expose and retract the buccal mucosal lining of the oral cavity for graft harvesting in 12 patients.Results
Adequate buccal mucosal graft size was obtained for each reconstruction. There were no oral donor site or urethral recipient site complications.Conclusions
This harvesting technique offers a simple and effective method for optimizing buccal mucosal graft harvests. 相似文献12.
M. Sauerbier G. Germann G. A. Giessler M. Sedigh Salakdeh M. D?ll 《Hand (New York, N.Y.)》2012,7(2):163-171
Background
This retrospective study was performed to verify the advantages and disadvantages of the free lateral arm flap for defect reconstruction of the forearm and hand.Patients and Methods
Between 2001 and 2010, 21 patients underwent defect coverage of the forearm and hand with the free lateral arm flap. The mean patient age was 48 years (17–78). The results concerning defect origin, flap size, pedicle length, operative time, revisions of the anastomoses or other complications, donor site morbidity, and length of hospital stay were evaluated.Results
The majority of defects were caused by infections or chronic wounds. The defects were localized at the forearm in 6 cases and at the hand in 15 cases. The flap width ranged from 3 to 8 cm, and the length was from 5 to 20 cm. All flaps survived. Only in one case, a revision of the anastomosis was necessary. Primary closure of the donor site was possible in all patients. No complications occurred during the healing procedure. The majority of the patients were satisfied with the aesthetic result at the recipient site as well as at the donor site.Conclusion
The free lateral arm flap is a very reliable option for defect coverage at the forearm and hand for small and medium size defects. A satisfactory aesthetic appearance, an excellent tissue quality, and frequent primary donor site closure are great advantages for selecting this flap. 相似文献13.
Armin Soave Roland Dahlem Hans O. Pinnschmidt Michael Rink Jessica Langetepe Oliver Engel Luis A. Kluth Birte Loechelt Philip Reiss Sascha A. Ahyai Margit Fisch 《European urology》2018,73(6):910-922
Background
Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial.Objective
To analyze in detail intensity and quality of pain as well as oral morbidity following closure (C) versus nonclosure (NC) of the donor site.Design, setting, and participants
Randomized controlled trial on 135 patients treated with BMGU between October 15, 2014 and December 18, 2015.Intervention
Following computer-based randomization, 63 and 72 patients, respectively, received C and NC of the donor site at the inner cheek. Preoperatively, on days 1, 5, and 21 as well as at 3 and 6 mo postoperatively, patients completed standardized questionnaires, including validated questions on intensity and quality of pain as well as oral morbidity.Outcome measurements and statistical analysis
The coprimary end points were intensity and quality of oral pain. Secondary end points included oral morbidity and intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of various covariates on intensity and quality of oral pain, oral morbidity, as well as intensity of pain of the perineogenital region.Results and limitations
There was noninferiority for NC versus C in intensity and affective quality of oral pain at every time point following BMGU. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, whistling, diet, and speech. Time from BMGU had significant effects on intensity (p < 0.001) and quality of oral pain (sensory pain: p < 0.001, affective pain: p < 0.001, total pain: p < 0.001). Length of buccal mucosa graft had significant effects on intensity (p = 0.001) and quality of oral pain (sensory pain: p = 0.020, total pain: p = 0.042).Conclusions
NC is noninferior to C of the donor site in intensity and quality of oral pain, and offers a treatment alternative. Time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications.Patient summary
We investigated pain, morbidity, and complications following closure (C) versus nonclosure (NC) of the buccal mucosa harvest site in patients undergoing buccal mucosa graft urethroplasty (BMGU). We found that NC is not worse than C regarding oral pain. In addition, time from BMGU and length of the buccal mucosa graft have effects on oral morbidity and complications. 相似文献14.
Philippe Hernigou Asuka Desroches Steffen Queinnec Charles Henri Flouzat Lachaniette Alexandre Poignard Jerome Allain Nathalie Chevallier Helene Rouard 《International orthopaedics》2014,38(9):1855-1860
Purpose
Using bone marrow mesenchymal stem cells (MSCs) with aspiration from the iliac crest is commonly used in reconstructive orthopaedic surgery. Because bone marrow aspiration is a percutaneous technique, the morbidity as compared with the classical bone graft should be decreased.Method
Therefore in a retrospective review of 523 consecutive cases of bone marrow aspiration performed at the Henri Mondor Hospital from 1990 to 2006 for the treatment of fractures, minor and major complications were identified and compared to the number of complications observed during the same period with 435 classical iliac crest bone graft procedures performed for the same indications of treatment of fractures. Minor complications included superficial infections, superficial seromas, and minor haematomas. Major complications included herniation of abdominal contents through massive bone graft donor sites, vascular injuries, deep infections at the donor site, neurologic injuries, deep haematoma formation requiring surgical intervention or transfusion, and iliac wing fractures.Result
Bone marrow aspiration decreased significantly the number of complications as compared with harvesting classical iliac crest bone graft that was associated with significant morbidity. Adverse events were significantly lower (p?0.01) in the 523 procedures with bone marrow aspiration as compared with the 435 bone iliac crest piece harvesting. This was true for anaemia (16 cases versus 87 cases), for early pain (six versus 152), persistent pain (two versus 21), neuralgia (three versus 11), minor complications (ten versus 56), and major complications (three cases versus 22 cases).Conclusion
In our series the number of complications with bone marrow aspiration was ten times less than the complications observed with the classical technique of bone piece harvesting from the iliac crest, and the complications were clearly less severe. 相似文献15.
Background
Malignant tumors of the thumb can be treated surgically with either wide local excision with reconstruction or amputation. Local excision of tumors in the thumb and hand often requires closer resection margin than at other sites, and there is also a need for tissue transfer from a donor site for reconstruction. Primary thumb amputation allows local tumor control while avoiding donor-site morbidity, but comes at great functional cost. We conducted this retrospective case review to assess the outcomes of thumb-sparing wide excisions and primary thumb amputations for malignant thumb tumors. 相似文献16.
Background
Conventional treatment for nasal augmentation utilizes autologous grafts, allografts, or synthetic implants such as silicon implants. Silicon implants could protrude/expose or induce nasal bone resorption. Autologous grafts are usually associated with donor site morbidity and the volume of harvested tissue is limited. We had developed a new method for nasal augmentation using cultured autologous chondrocytes (CAC). The current report presents the results of a study using that method with a larger number of patients and an improved graft technique for the nasal tip. 相似文献17.
Eweida AM Nabawi AS Elhammady HA Marei MK Khalil MR Shawky MS Arkudas A Beier JP Unglaub F Kneser U Horch RE 《Archives of orthopaedic and trauma surgery》2012,132(9):1353-1362
Introduction
The creation of axially vascularized bone substitutes (AVBS) has been successfully demonstrated in several animal models. One prototypical indication is bone replacement in patients with previously irradiated defect sites, such as in the mandibular region. The downside of current clinical practice, when free fibular or scapular grafts are used, is the creation of significant donor site morbidity.Methods
Based on our previous experiments, we extended the creation of an arterio-venous loop to generate vascularized bone substitutes to a new defect model in the goat mandibula. In this report, we review the literature regarding different models for axially vascularized bone substitutes and present a novel model demonstrating the feasibility of combining this model with synthetic porous scaffold materials and biological tissue adhesives to grow cells and tissue.Results
We were able to show the principal possibility to generate axially vascularized bony substitutes in vivo in goat mandibular defects harnessing the regenerative capacity of the living organism and completely avoiding donor site morbidity.Conclusion
From our findings, we conclude that this novel model may well offer new perspectives for orthopedic and traumatic bone defects that might benefit from the reduction of donor site morbidity. 相似文献18.
Dutta S Fullarton GM Forshaw MJ Horgan PG McMillan DC 《World journal of surgery》2011,35(5):1017-1025
Background
Infectious complications, particularly in the form of anastomotic leaks (ALs) or surgical site infections (SSIs), represent a serious morbidity after esophagogastric cancer resections. Therefore, early detection is of paramount importance. Although markers of the systemic inflammatory response, including C-reactive protein (CRP) and white cell count (WCC), have been used in this regard, their relative predictive value is unclear. The aim of the present study was to examine serial postoperative WCC, albumin, and CRP and their diagnostic accuracy in case of infectious complications. 相似文献19.
Takanobu Nakase Masakazu Fujii Akira Myoui Noriyuki Tamai Yasuhisa Hayaishi Takafumi Ueda Masayuki Hamada Hideo Kawai Hideki Yoshikawa 《Archives of orthopaedic and trauma surgery》2009,129(11):1539-1547
Introduction
Osseous defects in nonunited open fracture of the lower limbs are difficult to treat. Autogenous bone grafting is a promising treatment options, but a finite amount of autogenous bone graft is available from each individual and donor site morbidity remains a problem. These limitations have prompted the development and use of synthetic biomaterials such as hydroxyapatite (HA) ceramics. However, little information is available regarding the challenging cases such as nonunited open fractures The purpose of the present study is to evaluate the outcomes associated with the treatment of osseous defects in nonunited open fracture using novel HA ceramics. 相似文献20.
Endoscopic access to fascia lata for use in static facial reanimation—a cadaveric and clinical study