RESUMEN
Bacterial resistance against conventional antibiotics is increasing. This introduces challenges, for example, in the treatment of infected surgical wounds. Host defence peptides (HDP), which are endogenous peptide antibiotics, show broad-spectrum antimicrobial effectiveness. They protect the organism against pathological microorganisms. Synthetic HDP might supplement or even become alternatives to conventional antibiotics. Knowledge of their quantities under physiological and pathophysiological conditions is therefore required. The influence of gender on HDP expression is unknown. This study evaluates whether gender influences HDP expression in infected or healthy epithelium. Expression levels of HDP human beta-defensin (hBD)-1, -2 and -3 and psoriasin (S100A7) were analysed, by using real-time polymerase chain reaction, in samples of epithelium from infected surgical wounds (n = 20) and healthy epithelium (n = 14) from the neck in a basic medical research study (analytic observational design). The results demonstrated a significantly elevated expression of hBD-2, hBD-3 and psoriasin (P = 0.001 each) in infected epithelium compared with healthy epithelium. No difference in HDP expression levels was evident between samples from female and male patients, either within infected samples or within healthy epithelium samples. Thus, gender does not affect the cutaneous expression of the investigated HDP. This is fundamental knowledge for the study and potential use of HDP derivates as alternative antibiotic substances.
Asunto(s)
Infecciones Bacterianas/metabolismo , Epitelio/metabolismo , Proteína A7 de Unión a Calcio de la Familia S100/biosíntesis , beta-Defensinas/biosíntesis , Adolescente , Adulto , Anciano , Infecciones Bacterianas/genética , Investigación Biomédica , Femenino , Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Proteína A7 de Unión a Calcio de la Familia S100/genética , Factores Sexuales , Adulto Joven , beta-Defensinas/genéticaRESUMEN
PURPOSE: Osteoradionecrosis (ORN) of the jaws represents one of the most severe complications after primary or adjuvant radiation therapy (RT) of large head and neck tumors. In advanced ORN cases, surgical management is generally considered the therapy of choice. However, in several severe ORN patients with extensive bone and soft tissue defects, functional and aesthetic reconstruction represents a huge challenge for any surgeon, with an increased risk of post-operative wound healing disorders. Our aim here was to perform a double free flap technique as a therapeutic option in this difficult patient collective and to evaluate the post-operative outcome. MATERIALS AND METHODS: 15 patients with advanced and severe ORN undergoing mandibular and soft tissue reconstruction with a double free flap were retrospectively reviewed. In one single operation involving a three-team approach, an obligatory free fibular flap (FFF) was freely combined with another free flap according to the desired features: anterolateral thigh (ALT) or vastus lateralis flap (VLF), radial forearm flap (RFF) and latissimus dorsi flap (LDF). RESULTS: We found sufficient wound healing in the head and neck region in all patients with no need for any additional surgical intervention. The overall flap success rate was 93.3%, although three revisions of anastomosis were necessary. Furthermore, prolonged stay on the intensive care unit (ICU) and extended hospitalisation were avoided. CONCLUSION: The double free flap technique with an obligatory FFF provides a suitable surgical solution for the treatment of patients with severe ORN of the mandibular bone for which other conservative or surgical therapy strategies have reached their limits.
Asunto(s)
Colgajos Tisulares Libres , Enfermedades Mandibulares/cirugía , Osteorradionecrosis/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. MATERIALS AND METHODS: 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 planning costs/patient). RESULTS: We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). CONCLUSION: The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept.
Asunto(s)
Análisis Costo-Beneficio , Peroné/trasplante , Colgajos Tisulares Libres , Reconstrucción Mandibular/economía , Reconstrucción Mandibular/métodos , Planificación de Atención al Paciente/economía , Cirugía Asistida por Computador/economía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Advanced non-melanocytic skin cancer (NMSC) in the facial region causes extensive tissue loss, possibly coverable by local flaps. Remote free flaps are the reconstructive method of choice, despite disadvantages such as color and texture mismatch, and bulkiness with regard to facial skin. MATERIAL AND METHODS: Post-ablative facial NMSC defects in four patients were reconstructed using remote free flaps, including radial forearm, scapular, parascapular, and anterolateral thigh flaps. Four months later, a split-thickness skin graft (STSG) was acquired from the retroauricular region to generate a non-cultured autologous epidermal cell (NCAEC) suspension. The flap surfaces were de-epithelialized, and the NCAEC suspension was sprayed onto the flap surface to improve the mismatch between facial and flap color. Debulking was also carried out. The aesthetic outcome was examined by photography and clinical examination 3, 6, 9, and 12 months after the first operation. RESULTS: All flaps survived the 11- to 21-month follow-up. The secondary operation was accompanied by a delay in re-epithelialization in one case. No STSG donor-site problems occurred. Follow-up photographs showed significant improvements in the color and texture of the flaps. CONCLUSIONS: Facial reconstruction with a free flap results in a mismatch of color and texture. Secondary correction of the flap surface by de-epithelialization and NCAEC application significantly improves the aesthetic outcome.
Asunto(s)
Trasplante de Células/métodos , Células Epidérmicas , Neoplasias Faciales/cirugía , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Repitelización , Pigmentación de la Piel , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: Following its renaissance in ophthalmology during the 1990s, preserved human amniotic membrane (HAM) has become an attractive biomaterial for all surgical disciplines. This article reviews the current and potential use of HAM in oral and maxillofacial surgery, its postulated properties and common preservation techniques. METHODS: Literature was identified by an electronic search of PubMed in July 2012; this was supplemented from the reference lists of the consulted papers. RESULTS: HAM has been used in the field of oral and maxillofacial surgery from 1969 onwards because of its immunological preference and its pain-reducing, antimicrobial, mechanical and side-dependent adhesive or anti-adhesive properties. The effects of HAM on dermal and mucosal re-epithelialisation have been highlighted. Typically, HAM is applied after being banked in a glycerol-preserved, DMSO-preserved or freeze-dried and irradiated state. Whereas the use of HAM in flap surgery and in intra-oral and extra-oral lining is reported frequently, novel HAM applications in post-traumatic orbital surgery and temporomandibular joint surgery have been added since 2010. Tissue engineering with HAM is a fast-expanding field with a high variety of future options. CONCLUSIONS: Preserved HAM is considered to be a safe and sufficient biomaterial in all fields of oral and maxillofacial wound healing. Recently published novel indications for HAM application lack a high level of evidence and need to be studied further.
Asunto(s)
Apósitos Biológicos , Procedimientos Quirúrgicos Orales/métodos , Medicina Basada en la Evidencia , Humanos , Colgajos Quirúrgicos/cirugía , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Free flaps are commonly used for reconstruction of extensive tumor resection defects in the oral cavity. The radial forearm free flap (RFFF) is the most frequent choice. However, a major problem of RFFF is a limitation in its size. The anterolateral thigh free flap (ALTFF) has become popular as an alternative donor site in maxillofacial surgery. We have compared patient data after reconstructions of the oral cavity using the RFFF or ALTFF. MATERIALS AND METHODS: Perioperative data of 161 oral cancer patients with ALTFF (45) or RFFF (116) reconstructions were reviewed and statistically analyzed for the following characteristics: sex, histology, primary tumor localization, defect type, American Society of Anesthesiology score, success rates, revisions, wound healing disorders, fistula rates, type of reconstruction, prolonged stay in an intensive care unit (ICU) and in hospital, donor site, flap size, length of operation, and number of follow-up visits. RESULTS: Flap success was 97.8% (44 of 45) in the ALTFF group and 97.4% (113 of 116) for RFFF. The mean size was higher in ALTFF than in RFFF (110 vs. 29 cm(2); P < 0.001). ALTFF needed less postoperative care and developed fewer wound healing disorders (P = 0.005 and P = 0.035). Operative time was significantly shorter in RFFF reconstructions (P = 0.020). Intraoperative arterial spasm was the most significant complication in ALTF and postoperative venous thrombosis in RFFF. CONCLUSIONS: ALTFF has distinct advantages over RFFF with respect to intraoral reconstruction. However, the RFFF remains as a very reliable flap because of the minimal variability in its anatomy.