Masquelet Technique Combined with Tissue Flap Transplantation in The Treatment of Infectious Complex Tissue Defect: A Clinical Analysis

Background: Infectious complex tissue defects have been described as injuries with composite infectious bone defects and extensive soft tissue damage, which are still austere challenges for orthopedists all around the world. The study retrospectively evaluated the Masquelet technique combined with the tissue flap transplantation for the treatment of infectious complex tissue defects and assess key factors of success in this technique.Methods: From December 2016 to December 2019, 22 patients of infectious complex tissue defects were recruited for the study. All the cases experienced a two-stages treatment. Thorough debridement, stabilization of fracture by external fixation and implantation of a cement spacer mixed with antibiotics in the first stage. Simultaneously, suitable tissue flaps were designed and transplanted for the soft tissue defect. 6-8 weeks later, after the elimination of the infection, the cement spacer was removed carefully from the induced membrane and cancellous bone was grafted into the site of bone defect. The average duration of follow-up was 21 months.Results: Infection was eliminated after the first stage intervention without recurrence. All the transplanted tissue flaps were survived. Bone union was achieved in all patients in a period of 16-31 weeks following the second stage surgery. According to the Paley fracture healing score, 17 patients showed excellent results and 5 patients displayed good results regarding bone outcomes. When considering functional outcomes, 14 patients exhibited excellent results and 8 patients displayed good results.Conclusions: This study showed evidences that Masquelet technique combined with tissue flap transplantation was an effective method to repair the infectious complex tissue defects. We also demonstrate that a complete soft-tissue envelope plays an important role in the formation of the induced membrane which promote bone union and in the anti-infection treatment.

Anterior Skull Base Tumors and Surgery

Anterior skull base surgery requires intimate knowledge of a highly complex anatomic region containing critical neurovascular structures. A wide array of pathologies can occur along the anterior cranial base, including meningiomas, esthesioneuroblastomas, pituitary adenomas, craniopharyngiomas, chondrosarcomas, and chordomas. Advancements in endoscopic sinus surgery have allowed many of these tumors to be effectively treated via an endoscopic endonasal technique. This approach obviates the need for large incisions causing cosmetic deformity, improves magnification of the surgical field, and offers a direct path to lesions thus avoiding retraction of structures such as the brain and nerves. Surgeons must understand the limitations of endoscopic techniques and consider open or combined open and endoscopic approaches when appropriate. Reconstructive anterior skull base techniques vary depending on the size and location of defects, along with factors such as intracranial pressure and patient co-morbidities. Large skull base defects require multilayer reconstruction that include a watertight primary dural repair with either synthetic or autologous tissue, followed by local vascularized tissue flaps. This review contains 8 figures, 2 videos, 4 tables and 33 references Key words: Anterior skull base, meningioma, esthesioneuroblastoma, chordoma, pituitary, CSF leak, nasosptal flap, dural repair, expanded endonasal approaches, endoscopic surgery

Soft Tissue Injuries Management in Emergency Department: A Review

Soft tissue injuries (STI) is the damage of muscles, ligaments and tendons and they are one of the most common injuries that also being presented to the different emergency department but often approached differently. Accident and emergency (A&E) services frequently see acute soft tissues injuries. To achieve the best potential results for patients with soft tissue injuries, the quality of emergency department (ED) care offered is crucial. The unstable situations of injured people are caused by these critical aspects, which include polytrauma in many cases, a lack of precise recovery periods, the use of definite tissue flaps, and the type of circulation. Soft tissue injuries are also sometimes complicated with another injury.

Innovative Technique for the Closure of Rectovaginal Fistula Using Amplatzer™ Septal Occluder

Rectovaginal fistulas (RVF) result from an abnormal epithelial connection between the vagina and the rectum, allowing the intestinal contents to pass through the vagina.1 Patients may clinically present with vaginal faeces or gas discharge in addition to inflammation in the pelvic cavity, which may lead to severe infection and poor quality of life.2 RVF is seen in women who previously received treatment for a malignant disease in the pelvic region. The malignancies in the pelvic area are often treated with radiotherapy. This treatment results in tissue damage and poor healing.3 Management of postoperative RVF is difficult and the results are often unsatisfactory. Currently there is no widely accepted and standardized treatment for RVF.3, 4 In the treatment of RVF, various surgical flaps (endorectal or vaginal), vascular tissue flaps (Martius, gracilis), grafts or biomaterials have been used.3,5,6 This case shows the first results using the Amplatzer™ Septal Occluder for the closure of rectovaginal fistula.

Tissue distribution of epirubicin after severe extravasation in humans

Purpose As critical parameter after extravasation of cytotoxic vesicants, anthracyclines were determined in removed tissue from patients requiring surgical intervention due to tissue necrosis. We monitored their distribution within the affected lesion to establish a possible dose–toxicity relation. Methods From six patients scheduled for surgery, removed tissue flaps were systematically analysed by HPLC (epirubicin: 5 subjects; doxorubicin: 1 subject). Results After extravasation, tissue concentrations were highly variable with an individual anthracycline distribution pattern ranging from a few nanograms up to 17 µg per 100 mg tissue, which indicated a substantial difference in tissue sensitivity among patients. The resection borders coincided with the extension of the erythema and guided the surgical intervention after demarcation of the lesion, which occurred usually 2 or 3 weeks after extravasation. At that time, drug was hardly detected at the resection borders. Wound drains were negative for the extravasated drugs while showing a time profile of vascular growth factors and inflammatory cytokines, which was highly similar to routine surgery. In all six patients, surgical debridement with immediate wound closure led to healing within approximately 2 weeks, when therapy was resumed in all patients with reasonable time delay. Conclusion Surgical intervention after demarcation of the extravasation lesion allows for almost uninterrupted continuation of treatment independent of the amount of extravasated anthracycline. As even minor amounts of the vesicants may trigger tissue necrosis, preventive measures merit the highest priority.