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Callotasis in nonvascularized periosteal bone grafts and the role of periosteum : a new contribution to the concept of distraction osteogenesis

Bone lengthening by slow, progressive distraction has gained widespread acceptance. In this study we investigated the possibility of distraction osteogenesis in nonvascularized periosteal bone grafts, and assessed callus formation and callotasis by means of radiological and histological examination with the aim of determining the role of the periosteum. The process of distraction osteogenesis in nonvascularized bone grafts was studied histologically and radiotegically in 22 growing rabbits. The metatarsal bone grafts taken from the rabbits were divided into two groups. Group 1 contained 15 bone grafts covered with periosteum and group 2 (the control group) contained 7 bone grafts without periosteum. These grafts were subjected to osteotomy and then placed in the lumbar pocket. After 10 days, distraction was started and continued at 0.5 mm per day for 10 days. Thus an elongation of 4 to 6 mm was achieved in both groups. Radiological examination was performed postoperatively and after 10, 15, 20, and 30 days of starting the distraction. Histological examination was performed after 15, 20, and 30 days. Radiologically, progressive calcification and, histologically, both intramembranous and endochondral ossification were detected in group 1. However, in the control group (group 2), bone lengthening failed. Our study demonstrated the possibility of distraction osteogenesis in periosteal bone grafts, and provides information regarding the importance of periosteum as well as its osteogenic capacity.

The reversed-flow temporoparietal fascial flap.

A patient is reported whose forehead soft-tissue defect was reconstructed by a reversed-flow temporoparietal fascial flap. This procedure can shorten the operating time. The blood circulation of the flap is satisfactory. The only drawback is the resulting scar of the skin-grafted area.

Orbital apex syndrome associated with fractures of the zygoma and orbital floor

SummaryThe orbital apex syndrome can be caused by trauma. The patient presented was hit by an elbow in the right periorbital area with resulting fractures to the right zygoma and orbital floor. Examination revealed visual loss, total ophthalmoplegia, and ptosis of the right upper eyelid with hypoesthesia in the ophthalmic division of the trigeminal nerve. After a week of supportive therapy and observation, the orbital floor fracture was repaired by reducing the bone fragments, and the zygomatic fracture was reduced through a Gillies incision. Over the next six months, there was complete resolution of the ophthalmoplegia, the ptosis, the loss of sensation in the ophthalmic division of the trigeminal nerve, and the vision.

Callotasis in a fasciosteal flap model in rabbits: part II. a new contribution to the concept of distraction osteogenesis.

The basis of lengthening bones at their anatomic locations has been defined in detail by many authors. The possibility of distraction osteogenesis in vascularized bone grafts and the role of periosteum was investigated in 35 growing New Zealand White rabbits in four experimental groups: group 1, the scintigraphic assessment group (N = 4); group 2, the distraction group with intact periosteum (N = 15); group 3, the control group without periosteum in the distraction area (N = 6); and group 4, the control group in which the flaps were wrapped in silicone leaves (N = 10). Scintigraphy was used to evaluate the survival of the bone graft. Metatarsal fasciosteal flaps were fixed by external fixators and then subjected to osteotomy. Distraction was started after 10 days of osteotomy and continued at 0.5 mm/24 hr for 10 days, with a total elongation of 4 to 6 mm. Radiological examination at day 10 of starting the distraction, and both radiological and histological examinations at days 15, 20, and 30 were performed. In group 1, positive scintigraphic images of the flaps were obtained. In group 2, progressive calcification was detected radiologically and mixed-type ossification was observed histologically. However, in group 3, distraction failed. Group 4 was excluded from the study due to silicone exposition. The authors demonstrated that vascularized bone segments can be lengthened, and provided information about the importance of periosteum in distraction osteogenesis.

Continued reinnervation of full thickness skin after transposition

SummaryThe aim of this experiment was to investigate the transposition of reinnervated skin grafts. In the first stage, a full thickness graft was placed on the sensory nerve supplying the anterolateral thigh skin of a rat (n = 72). The animals were then divided into three groups according to the period between the first and second stages: Group I, 2 weeks (n=24); Group II, 4 weeks (n=24); and Group III, 8 weeks (n=24). In six rats from each of the three groups, the grafts were excised for histochemical examination at the end of the interval between the first and second stages. In the remaining rats, the grafts based on the sensory nerves were transposed to other recipient sites (stage 2). By subdividing each of the three groups into three subgroups skin grafts were then excised for histochemical examination at 2-week, 4-week and 8-week intervals. The contralateral side acted as the control. Specific thiocholine methods were employed to demonstrate the cholinesterase activities of the regenerating nerves into the grafts. In all groups, apart from the first group, nerve regeneration into the graft showed no interruption. This study demonstrated that a skin graft based on a sensory nerve may substitute for a secondary end organ, and its transposition does not result in loss of reinnervation.

Use of levator labii superioris muscle flap in the muscle repair of cleft lips

SummaryIn order to facilitate and improve muscle repair in wide cleft lips, a levator labii superioris muscle flap has been used to augment the orbicularis oris muscle. The neurovascular pedicle of this muscle flap can be preserved to eliminate the possibility of ischemic muscle fibrosis and atrophy. Eleven patients between the ages of 4 months and 24 years having wide cleft lips underwent this procedure. Seven had a unilateral and 4 had a bilateral cleft lip deformity. In one patient who had a bilateral complete cleft lip, the levator labii superioris muscle was directly approximated to the contralateral muscle. In the other three patients with bilateral cleft lips, the levator labii superioris muscle flaps were approximated to the contralateral orbicularis oris muscles. In all 7 of the unilateral cases, the levator labii superioris muscle flaps were used to obtain a tension free closure and for filling out the defect below the nostril sill. None of the patients had wound infection, wound dehiscence or scar widening. The functional loss resulting from the transposition of the flap is compensated for by the remaining synergistic muscle, the zygomaticus minor. This method of muscle repair seems to be completely benign, and the muscle flap dissection can be performed easily and safely.

Surgical correction of a tessier no. 4 cleft

SummaryTessier no. 4 cleft is a very rare congenital anomaly. Various names have been applied to describe this malformation. Complete, incomplete, unilateral and bilateral forms have been presented. In this paper, a case of the no. 4 cleft is presented with its clinical findings and surgical correction technique which was used. The correction was carried out by rotation-advancement skin flaps to cover the defect and restore the orbicularis oris sphincter.