Petros Konofaos

FK506 and nerve regeneration: Past, present, and future

Promoting neurological recovery requires strategies that simultaneously provide protection to injured neurons and increase the numbers of neurons that extend axons while inducing more rapid and extensive axon regeneration across long nerve gaps. An agent that facilitates the speed and success of reinnervation will have direct applicability to the clinical management of severe peripheral nerve injuries. The immunosuppressive drug FK506 has been proven to have neuroprotective and neurotrophic actions in experimental models, increasing neurite elongation and accelerating the rate of nerve regeneration in vitro and in vivo. This review examines the role played by FK506, with primary focus on its role as a neurotrophic agent and its potential clinical use as a promoter of neurological recovery following peripheral nerve injuries.

De Garengeot's hernia in a 60-year-old woman: A case report

IntroductionDe Garengeot first described the presence of the appendix within a femoral hernia in 1731.Case presentationWe report the case of a 66-year-old Caucasian woman who presented with acute appendicitis within an incarcerated femoral hernia. This is the first reported case of de Garengeots hernia in the Balkan area.ConclusionsAppropriate management without incurring any delay for radiological imaging can be promising for an uneventful postoperative course. The treatment of choice of this disease entity is emergency surgery and consists in simultaneous appendectomy through the hernia incision and primary hernia repair. In patients with large hernia defects or in older people the use of mesh for repairing the hernia defect can be an excellent choice.

Management of external ear keloids using form-pressure therapy

Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear‐piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form‐pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24–30 mmHg, and the duration of the form‐pressure therapy in our patients was about 25 weeks.

Orbitopalpebral repair after 835 excisions of malignant tumours

Repair of any defect in the eyelid depends on its size and position and the state of the surrounding tissues. Basal cell carcinoma (BCC) is the most common malignant tumour of the eyelids, and squamous cell carcinoma (SCC), mixed carcinomas or basosquamous cell carcinomas (BSC), and cutaneous melanomas (CM), also invade the eyelids and periocular zones. Reconstruction of the eyelids and associated orbital structures after resection requires a complete understanding of the anatomy. The adequacy of the reconstruction is judged by the quality of functional restoration and the aesthetic appearance. The purpose of this study was to document various, simple or complex reconstructive procedures that may be used after excision of malignant tumours of the eyelids and to assess the outcome of surgical treatment.

A novel device for long bone osteodistraction: description of device and case series.

Summary: The purpose of this study was to present a novel intramedullary device (M-Bone; Phenix, Paris, France) that contains a mechanism for internal osteodistraction and bone transport in patients with segmental bone defects or limb length discrepancy after limb salvage operations. A total of five patients with primary bone tumors were enrolled in the study. After implantation, daily lengthening was performed in an outpatient setting either by the patient or with the help of a therapist, without the use of anesthesia. This unique device offers a totally new approach for the treatment of segmental bone defects or limb length discrepancy. It is designed to expand the remaining native bone by a magnetically activated drive system and induces new bone formation using osteodistraction and bone transport. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Primary parotid gland lymphoma: a case report

IntroductionMucosa associated lymphoid tissue lymphomas are the most common lymphomas of the salivary glands. The benign lymphoepithelial lesion is also a lymphoproliferative disease that develops in the parotid gland. In the present case report, we describe one case of benign lymphoepithelial lesion with a subsequent low transformation to grade mucosa associated lymphoid tissue lymphoma appearing as a cystic mass in the parotid gland.Case presentationA 78-year-old Caucasian female smoker was referred to our clinic with a non-tender left facial swelling that had been present for approximately three years. The patient underwent resection of the left parotid gland with preservation of the left facial nerve through a preauricular incision. The pathology report was consistent with a low-grade marginal-zone B-cell non-Hodgkin lymphoma (mucosa associated lymphoid tissue lymphoma) following benign lymphoepithelial lesion of the gland.ConclusionsSalivary gland mucosa associated lymphoid tissue lymphoma should be considered in the differential diagnosis of cystic or bilateral salivary gland lesions. Parotidectomy is recommended in order to treat the tumor and to ensure histological diagnosis for further follow-up planning. Radiotherapy and chemotherapy should be considered in association with surgery in disseminated forms or after removal.

One‐stage reconstruction of the antihelix and concha using postauricular island flap

Tissue defects in the antihelix and the concha due to oncological resection and trauma can be successfully repaired with a subcutaneously based postauricular island flap. Alternative methods of regional reconstruction usually need two stages or may require grafts in some patients. We present the one‐stage technique, as described by Masson, without grafts, to provide adequate reconstruction and aesthetic restoration of the area, illustrated by 62 patients. In all patients there has been a follow‐up period of 12 months. This report provides evidence for the aesthetic superiority of this method. An excellent aesthetic outcome was achieved in 46 patients, an adequate outcome in 15 patients, and a poor result in only 1 patient. No flap necrosis was observed. The method has considerable advantages for the repair of anterior conchal and antihelical defects.

The Role of Resorbable Mesh as a Fixation Device in Craniosynostosis.

AbstractThe purpose of the study was to present our experience with endocranial fixation using the Resorb-X mesh (KLS Martin, Jacksonville, FL) in frontoorbital reconstruction. A retrospective review of all patients underwent frontoorbital advancement at our institution from 2003 to 2012 was performed. Inclusion criterion included: pediatric patients who underwent frontoorbital advancement for craniosynostosis; patients underwent treatment of the craniosynostosis only at our center; resorbable fixation devises were applied only endocranially; and follow-up was ≥2 years. Patients’ evaluation included demographic information, postoperative complications, surgical outcomes, and postoperative computed tomographic imaging if accessible. Thirty-nine patients met the inclusion criteria. Resorbable plates were used in 16 patients and Resorb-X mesh in 23 patients. Observed complications were unrelated to the fixation system used. Resorption of fixation devices was evident in all patients after 20 months following reconstruction. There were no incidents of local reaction to the fixation system. Frontoorbital area contour was deemed good in 24 patients and excellent in 15 patients by both families and attending surgeon. There was a statistical significant difference (P = 0.030) between patients ⩽12 months and >12 months regarding the complications rate. Endocranial fixation using the Resorb-X mesh is easily applicable, avoids material palpability, and provides stable and secure fixation. This technique is superior to the conventional endocranial osseous fixation with absorbable plates, as it avoids some of its possible complications while providing all the benefits of resorbable fixation.

Comparison of Autogenous and Alloplastic Cranioplasty Materials Following Impact Testing.

AbstractAlloplastic materials are often used when significant defects exist. Benefits include no donor site morbidity, relative ease of use, limitless supply, and predictable durability. Depending on the type of alloplast, limitations include a persistent risk of extrusion and infection. Of particular interest in relation to cranioplasties is the ability of the material to provide neuroprotection. The integrity and neuroprotective properties of autologous bone flaps, polymethylmethacrylate (PMMA), and high-density porous polyethylene (PP) were evaluated following impact testing. Three groups of New Zealand white rabbits (N = 4) underwent a cranioplasty with either a bone flap, PMMA, or PP. In the control group (N = 4), the animals had no cranioplasty. At the end of the eighth week, an impact was delivered to the center of each cranioplasty. At necropsy each cranium and brain was evaluated grossly and histologically. There was a statistical significant difference among groups for the severity of the hemorrhage (P = 0.022) and the grade of cranioplasty disruption (P = 0.0045). Autologous bone was found to be the weakest of the materials tested. In this group severe injury resulted at much lower energy levels than was observed in the control, PMMA, or PP groups. Both PMMA and PP were resistant to fracture and disruption. PMMA provided the greatest neuroprotection, followed by PP. Autologous bone provided the least protection with cranioplasty disruption and severe brain injury occurring in every patient. Brain injury patterns correlated with the degree of cranioplasty disruption regardless of the cranioplasty material. Regardless of the energy of impact, lack of dislodgement generally resulted in no obvious brain injury.

Total scalp reconstruction following a dog bite in a pediatric patient.

Abstract The purpose of this case report is to present the reconstruction of a full-thickness scalp defect in a 2-year-old Hispanic male mauled by a dog, which was performed by a novel technique. After the scalp defect was debrided multiple times and treated with greater than 600 cm2 of cryopreserved human skin allograft, Integra was applied to the scalp defect following debridement and burring-out the outer bony cortex to promote bleeding and integration, followed by the application of a VAC dressing. Four weeks later, the mature Integra was grafted with split-thickness grafts. One year after the original injury, the patient demonstrated 98% take of the skin grafts to the calvarium. The resultant soft-tissue cover was supple, pliable, uniform in texture, and stable. The proposed technique of reconstruction of large full-thickness scalp defects in pediatric patients is easily reproducible, involves a short operative time, and produces satisfying cosmetic results.